强直性脊柱炎的磁共振成像炎症分期与中医证型和临床特征关系

目的 探讨强直性脊柱炎（ankylosing spondylitis, AS）的磁共振成像（magnetic resonance imaging, MRI）炎症分期与中医证型和临床特征的关系。方法 采用骶髂关节MRI扫描技术将40例AS患者分为骨髓水肿组（早期炎症组）或脂肪浸润组（晚期炎症组），比较两组患者中医证型分布情况、强直性脊柱炎病情活动度 C反应蛋白（ankylosing spondylitis disease activity score C reactive protein，ASDAS CRP）积分和血沉（erythrocyte sedimentation rate, ESR）、CRP水平。结果 早期炎症组共24例患者，晚期炎症组共16例患者。早期炎症组以肾虚湿热证为主（占91.7%），晚期炎症组以肾虚督寒证为主（占87.5%），差异具有统计学意义（P<0.05）。早期炎症组较晚期炎症组ASDAS CRP积分及ESR、CRP水平显著升高（P<0.05）。Pearson相关分析显示，肾虚湿热证证候积分与加拿大脊柱关节炎研究协会（Spondyloarthritis Research Consortium of Canada，SPARCC）MRI积分具有正相关性（n=24，r=0.627,P<0.05），肾虚督寒证证候积分与SPARCC MRI积分无相关性（n=16，r=0.167，P＞0.05）。结论 AS的MRI炎症分期对中医辨证、病情活动度及炎性指标的预测具有指导意义。

Correlation of Inflammation Stage of Ankylosing Spondylitis on Magnetic Resonance Imaging with TCM Syndrome Types and Clinical Features

Objective To investigate the correlation of inflammation stage of ankylosing spondylitis (AS) on magnetic resonance imaging (MRI) with TCM syndrome types and clinical features. Methods A total of 40 patients with AS were divided into bone marrow edema (early inflammation) group and fatty infiltration (late inflammation) group, according to the results of sacroiliac joint MRI. The two groups were compared in terms of distribution of TCM syndrome types, ankylosing spondylitis disease activity score-C-reactive protein (ASDAS-CRP) score, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level. Results There were 24 patients in the early inflammation group and 16 in the late inflammation group. Of all patients in the early inflammation group, 91.7% had kidney deficiency and damp-heat syndrome, while in the late inflammation group, 87.5% had kidney deficiency and Du meridian cold syndrome; there was a significant difference between the two groups (P<0.05). The early inflammation group had significant increases in ASDAS-CRP score, ESR, and CRP level compared with the late inflammation group (P<0.05). The Pearson correlation analysis showed that the syndrome score of kidney deficiency and damp-heat syndrome was positively correlated with Spondyloarthritis Research Consortium of Canada (SPARCC) MRI score (n=24, r=0.627, P<0.05), while there was no correlation between the syndrome score of kidney deficiency and Du meridian cold syndrome and SPARCC MRI score (n=16, r=0.167, P>0.05). Conclusion The inflammation stage of AS on MRI can provide guidance to TCM syndrome differentiation and prediction of disease activity and inflammatory indices.