| ObjectiveTo explore the value of color Doppler ultrasound (CDUS) in evaluating sacroiliitis and enthesopathy in ankylosing spondylitis (AS) patients of sacroiliac joints and enthesis in AS patients and healthy volunteers by CDUS, and discuss the value of CDUS in assessing the inflammatory activity by observing the above-mentioned indices for AS patients of active phase and after treatment stable period.Methods1. Color Doppler ultrasound should be performed in bilateral sacroiliac joints, ligaments around and tendon enthesis, quadriceps tendon enthesis, patellar ligament enthesis for patella and tibia, achilles tendon enthesis and plantar fascia tendon enthesis between86AS patients and30healthy volunteers. Analyze the differences between the two groups by statistics and evaluate the diagnostic value of CDUS.2. Recheck the same indicators of sacroiliac joints and tendon enthesis by CDUS for30selected active AS patients who have been in stable condition after standard treatment in Rheumatism Immunity Branch. Compare the changes of ultrasonograms before and after treatment and explore the value of these indices in evaluating the activily to AS by statistical analysis.Result1. Difference in sacroiliac joints, ligaments around and tendon enthesis between AS group and control group were statistically significant (P<0.05).2. Variances of the rich degree and RI of blood flow between AS group and control group were statistically significant (P<0.05). According to the ROC curves, the max area below the curve came to0.916(P<0.01). With RI=0.695as the optimum-critical point, the sensitivity and specificity to diagnose AS is90.9%and81.3%.3. In AS group, thickening was much more than other abnormalities in860tendon enthesis enthesis, synovitis anomaly were most common in quadriceps tendon enthesis, changes in thickness and echo, calcification, osteophyte, erosion and abnormal blood flow of achilles tendon were more than other location. Differences of abnormal changes in tendon enthesis between each group to control group were statistically significant (P<0.05).4. There was significant integral difference on rich degree and RI of blood flow of sacroiliac joints of active AS patients in before treatment and after treatment (P<0.05).According to the ROC curves, the max area below the curve came to0.898(P<0.01). With RI=0.71as the optimum critical point, the sensitivity and specificity to diagnose AS is81.5%and89.3%.5. Significant differences on thickness of tendon enthesis and synovium, hydrops of bursa, changes of echo and abnormal blood flow of lower limbs of active AS patients were present in pretherapy and post-treatment (P<0.05), but abnormity in calcification, ostrophyte and erosion had no statistical significance(P＞0.05).Conclusion1.Blood flow of sacroiliac joints in AS patients has the higher positive rate which mainly represent as abundant blood flow signals and lower RI, however, the control group is opposite to a lower positive rate that mainly express low blood flow and higher RI. The blood flow and RI can be the reference index to diagnose sacroiliitis in AS.2.High-frequency ultrasound can display various pathologic changes of enthesopathy in AS early. Owing to discovering the enthesopathy in early stage of AS, objective bases for clinical diagnosis can be providing by it.3. For active AS patients in before treatment and after treatment, blood flow of sacroiliac joints reduces that mainly express low blood flow and higher RI in stable phase. Changes in thickness of tendon enthesis and synovium, hydrops of bursa mucosa, echo and blood flow that are significant to active stage can be the effective index to evaluate the activity and therapy of AS.4. As an easy,cheap and non-invasive detection, CDUS can sensitively detect sacroiliitis and enthesopathy in AS and even dynamically observate the curative effect. CDUS is an effective method,which contribute to diagnose and antidiastole AS in early and evaluate the effectiveness of pharmacotherapy. Clinical application and promotion of CDUS will be deserved. |
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