强直性脊柱炎寒热证型超声下外周附着点炎表现的差异研究Study on the difference of ultrasonic manifestations of peripheral enthesitis between cold and heat syndrome in ankylosing spondylitis
刘扬;沈逸;朱琦;何东仪;郭梦如;丁泓百;杨阳;
摘要(Abstract):
目的 研究强直性脊柱炎患者寒热证型超声下外周附着点炎表现的差异及其与临床指标的相关性。方法 选择2018年12月—2019年12月上海中医药大学附属光华医院关节内科门诊和病房收治的强直性脊柱炎患者58例,收集患者临床信息,检测C反应蛋白(CRP)、血沉(ESR)水平,记录强直性脊柱炎疾病活动评分(ASDAS-CRP、ASDAS-ESR)、Bath AS疾病活动指数(BASDAI)、Bath AS功能指数(BASFI)、Bath AS测量指数(BASMI)及寒热证型中医证候评分;采用肌肉骨骼超声对患者进行外周肌腱附着点扫查,根据MASEI评分系统进行超声下附着点炎病变评分。根据Maastrict强直性脊柱炎附着点炎评分将外周附着点炎患者分为临床附着点炎组和亚临床附着点炎组,比较2组超声下6项病变评分及附着点炎总评分;按照中医辨证将患者分为寒证组与热证组,比较2组超声下6项病变评分及附着点炎总评分;分析58例患者超声下附着点炎总评分与临床指标的相关性、寒热证型患者超声下附着点炎总评分及超声下6项病变评分与临床指标的相关性、寒热证型患者超声下附着点炎总评分与中医证候评分的相关性。结果 58例患者中有55例存在超声下附着点炎,其中亚临床附着点炎43例,临床附着点炎12例;中医辨证属于寒证30例,热证28例。临床附着点炎组患者超声下附着点炎总评分及能量多普勒血流评分均明显高于亚临床附着点炎组(P均<0.05);热证组患者超声下附着点炎总评分、肌腱厚度评分、滑囊炎评分均明显高于寒证组患者(P均<0.05)。58例患者超声下附着点炎总评分与CRP、ESR、ASDAS-CRP、ASDAS-ESR、BASDAI、BASFI、BASMI、MASES、病程均呈正相关(P均<0.05)。热证组患者超声下附着点炎总评分与CRP、ASDAS-CRP、BASDAI均呈正相关(P均<0.05),肌腱结构评分与ESR、ASDAS-ESR均呈正相关(P均<0.05),能量多普勒血流评分与CRP、ESR、ASDAS-CRP、ASDAS-ESR、BASDAI均呈正相关(P均<0.05),滑囊炎评分与CRP、ESR、ASDAS-CRP、BASDAI均呈正相关(P均<0.05);寒证组患者超声下附着点炎总评分与病程、BASFI、BASMI均呈正相关(P均<0.05),肌腱结构评分与BASFI呈正相关(P<0.05),骨侵蚀评分与ASDAS-CRP、BASDAI、BASFI、BASMI均呈正相关(P均<0.05),能量多普勒血流评分、钙化评分与BASMI均呈正相关(P均<0.05)。热证组和寒证组患者超声下附着点炎总评分与中医证候评分均呈正相关(P均<0.05)。结论 强直性脊柱炎患者超声下亚临床附着点炎发生率高,超声下附着点炎评分能反映疾病活动度。热证患者较寒证患者外周附着点炎表现更严重;热证患者附着点炎症性病变与疾病活动密切相关,寒证患者附着点结构性病变与病程及功能密切相关。
关键词(KeyWords): 强直性脊柱炎;寒热证候;肌骨超声;附着点炎
基金项目(Foundation): 国家中医药管理局区域中医(专科)诊疗中心(风湿病)建设项目;; 上海市科委科研计划项目(18401901100);; 上海市卫健委上海市中医专科(专病)联盟建设项目[ZY(2018-2020)-FWTX-4017];上海市卫健委上海市杏林新星计划[ZY(2018-2020)-RCPY-3017]
作者(Authors): 刘扬;沈逸;朱琦;何东仪;郭梦如;丁泓百;杨阳;
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