强直性脊柱炎的骶髂关节病变:MRI与螺旋CT对照研究

目的评价强直性脊柱炎(AS)患者骶髂关节炎(SIJ)的螺旋CT和MR影像学特征及评分差异。并比较CT和MR影像在诊断SIJ中的作用。资料与方法对42例临床疑诊AS患者分别行螺旋CT各向同性扫描并斜冠状位、斜轴位重组,和MR(1.5T)检查,扫描序列包括SET1WI、FS-T2WI、FS-T1WI和3D-FLASH。分别评价CT及MR图像,对分级结果行统计学分析。结果对于<Ⅱ级病变,MRI较CT发现更多病变(12:7),两者相比差异有统计学意义(P<0.05);对于≥Ⅱ级病变二者之间差异无统计学意义(P>0.05)。MRI对于≥Ⅱ级病变的显示较CT无明显差别,但能发现更多早期病变,并能更好地反映病变的活动性。结论MR对于<Ⅱ级SIJ病变明显优于螺旋CT,适于AS各级SIJ病变(尤其适用于早期)检查。     

Post-traumatic stress disorder prior to diagnosis is as rare in spondyloarthritis as in non-inflammatory rheumatic conditions and rheumatoid arthritis

ObjectivePost-traumatic stress disorder (PTSD) may be a risk factor for the development of rheumatoid arthritis (RA). No data are available in spondyloarthritis (SpA). The aim of the present study was to investigate the frequency of traumatic events and PTSD in patients with SpA and its different phenotypes and to compare the results to patients with non inflammatory rheumatic disease and RA patients.MethodsThis was an observational, cross-sectional and bi-centric study. Participants were patients diagnosed with SpA, non-inflammatory rheumatic or autoimmune disease (controls), or RA. Traumatic events were identified by the brief trauma questionnaire (BTQ). PTSD was defined as the presence of a traumatic event and ≥4 symptoms on the short PTSD checklist scale.ResultsAmong 1389 participants, 510 patients were diagnosed with SpA (167 ankylosing spondylitis, 140 psoriatic arthritis, 130 non-radiographic-axial SpA, and 51 peripheral SpA), 365 with non-inflammatory rheumatic disease and 514 patients with RA. The frequency of trauma in SPA patients was 33.7%, of which 30.5% in AS, 30.7% in PsA, 37.7% in nr-axSpA and 41.2% in peripheral SpA (P = NS). The prevalence of PTSD in SPA patients was 4.9%, (of which 3.6% in AS, 2.9% in PsA, 6.2% in nr-axSpA and 7.8% in peripheral SpA [P = NS]) and was not significantly different from the controls (after IPTW 4.8% vs. 6.7%). The frequency of trauma and PTSD was also comparable between RA and controls and between SPA and RA.ConclusionTraumatic events and PTSD occurring prior to diagnosis is as rare in SpA as in non-inflammatory rheumatic diseases and RA.     

骨痹消对大鼠佐剂性关节炎血清中TNF-α、IL-1β、IL-6水平的影响

目的：观察骨痹消对关节损伤的防治作用及机制,为AS的治疗提供实验依据。方法：取Wistar雄性大鼠40只,随机分为4组,每组10只。分别为模型组、中药组、罗非西布组、对照组。用佛氏佐剂注射于模型组、中药组、罗非西布组大鼠左后足掌皮下,造佐剂性关节炎模型;对照组注射等量生理盐水。中药组和罗非西布组分别灌胃给中药水煎剂2ml／200g、罗非昔布2ml／200g（0．2mg）,模型组和对照组灌胃给自来水2ml／200g,每天灌胃1次。结果：在使用中药骨痹消方后,大鼠血清TNF-α、IL-1β、IL-6水平均显著下降。结论：中药骨痹消对大鼠佐剂性关节炎有一定的治疗作用,可减轻炎症反应和关节肿胀,改善关节功能,其机制可能与下调TNF-α、IL-1β、IL-6,抑制炎症反应有关。     

化脓性脊柱炎的手术治疗选择及疗效分析

目的 探讨手术辅以抗感染药物治疗化脓性脊柱炎的临床疗效及预后。方法 2013年11月—2021年1月，新疆医科大学第一附属医院手术治疗化脓性脊柱炎患者83例，根据感染部位、邻近椎体破坏程度和神经压迫情况制订手术计划。记录住院时间、手术时间、术中出血量及并发症发生情况，记录术前、术后1个月、术后3个月及末次随访时的白细胞计数（WBC）、红细胞沉降率（ESR）、C反应蛋白（CRP）水平等指标。采用疼痛视觉模拟量表（VAS）评分评估疼痛程度，采用美国脊髓损伤协会（ASIA）分级评估神经功能恢复情况。结果 所有手术顺利完成，除1例患者死亡，其余患者随访12 ~ 46个月，平均25.2个月；住院时间为6 ~ 30（18.11±8.01） d，手术时间为45 ~ 345（151.67±58.82） min，术中出血量为50 ~ 1 200 mL。所有患者术后均静脉滴注抗生素6 ~ 60（20.51±10.92） d，之后口服抗生素6 ~ 90（44.71±14.59） d。共51例患者行细菌培养，其中34例检出病原菌，阳性率为66.7%。所有患者术后各时间点WBC、ESR、CRP水平及VAS评分随着随访时间延长逐渐改善，差异均有统计学意义（P < 0.05）。术前46例患者存在脊髓神经功能损伤，除1例ASIA分级为A级的患者死亡，其余患者ASIA分级均较术前改善。术中发生脑脊液漏1例，术后发生切口不愈合2例，经对症处理后均明显缓解。结论 手术治疗化脓性脊柱炎可彻底清除病灶、重建脊柱序列、矫正后凸畸形，再辅以抗感染药物治疗6 ~ 8周可获得满意疗效，复发率低，患者预后良好。