肌骨超声在强直性脊柱炎合并外周关节骨赘中的应用

doi:10.3969/j.issn.1004-583X.2024.09.003

摘要/Abstract

摘要：

目的探讨肌骨超声技术在强直性脊柱炎患者( ankylosing spondylitis,AS)合并外周关节骨赘中的应用意义。方法对80例确诊的AS患者行外周关节超声检查,依据关节骨赘的检出情况分为观察组(合并有骨赘)42例及对照组(未合并骨赘)38例,比较分析2组的临床特点、实验室指标、双能骨密度(bone mineral density,BMD)及Bath强直性脊柱炎疾病活动指数(BASDAI)评分。采用t检验及Sperman秩相关进行统计分析。结果 ①观察组手指关节骨赘发生率最高,占33.3%;②观察组C反应蛋白(C-reactive protein,CRP)、BASDAI评分及病程均高于对照组,BMD低于对照组,差异有统计学意义。③观察组中吸烟亚组红细胞沉降率(erythrocyte sedimentation rate,ESR)、CRP及病程高于非吸烟亚组,差异有统计学意义。CRP与ESR、BASDAI评分及吸烟指数呈正相关。结论强直性脊柱炎患者的炎症反应可能与骨赘形成相关;肌骨超声用于检测骨赘,有助于病情评估。

关键词: 脊柱炎,强直性, 骨赘, 肌骨超声

Abstract:

Objective To investigate the application of musculoskeletal ultrasound in ankylosing spondylitis (AS) patients with peripheral osteophytes. Methods Peripheral joint ultrasound examination was performed in 80 patients with AS. According to the detection of osteophytes, the patients were divided into the observation group (42 cases with osteophytes) and the control group (38 cases without osteophytes). The clinical characteristics, laboratory indexes, dual-energy bone mineral density (BMD) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score were compared. The t-test and Sperman's rank correlation were used for statistical analyses. Results The highest incidence of osteophytes of finger joints (33.3%) was detected in the observation group. The C-reactive protein (CRP), BASDAI score and course of disease in the observation group were significantly higher than those of the control group, and the BMD was significantly lower (P<0.05). In the observation group, the erythrocyte sedimentation rate (ESR), CRP and course of disease in the smoking subgroup were significantly higher than those of the non-smoking subgroup (P<0.05). CRP was positively correlated with ESR, BASDAI score and smoking index. Conclusion Inflammatory response in patients with AS is related to osteophyte formation. Musculoskeletal ultrasound is used to detect osteophytes, which is helpful to disease assessment.

Key words: spondylitis, ankylosing, osteophyte, musculoskeletal ultrasonography

中图分类号:

R593.23

谢建丽, 王俊祥, 陈海英. 肌骨超声在强直性脊柱炎合并外周关节骨赘中的应用[J]. 临床荟萃, 2024, 39(9): 787-791.

Xie Jianli, Wang Junxiang, Chen Haiying. Application of musculoskeletal ultrasound in ankylosing spondylitis with peripheral osteophytes[J]. Clinical Focus, 2024, 39(9): 787-791.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.09.003

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I9/787

图/表 4

表1 两组临床资料比较

Tab.1 Clinical data between the observation group and the control group

组别	例数	ESR(mm/h)	CRP(mg/L)	BMD	BASDAI评分(分)	骶髂关节分级(级)	病程(年)
观察组	42	5.10±1.43	73.95±25.69	-2.39±0.19	61.70±31.61	3.50±0.50	18.13±6.17
对照组	38	4.45±1.31	29.76±17.16	0.89±0.35	33.27±24.74	3.00±0.00	10.52±3.15
$t$ 值		1.073	2.542	-9.235	2.312	1.100	2.123
P值		0.292	0.041	<0.01	0.032	0.252	0.043

表1 两组临床资料比较

Tab.1 Clinical data between the observation group and the control group

组别	例数	ESR(mm/h)	CRP(mg/L)	BMD	BASDAI评分(分)	骶髂关节分级(级)	病程(年)
观察组	42	5.10±1.43	73.95±25.69	-2.39±0.19	61.70±31.61	3.50±0.50	18.13±6.17
对照组	38	4.45±1.31	29.76±17.16	0.89±0.35	33.27±24.74	3.00±0.00	10.52±3.15
$t$ 值		1.073	2.542	-9.235	2.312	1.100	2.123
P值		0.292	0.041	<0.01	0.032	0.252	0.043

表2 合并关节骨赘的AS患者吸烟和非吸烟亚组临床资料比较

Tab.2 Clinical data between the smoking group and nonsmoking group

组别	例数	ESR(mm/h)	CRP(mg/L)	BMD	BASDAI(分)	病程(年)	骶髂关节分级(级)
吸烟组	15	47.55±35.44	88.54±68.15	-0.68±1.67	5.05±1.54	14.09±12.72	3.27±0.47
非吸烟组	27	25.11±28.35	36.50±22.13	-0.66±2.09	4.55±1.20	9.20±7.45	3.20±0.42
$t$ 值		2.071	2.126	0.023	0.921	1.080	0.372
P值		0.041	0.033	0.980	0.372	0.030	0.716

表2 合并关节骨赘的AS患者吸烟和非吸烟亚组临床资料比较

Tab.2 Clinical data between the smoking group and nonsmoking group

组别	例数	ESR(mm/h)	CRP(mg/L)	BMD	BASDAI(分)	病程(年)	骶髂关节分级(级)
吸烟组	15	47.55±35.44	88.54±68.15	-0.68±1.67	5.05±1.54	14.09±12.72	3.27±0.47
非吸烟组	27	25.11±28.35	36.50±22.13	-0.66±2.09	4.55±1.20	9.20±7.45	3.20±0.42
$t$ 值		2.071	2.126	0.023	0.921	1.080	0.372
P值		0.041	0.033	0.980	0.372	0.030	0.716

表3 观察组中临床资料的相关性分析( r值)

Tab.3 Correlation analysis of the clinical data in the observation group

项目	骶髂关节分级	病程	ESR	CRP	BMD	BASDAI评分	SI
骶髂关节分级	1	0.74^#	0.43^*	0.05	-0.51^*	0.22	0.08
病程	0.74^#	1	0.49^*	0.17	-0.78^#	0.22	0.23
ESR	0.43^*	0.49^*	1	0.69^#	-0.40	0.84^#	0.02
CRP	0.05	0.17	0.69^#	1	-0.21	0.82^#	0.43*
BMD	-0.51^*	-0.78^#	-0.40	-0.21	1	-0.19	0.00
BASDAI	0.22	0.22	0.84^#	0.82^#	-0.19	1	-0.20
SI	0.05	0.23	0.02	0.43*	0.00	-0.20	1

图1 新骨形成过程假说[24]

Fig.1 New bone formation process hypothesis

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