摘要目的 探讨脊柱关节炎(SpA)患者附着点炎的特征性超声表现及其诊断价值.方法 超声观测SpA、类风湿关节炎(RA)、骨关节炎(OA)患者及健康对照者下肢附着点(股四头肌腱、髌腱起点、髌腱止点、跟腱、跖底筋膜),比较其下肢附着点超声表现的异同.结果 2014年6-8月解放军总医院风湿科共纳入46例SpA患者,23例RA患者,12例OA患者和23例健康对照者,其中26例SpA患者、7例RA患者有足跟疼痛史.SpA患者460处附着点125处(27.2％)异常,RA患者230处附着点54处(23.5％)异常,OA患者120处附着点27处(22.5％)异常,差异无统计学意义(P＞0.05).SpA患者髌腱止点异常65处(70.7％),明显多于RA患者[19处(41.3％);P＜0.05]和OA患者[13处(54.2％)];SpA患者髌腱止点肌腱增厚(26处)和骨侵蚀(22处)也显著多于RA患者(各发现1处;P ＜0.05)和OA患者(各发现4处及0处;P ＜0.05).同时纳入髌腱止点肌腱增厚、滑囊炎、骨侵蚀时诊断SpA的敏感性为70.7％,特异性为65.5％,AUC为0.740.结论 附着点的肌腱增厚和骨侵蚀可能是SpA特征性的表现.髌腱止点处肌腱增厚、滑囊炎及骨侵蚀可作为SpA较理想的诊断与鉴别超声表现.

abstractsObjective To explore the distinctive ultrasonographic characters of enthesitis in patients with spondyloarthritis (SpA) and evaluate the diagnostic value of ultrasonography in SpA by comparing ultrasonography of enthesis in the lower limbs of patients with SpA,rheumatoid arthritis (RA) and osteoarthritis(OA).Methods Entheses in the lower limbs (quadriceps tendon,proximal patellar ligament,distal patellar ligament,achilles tendon and plantar aponeurosis) were detected in SpA,RA,OA patients and health controls by ultrasonographic examination.Results A total of 46 SpA,23 RA and 12 OA patients were enrolled in this study,with 26 SpA and 7 RA patients complaining of heel pain(P ＜0.05).There were 126 enthesal sites(126/460,27.2％) were detected abnormal in SpA group,compared with 54 of 230 (23.5 ％) sites in RA group and 27 of 120 (22.5 ％) sites in OA group (P ＞ 0.05).Sixty five (70.7 ％) sites of the distal patellar ligaments were abnormal in SpA group,while that were 19(41.3％)in RA group(P ＜ 0.05)and 13 (54.2％)in OA group.Twenty six sites of tendon thickness and 22 sites of bone erosion in the distal patellar ligaments were found in SpA group,while only one site of each in RA group(P ＜ 0.05) and 4 sites of tendon thickness in OA group (P ＜ 0.05) were found.Tendon thickness,bursal synovitis and bone erosion coexisting in one distal patellar ligament indicated SpA,the sensitivity,specificity and the area under the curve (AUC) of which were 70.7％,65.5％ and 0.740,respectively.Conclusion Tendon thickness and bone erosion of entheses were more likely the distinctive ultrasonographic characters of enthesitis in SpA patients.Tendon thickness,bursal synovitis and bone erosion in the distal patellar ligament could be an ideal tool for SpA diagnosis.