Application value of Doppler ultrasound in early active axial spondyloarthropathy

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(Department of Ultrasound, the First Affiliated Hospital ofNanchang University, Nanchang 330006, China)

Application value of Doppler ultrasound in early active axial spondyloarthropathy

WANGLu,CHENLi*

(DepartmentofUltrasound,theFirstAffiliatedHospitalofNanchangUniversity,Nanchang330006,China)

Objective s To investigate the value of Doppler ultrasound in diagnosing active sacroiliitis of axial spondyloarthropathy (axSpA) patients. Methods The Doppler ultrasound and MRI data of 51 patients with early axSpA was retrospectively analyzed. According to MRI results, axSpA patients were divided into active sacroiliitis ( active group ) and inactive sacroiliitis ( inactive group). The color flow display and blood flow resistance index (RI) were compared. Considering MRI as the diagnostic standard, ROC curve was used to evaluate the diagnostic efficacy of RI in detecting active sacroiliitis. Results There were 32 cases wth 58 joints (6 cases were single active sacroiliitis) in activity group and 19 cases with 38 joints in inactivity group. The flow signals demonstration rate of sacroiliac joint in activity group (51/58, 87.93%) was higher than that in inactive group (26/38, 68.42%;χ2=5.505,P=0.019). There was no statistical difference of the indegree of blood flow between the two groups (Z=-1.93,P=0.053). RI in active group (0.59±0.08 ) was lower than that in inactive group (0.71±0.09;t=-6.04;P<0.001). Taking RI=0.64 for diagnosis of active sacoriliitis in axSpA patients, the sensitivity, specificity and accuracy rate were 80.8%, 74.5% and 78.7%, respectively. Conclusion Through observing abnormal blood flow signals around and internal the sacroiliac joints, ultrasonography can response active sacroiliitis in axSpA patients with higher accuracy.

Spondyloarthropathy； Sacroiliitis； Ultrasonography, Doppler, color

中轴型脊柱关节病(axial spondyloarthropathy, axSpA)是一种高度遗传复杂的关节炎性疾病，可影响骨骼系统的中轴框架，从而导致结构和功能障碍[1-2]，早期表现为交替性臀部疼痛，逐渐向背部进展，腰背部明显僵硬继而活动受限，直至晚期出现脊柱强直。其早期临床表现不典型，且缺乏特异性的实验室检查指标。MRI有助于发现早期的活动性骶髂关节炎，但其检查价格昂贵、耗时长，临床应用受到一定限制。本研究对axSpA患者进行多普勒超声检查，观察axSpA患者骶髂关节的超声特征，并与MRI对比，探讨多普勒超声诊断早期活动性axSpA的价值。

1 资料与方法

1.1 一般资料 回顾性分析2015年9月—2016年4月临床确诊为早期axSpA的51例患者的资料，其中男36例，女15例，年龄15～43岁，平均(30.0±10.6)岁。所有患者骨盆X线检查未见明确的骶髂关节炎征象，但临床均表现为不同程度腰背部疼痛、活动受限、晨僵，其中32例患者伴有髋关节痛、腿痛，活动后减轻。51例患者均于1周内先后接受多普勒超声检查及MRI，并依据MRI结果分为活动性骶髂关节炎(活动)组及非活动性骶髂关节炎(非活动)组。

1.2仪器与方法

1.2.1 超声检查 采用Philips iU22超声诊断仪，C5-1凸阵探头，探头频率2～5 MHz，以肾脏模式扫查。嘱受检者取俯卧位，将探头横置于其骶尾部。灰阶超声显示骶髂关节与人体脊柱呈倒“八”字夹角，骶骨与髂骨背侧面骨皮质呈高回声，两者之间的低回声裂隙区为骶髂关节(图1)。多普勒超声显示骶髂关节区域的彩色血流信号，取样框调至合适的大小置于骶髂关节，适当调节彩色增益，壁滤波66～84 Hz，血流—声束夹角<60°。

观察并记录骶髂关节血流信号特点[3]：①血流显示率；……