磁共振成像SPARCC评分与HLA-B27诊断早期强直性脊柱炎的临床价值

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。

Clinical value of magnetic resonance imaging graded by SPARCC and HLA-B27 in diagnosing early ankylosing spondylitis

Objective To study the clinical value of magnetic resonance imaging(MRI) in low fields on sacroiliac joints(SIJs) and human leukocyte antigen(HLA)-B27 in diagnosing early ankylosing spondylitis(AS). Methods Forty patients with AS corresponding to the modified New York criteria were included.The HLA-B27 was measured,and MRI in low fields on SIJs was examined in all patients.The results of MRI were scored according to the spondyloarthritis research consortium of Canada(SPARCC),and the correlative analysis between SPARCC score of MRI and Bath AS disease activity index(BASDAI) score in clinic was performed. Results The positive and negative expressions of HLA-B27 were 35 cases(87.5%) and 5 cases(12.5%),respectively.There was no significant difference in SPARCC score between HLA-B27 negative group(18.30±9.78)and positive group(12.40±4.86)(t=1.709,P=0.105).The SPARCC score in active period was higher than that in quiescent period(17.14±3.80 vs 5.58±2.40,t=8.521,P=0.000).Pearson correlative analysis showed that SPARCC score was positively correlated to the BASDAI score(r=0.675,P<0.05),and demonstrated that there was a better correlation in two score systems. Conclusions SPARCC score of MRI on SIJs could provide important evidence for diagnosing the early AS.HLA-B27 detection must rely on imaging condition as foundation in order to display its effect.