超声联合血清学指标对强直性脊柱炎外周附着点病变的诊断价值

Diagnostic value of ultrasound combined with serological indexes in peripheral enthesopathy of ankylosing spondylitis

目的探讨超声联合血清学指标红细胞沉降率(ESR)、细胞核因子κB受体活化因子配基(RANKL)、护骨素(OPG)在强直性脊柱炎(AS)外周附着点病变诊断中的临床应用价值。方法选取AS患者34例(观察组)和健康体检者30例(对照组),两组均行超声和血清学检查,比较两组外周附着点病变检出率、附着点病变分布情况,以及ESR、RANKL、OPG和格拉斯哥超声附着点炎评分系统(GUESS)评分的差异。分析ESR、RANKL、OPG与外周附着点病变超声表现的相关性;绘制受试者工作特征(ROC)曲线评估ESR、RANKL、OPG、GUESS评分及四项联合诊断AS外周附着点病变的价值。结果观察组检出附着点病变205个,其中骨赘(25.37%)最常见,其次为滑囊炎(23.41%)、肌腱增厚(20.98%)、骨侵蚀(12.20%)、关节腔积液(11.71%);对照组检出附着点病变41个,其中肌腱增厚(53.66%)最常见,其次为骨赘(34.15%)、滑囊炎(9.76%)。观察组ESR、RANKL、GUESS评分均高于对照组,OPG低于对照组,差异均有统计学意义(均P<0.001)。相关性分析显示,ESR、RANKL与滑囊炎、关节腔积液均呈正相关(均P<0.05),OPG与滑囊炎、关节腔积液、骨侵蚀、骨赘、血流信号均呈负相关(均P<0.05)。ROC曲线分析显示,ESR、RANKL、OPG、GUESS评分及四项联合诊断AS外周附着点病变的曲线下面积分别为0.773、0.778、0.774、0.833、0.955,联合诊断的曲线下面积高于各指标单独诊断(均P<0.05)。结论超声联合ESR、RANKL、OPG在AS外周附着点病变诊断中具有较高的临床应用价值。

Objective To explore the clinical application value of ultrasound combined with serological indexes including erythrocyte sedimentation rate(ESR),receptor activator of nuclear factorκB ligand(RANKL)and osteoprotegerin(OPG)in the diagnosis of peripheral enthesopathy in ankylosing spondylitis(AS).Methods A total of 34 AS patients(observation group)and 30 healthy subjects(control group)were selected,both groups underwent ultrasound and serological examinations to evaluate the detection rate of enthesopathy,the distribution of peripheral enthesopathy was observed,and the differences of ESR,RANKL,OPG and Glasgow ultrasound enthesitis scoring system(GUESS)score between the two groups were compared.The correlation between ESR,RANKL,OPG and ultrasonic manifestation of peripheral enthesopathy was analyzed.Receiver operating characteristic(ROC)curve was drawn to evaluate the value of ESR,RANKL,OPG,GUESS score and the combination of the four in diagnosing peripheral enthesopathy of AS.Results There were 205 enthesopathy detected in the observation group,among which osteophyte lesions(25.37%)were the most common,followed by bursitis(23.41%),tendon thickening(20.98%),bone erosion(12.20%),and joint effusion(11.71%).There were 41 enthesopathy detected in the control group,among which tendon thickening(53.66%)was the most common,followed by osteophytes(34.15%)and bursitis(9.76%).The ESR,RANKL and GUESS score of the observation group were higher than those of the control group,and the OPG was lower than that of the control group,the differences were statistically significant(all P<0.001).Correlation analysis showed that ESR and RANKL were positively correlated with bursitis and joint effusion(all P<0.05),OPG was negatively correlated with bursitis,joint effusion,bone erosion,osteophyte and blood flow signal(all P<0.05).ROC curve analysis showed that the area under the curve of ESR,RANKL,OPG,GUESS score,and the combination of the four in diagnosing peripheral enthesopathy of AS were0.773,0.778,0.774,0.833,and 0.955,respectively.The area under the curve of combined diagnosis was higher than that of individual diagnosis of each index(all P<0.05).Conclusion Ultrasound combined with ESR,RANKL and OPG has high clinical value in the diagnosis of peripheral enthesopathy of AS.