人白细胞抗原B27与磁共振成像诊断早期强直性脊柱炎的临床价值

目的探讨人白细胞抗原B27(HLA-B27)和磁共振成像(MRI)对早期强直性脊柱炎(AS)的诊断价值。方法回顾分析66例早期AS患者MRI图像和HLA-B27检测结果,分析和总结二者的临床作用。结果 66例早期AS病例中,MRI图像分析63例滑膜软骨异常,56例有骨髓水肿,46例有骨质浸蚀,39例有脂肪沉积;HLA-B27(+)60例。结合HLA-B27(+)和MRI异常表现正确诊断52例;漏诊或误诊的14例中HLA-B27(-),放射学有所改变6例;HLA-B27(+),放射学改变不典型5例;HLA-B27(+)3例。结论骶髂关节MRI影像表现和HLA-B27检测结果能为早期AS的诊断提供重要依据;对不具备AS典型症状和放射学改变的患者应该全面分析与有相似症状的其他病症详细鉴别,定期复查随访可以减少误诊及漏诊。

Clinical value of magnetic resonance imaging and human leucocyte antigen B27 in diagnosing early ankylosing spondylitis

Objective To study the clinical value of magnetic resonance imaging( MRI) and human leucocyte antigen B27( HLA-B27) in diagnosing early ankylosing spondylitis( AS) . Methods The changes of MRI and HLA-B27 of sixty-six patients with AS were retrospectively analyzed,and the clinical value was summarized. Results Among sixty-six patients of AS,MRI showed that sixty-three patients with synovial cartilage abnormalities,fifty-six patients with bone marrow edema,forty-six patients with bone erosion,and thirty-nine patients with fatty deposition. Sixty patients presented HLA-B27( + ) . Fifty-two patients were correctly diagnosed by combining of HLA-B27 ( + ) and MRI. Fourteen patients were missed diagnosis or misdiagnosed,among them,six patients presented HLA-B27( ) ,but with radiological changes; Five patients presented HLA-B27( + ) ,but with atypical radiological changes HLA-B27 ( + ) . Three patients presented HLA-B27 ( + ) . Conclusion The manifests of MRI and HLA-B27 of sacroiliac joint can provide valuable evidence for diagnosing the early AS; Patients without typical symptoms and images of MRI were needed to multi-analysis and identify fully to other diseases with the similar symptoms,and periodic check and follow-up examination should be carried out so as to reduce the rate of diagnostic errors and missed diagnosis.