强直性脊柱炎诊断及疾病活动度评价指标的研究进展

Research Progress of Ankylosing Spondylitis Diagnosis and Disease Activity Evaluation Index

早期诊断并干预治疗是控制强直性脊柱炎(ankylosing spondylitis,AS)进展的关键,对疾病活动度的评价是制定AS治疗方案的重要依据。随着分子生物学和影像学技术的进步,AS诊断标准不断细化,评价疾病活动度的指标日益完善,目前以临床症状、血液标志物及影像学指标作为诊断及判定疾病活动度的依据,指导AS治疗。在诊断方面,除已有的人类白细胞表面抗原B27(human leucocyte Antegen B27,HLA-B27)及其亚型、C反应蛋白(C-reactive protein,CRP)及红细胞沉降率(erythrocyte sedimentation rate,ESR)等指标外,自身抗体、细胞因子及游离DNA片段等在AS患者及健康人之间的表达差异也可能是诊断的重要指标,但尚缺乏大样本本土化的临床验证,亟须开展多中心横断面研究以证实数据的有效性。在影像学方面,既往的放射、计算机X线断层扫描(computed tomography,CT)、磁共振成像(magnetic resonance imaging,MRI)及核医学等技术均能不同程度地对AS诊断及疾病活动度提供数据支持,但目前研究仅关注骨骼及软组织的变化,可进一步将血管功能的影像学信息作为AS诊断及疾病活动度判断的重要指标,以实现对AS患者的早诊断及早治疗,延缓致残,提高生存质量。

Early diagnosis and intervention are the keys to controlling the progression of ankylosing spondylitis(AS).The evaluation of disease activity is an important basis for formulating the treatment plan for AS.With the advancement of molecular biology and imaging technology,the diagnostic criteria for AS have been refined,and the indicators for evaluating disease activity have been increasingly improved.At present,clinical symptoms,blood markers,and imaging indicators are used as the basis for diagnosis and determination of disease activity to guide the treatment of AS.In terms of diagnosis,in addition to the existing human leucocyte Antegen B27(HLA-B27)and its subtypes,C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)and other indicators,the Differences in the expression of antibodies,cytokines and cell-free DNA fragments between AS patients and healthy individuals may also be important indicators for diagnosis.However,there is still a lack of localized clinical validation of large samples,and a multicenter cross-sectional study is urgently needed to confirm the validity of its data.In terms of imaging,previous techniques such as radiology,computed tomography(CT),magnetic resonance imaging(MRI)and nuclear medicine can provide data support for AS diagnosis and disease activity stage to varying degrees.However,at present,it only focuses on the changes of bones and soft tissues.In the future,the imaging information of vascular function can also be used as an important indicator for the diagnosis of AS and the judgment of disease activity,so as to realize the early diagnosis and early treatment of AS patients,delay the disability,and improve the quality of life.