MRI评价强直性脊柱炎患者腰椎间盘退行性变

摘要

Objective To evaluate the risk factors of intervertebral disc degeneration, MRI findings of lumbar intervertebral disc degeneration in ankylosing spondylitis (AS) patients and control patients were compared. Methods This study retrospec-tively analyzed 40 AS patients and 40 age-and sex-matched control patients without history of rheumatic disease. Four hundred in-tervertebral discs were assessed in terms of degeneration by analyzing signal intensity and morphology on T2weighted magnetic res-onance images. Degeneration degree of the intervertebral discs was compared between the two groups,and the risk factors of disc degeneration in AS patients were analyzed. Results The mean of total degeneration degrees for five lumbar intervertebral discs was significantly higher in AS patients compared to the control group(16.77 ± 4.67 vs 13.00 ± 4.08,P =0.001). With the ex-ception of L5/S1,disc degeneration was significantly higher in AS patients compared to the control group,when different segment intervertebral discs were analyzed respectively. Age,duration of disease and discitis were significantly associated with degenera-tion degree in AS patients( r =0.74,r =0.48,P <0.05). No significant correlation was determined between disc degeneration and vertebral inflammation ( r =0.15,P =0.43). Conclusion Magnetic resonance imaging is effective for evaluation of lum-bar discs in patients with AS. AS and its inflammatory effects on the discs are risk factors for disc degeneration. The duration of AS and impaired posture may aggravate disc degeneration.%目的 通过MR评估强直性脊柱炎(ankylosing spondylitis, AS)患者与对照组患者腰椎间盘退行性变的MRI表现,探寻椎间盘退行性变的危险因素.方法 回顾性分析了40例AS患者和40例年龄性别匹配的无风湿性疾病史的对照组患者.均行腰椎磁共振扫描,共扫描了400个椎间盘,通过分析磁共振T2WI信号强度和形态评估退行性变,比较两组患者间整个腰椎椎间盘退行性变程度和各节段椎间盘退行性变程度差异,并分析AS患者引起椎间盘退行性变的危险因素.结果 与对照组相比,AS患者5个节段腰椎间盘整体退行性变程度较对照组明显升高(16.77 ± 4.67 vs 13.00 ± 4.08,P <0.001);对每个节段椎间盘进行独立分析时,除L5~S1椎间盘外,L1~4椎间盘在AS患者中退行性变程度较对照组明显升高( P <0.001);年龄、AS持续时间、椎间盘炎和AS患者椎间盘退行性变程度明显相关( r =0.74,r =0.48,r =0.57,P <0.05);椎角炎和椎间盘退行性变程度无明显相关( r =0.15,P =0.43).结论 磁共振成像是强直性脊柱炎患者成像和评估的有效工具,AS及其伴发的椎间盘炎是椎间盘退行性变的危险因子,AS持续的时间及其导致的姿势异常会加重椎间盘退行性变.