全身骨显像在脊柱关节病临床随访中的应用观察
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摘要
目的探讨全身骨显像在脊柱关节病(SpA)临床随访中的应用价值。方法随访2年的脊柱关节病患者80例,分别收集基线和治疗2年后的全身骨显像、磁共振成像(MRI)、X线等影像学检查以及红细胞沉降率(ESR)、C反应蛋白(CRP)、疾病活动度评分(ASDAS-CRP)等检查结果,进行比较分析。结果 80例患者中,基线期时ASDAS-CRP评分<2.1分的患者治疗2年后全身骨显像获得改善/稳定的比例明显高于基线期时ASDAS-CRP评分≥2.1分的患者,差别有统计学意义(80%和55.6%,χ2=5.009,P<0.05)。在随访监测骶髂关节病变变化情况上,全身骨显像检查和MRI增强检查2组之间差异无统计学意义,但全身骨扫描一次成像可同时观察到全身其他骨及关节的病变情况,如脊柱、膝踝关节、肋胸关节、足跟等。全身骨显像发现脊柱病变进展的敏感性高于X线(56.3%和18.8%,P<0.05)。基线时CRP升高或ESR升高的患者2年后全身骨显像出现进展的比例明显高于基线时CRP正常或ESR正常的患者(44.2%和21.6%,χ2=4.529,P<0.05; 46.2%和22.0%,χ2=5.236,P<0.05)。基线时伴有附着点炎的患者2年后全身骨显像出现进展的比例明显高于没有附着点炎的患者(52.4%和27.1%,χ2=4.420,P<0.05)。结论全身骨显像用于评估治疗前后炎症程度改变,与ASDAS-CRP改变具有较好的一致性,可做为脊柱关节病患者临床随访中评价病情活动的有效手段之一。全身骨显像在随访骶髂关节病变上与MRI能力相当,但一次扫描可了解全身骨及关节情况且价格更低廉。在随访脊柱病变方面优于X线。
Objective To investigate the value of whole body bone scan(WBBS)in the clinical follow-up of spondyloarthropathies(SpA). Methods Eighty cases of SpA patients fulfilled the Assessment of Spondyloarthritis International Society(ASAS) classification criteria for Axial Spondyloarthritis or Peripheral Spondyloarthritis were fol-lowed-up for 2 years. In all patients, WBBS, X-ray plain scan and enhanced MRI were undertaken, meanwhile ESR,CRP and other clinical features were checked at baseline time and after 2 years follow-up. The results of imaging, laboratory tests, disease activity scores(ASDAS-CRP) and other clinical features data were collected and analyzed. Results The results of presented study showed that after 2 years follow-up, the percentage of patients who obtained improved WBBS in the low disease activity group(baseline ASDAS-CRP<2.1) was significantly higher than that of patients in high disease activity group(baseline ASDAS-CRP≥2.1)(80% vs 55.6%, χ2=5.009, P<0.05). The study also showed that there were no significant difference between the ratio of sacroiliitis detected by WBBS and by enhanced MRI( 81.3% vs 72.9%, P>0.05). After 2 years of follow-up, the percentage of development of spinal lesions detected by WBBS was significantly higher than that detected by X-ray(56.3% vs 18.8%, P<0.05). However, WBBS could detect inflammation lesions in bones and joints of whole body at the same scan time, such as spinal column, knee, an-kle, sternocostal joint and heel. The study also found that after 2 years of follow-up, in the group of abnormal CRP/ESR, the percentage of patients with progressive WBBS results was higher than that in the group of normal CRP/ESR, respectively(44.2% vs 21.6%, χ2=4.529, P<0.05 and 46.2% vs 22.0%, χ2=5.236, P<0.05, respectively), while the percentage of patients with progressive WBBS in the group with enthesitis at baseline was significantly higher than that of the group without enthesitis at baseline(52.4% vs 27.1%, χ2=4.420, P<0.05). Conclusion WBBS might be used as a valuable supplementary imaging modality in evaluating the disease activity in the clinical follow-up of SpA patients.
Objective To investigate the value of whole body bone scan(WBBS)in the clinical follow-up of spondyloarthropathies(SpA). Methods Eighty cases of SpA patients fulfilled the Assessment of Spondyloarthritis International Society(ASAS) classification criteria for Axial Spondyloarthritis or Peripheral Spondyloarthritis were fol-lowed-up for 2 years. In all patients, WBBS, X-ray plain scan and enhanced MRI were undertaken, meanwhile ESR,CRP and other clinical features were checked at baseline time and after 2 years follow-up. The results of imaging, laboratory tests, disease activity scores(ASDAS-CRP) and other clinical features data were collected and analyzed. Results The results of presented study showed that after 2 years follow-up, the percentage of patients who obtained improved WBBS in the low disease activity group(baseline ASDAS-CRP<2.1) was significantly higher than that of patients in high disease activity group(baseline ASDAS-CRP≥2.1)(80% vs 55.6%, χ2=5.009, P<0.05). The study also showed that there were no significant difference between the ratio of sacroiliitis detected by WBBS and by enhanced MRI( 81.3% vs 72.9%, P>0.05). After 2 years of follow-up, the percentage of development of spinal lesions detected by WBBS was significantly higher than that detected by X-ray(56.3% vs 18.8%, P<0.05). However, WBBS could detect inflammation lesions in bones and joints of whole body at the same scan time, such as spinal column, knee, an-kle, sternocostal joint and heel. The study also found that after 2 years of follow-up, in the group of abnormal CRP/ESR, the percentage of patients with progressive WBBS results was higher than that in the group of normal CRP/ESR, respectively(44.2% vs 21.6%, χ2=4.529, P<0.05 and 46.2% vs 22.0%, χ2=5.236, P<0.05, respectively), while the percentage of patients with progressive WBBS in the group with enthesitis at baseline was significantly higher than that of the group without enthesitis at baseline(52.4% vs 27.1%, χ2=4.420, P<0.05). Conclusion WBBS might be used as a valuable supplementary imaging modality in evaluating the disease activity in the clinical follow-up of SpA patients.
引文
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[8] Van Onna M, van Tubergen A, Jurik AG, et al.Natural course of bone marrow edema on magnetic resonance imaging of the sacroiliac joints in patients with early inflammatory back pain:a 2-year follow-up study[J]. Scand J Rheumatol, 2015,44:129-134.
[9] Cui Y, Zheng JP,Zhang X, et al. Evaluation of treatments for sacroiliitis in spondyloarthropathy using the Spondyloarthritis Research Consortium Canada scoring system[J]. Arthritis Res Ther, 2016, 18(38):1-7.
[10]张妍婕,王峻,牛金亮,等.脊柱磁共振成像在强直性脊柱炎疗效评估中的应用[J].中国药物与临床,2014,14(2):200-202.
[11] Appel H,Loddenkemper C,Grozdanovic Z,et al. Correlation of histopathological findings and magnetic resonance imaging in the spine of patients with ankylosing spondylitis[J]. Arthritis Res Ther,2006,8(5):R143.
[12] Gong Y,Zheng N,Zeng QY,et al. Ten Years’ Experience With Needle Biopsy in the Early Diagnosis of Sacroiliitis[J]. Arthr Rheum,2012,64(5):1399-1406.
[13] Rennie WJ,Dhillon SS,Conner-Spasdy B,et al. Magnetic Resonance Imaging Assessment of Spinal Inflammation in Ankylosing Spondylitis:Standard Clinical Protocols May Omit Inflammatory Lesions in Thoracic Vertebrae[J]. Arthritis Rheuma,2009,61(9):1187-1193.
[14] Bochkova AG,Bunchuk NV,Braun J,et al. Spinal inflammation lesions as detected by magnetic resonance imaging in patients with early ankylosing spondylitis are more often observed in posterior structures of the spine[J]. Rheumatology,2010,49:749-755.
[2]李俊雄,林琛,欧阳亮. MRI及核素骨显像对强直性脊柱炎的诊断价值[J].中国脊柱脊髓杂志,2004,14(9):531-533.
[3]王夕文,王艳萍,秦涛,等.SPECT、CT检查在早期强直性脊柱炎的应用比较[J].中国实用医药,2011,6(31):87-88.
[4] Rudwaleit M,van der Heijde D,LandewéR,et al. The Development of Assessment of SpondyloArthritis international Society(ASAS)Classification Criteria for Axial Spondyloarthritis(Part II):Validation and Final Selection[J].Ann Rheum Dis 2009,68:777-783.
[5] Sieper J,Rudwaleit M,Baraliakos X,et al.The Assessment of SpondyloArthritis international Society(ASAS)handbook:a guide to assess Spondyloarthritis[J]. Ann Rheum Dis,2009,68(Suppl II):ii1-ii44.
[6]周前,屈婉莹.中华影像学影像核医学卷[M].2版.北京:人民卫生出版社,2010:37.
[7]杜旭娜,朱剑,黄烽,等.强直性脊柱炎病情活动度评分对强直性脊柱炎患者病情活动性判断的价值[J].中华内科杂志,2012,51(3):206-209.
[8] Van Onna M, van Tubergen A, Jurik AG, et al.Natural course of bone marrow edema on magnetic resonance imaging of the sacroiliac joints in patients with early inflammatory back pain:a 2-year follow-up study[J]. Scand J Rheumatol, 2015,44:129-134.
[9] Cui Y, Zheng JP,Zhang X, et al. Evaluation of treatments for sacroiliitis in spondyloarthropathy using the Spondyloarthritis Research Consortium Canada scoring system[J]. Arthritis Res Ther, 2016, 18(38):1-7.
[10]张妍婕,王峻,牛金亮,等.脊柱磁共振成像在强直性脊柱炎疗效评估中的应用[J].中国药物与临床,2014,14(2):200-202.
[11] Appel H,Loddenkemper C,Grozdanovic Z,et al. Correlation of histopathological findings and magnetic resonance imaging in the spine of patients with ankylosing spondylitis[J]. Arthritis Res Ther,2006,8(5):R143.
[12] Gong Y,Zheng N,Zeng QY,et al. Ten Years’ Experience With Needle Biopsy in the Early Diagnosis of Sacroiliitis[J]. Arthr Rheum,2012,64(5):1399-1406.
[13] Rennie WJ,Dhillon SS,Conner-Spasdy B,et al. Magnetic Resonance Imaging Assessment of Spinal Inflammation in Ankylosing Spondylitis:Standard Clinical Protocols May Omit Inflammatory Lesions in Thoracic Vertebrae[J]. Arthritis Rheuma,2009,61(9):1187-1193.
[14] Bochkova AG,Bunchuk NV,Braun J,et al. Spinal inflammation lesions as detected by magnetic resonance imaging in patients with early ankylosing spondylitis are more often observed in posterior structures of the spine[J]. Rheumatology,2010,49:749-755.