应用彩色超声评估强直性脊柱炎患者的疗效

目的 探讨彩色多普勒超声在强直性脊柱炎(AS)患者疗效评价中的价值.方法 对比30名健康志愿者和50例AS患者的彩色多普勒高频声像和血流情况及AS患者病变部位重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白质治疗前后的高频声像和血流的改变,并与治疗前后的血红细胞沉降率(ESR)、C反应蛋白(CRP)和毕氏强直性脊柱炎活动指数(BASDAI)等作对比分析.结果 与健康志愿者比较AS患者骶髂关节、跟腱附着端、髌韧带附着端、股直肌肌腱附着端超声检查阳性率比较差异有统计学意义(P<0.05).Bath AS疾病活动性指数(BASDAI)≥4的患者在外周肌腱端阳性率较BASDAI<4差异有统计学意义(P<0.05),并在Bath AS功能指数、患者总体评价VAS、夜间背痛和总体背痛VAS、晨僵时间、ESR、CRP均较BASDAI<4差异有统计学意义(P<0.05).重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白质治疗后12和24周后超声检查骶髂关节、跟腱附着端、髌韧带附着端、股直肌肌腱附着端阳性率均较治疗前亦有明显下降(P<0.05);治疗前、治疗后12和24周比较,患者BASDAI、Bath AS疾病功能指数(BASFI)、ESR、CRP差异均有统计学意义(均P<0.05).结论 超声能敏感地发现关节滑膜和肌腱端病变的变化情况,可作为常规监测手段用于AS患者病情的追踪和临床疗效的评价.

Evaluation of therapeutic effects on sacroilitis and enthesopathy in ankylosing spondylitis patients by color ultrasound

Objective To explore the value of color Doppler ultrasound in evaluating the therapeutic effects on ankylosing spondylitis ( AS ) patients. Methods Color Doppler high-frequency ultrasound images and blood flow in 30 healthy volunteers and 50 AS patients, changes of high-frequency ultrasound images and blood flow of involved sites in AS patients pre- and after-Etanercept treatments, as well as erythrocyte sedimentation rate (ESR) , C-reactive protein (CRP) and the Bath AS disease activity indices pre- and post-treatment were compared. Results Positive rates were significantly different between healthy volunteers and AS patients in terms of sacroiliac joints, Achilles tendon attachments, patellar ligament attachments, and rectus femoris tendon attachments by ultrasonograph (P < 0. 05); and the fibular collateral ligament attachments positive rates had no significant difference with those at pre-treatment (P > 0. 05). There was significant difference between patients with Bath AS disease activity index (BASDAI) ≥ 4 and those with BASDAI < 4 with respects to peripheral enthesis positive rate, Bath AS functional index (BASFI) , patient's global assessment VAS (PGA) , nocturnal back pain and general back pain VAS, morning stiffness duration, ESR and CRP ( P < 0. 05 ). Positive rates of sacroiliac joints, Achilles tendon attachments, patellar ligament attachments and rectus femoris tendon by ultrasonograph significantly decreased at Weeks 12 and 24 at post-treatment compared to that at pre-treatment (P <0. 05); there was significant difference for patient's BASDAI, BASFI, ESR and CRP at pre-treatment and weeks 12 and 24 post-treatment ( P < 0. 05). Conclusion Ultrasound can sensitively detect the pathological changes of joint synovium and enthuses so that it may be used as a routine method of monitoring diseases in these soft tissues, following up AS patients and evaluating clinical efficacy.