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目的探讨骶髂关节低场磁共振成像(MRI)表现和人白细胞抗原(HLA)-B27检测对强直性脊柱炎(AS)早期诊断的价值。方法 40例符合纽约修订分类标准的AS病例,均进行HLA-B27检测及骶髂关节低场MRI检查,依据加拿大脊柱骨关节研究协会评分系统(SPARCC)对MRI结果进行评分,并对SPARCC评分与Bath强直性脊柱炎活动指数(BASDAI)评分进行相关性分析。结果 HLA-B27表达阳性35例(87.5%),阴性5例(12.5%);MRI表现的SPARCC评分在HLA-B27阴性组(18.30±9.78)和阳性组(12.40±4.86)组间比较,差异无统计学意义(t=1.709,P=0.105);SPARCC评分活动期组明显高于静止期组(17.14±3.80 vs 5.58±2.40,t=8.521,P=0.000)。Pearson相关分析显示,MRI的SPARCC评分与临床BASDAI评分之间呈正相关(r=0.675,P<0.05),提示两种评分系统具有较好的相关性。结论骶髂关节MRI影像表现的SPARCC评分能为早期AS的诊断提供重要依据,HLA-B27检测须以影像学诊断条件为基础,才能发挥其作用。
Objective To explore the value of low field MRI and HLA-B27 detection of sacroiliac joint in the early diagnosis of ankylosing spondylitis (AS). Methods Forty cases of AS patients who met New York classification criteria were examined by HLA-B27 and low-field MRI of sacroiliac joint. The results of MRI were scored according to the Canadian Association of Spine and Orthognathic Research (SPARCC) scoring system. The SPARCC score and Bath ankylosing spondylitis activity index (BASDAI) score correlation analysis. Results The positive expression of HLA-B27 was found in 35 (87.5%) and 5 (12.5%) negative patients respectively. The SPARCC score of MRI was significantly higher in HLA-B27 negative group (18.30 ± 9.78) and positive group (12.40 ± 4.86) There was no statistical significance (t = 1.709, P = 0.105). SPARCC score was significantly higher in the active group than in the quiescent group (17.14 ± 3.80 vs 5.58 ± 2.40, t = 8.521, P = 0.000). Pearson correlation analysis showed that there was a positive correlation between MRI SPARCC score and clinical BASDAI score (r = 0.675, P <0.05), suggesting that the two scoring systems have a good correlation. Conclusion The SPARCC score of sacroiliac MRI can provide an important basis for the diagnosis of early AS. The detection of HLA-B27 must be based on the diagnostic criteria of imaging to play its role.