高频超声参数与炎症因子的关系及其对肌腱附着点炎进展为强直性脊柱炎的预测价值

Relationship between high-frequency ultrasound parameters and inflammatory factors and their predictive value for the progression of tendon attachment point inflammation to ankylosing spondylitis

中文关键词:  高频超声  肌腱附着点炎  强直性脊柱炎  炎症因子

英文关键词:High-frequency ultrasound  Tendon enthesitis  Ankylosing spondylitis  Inflammatory factor

中文摘要:

  【摘要】 目的：探究高频超声技术对肌腱附着点炎进展为强直性脊柱炎（ankylosing spondylitis，AS）的预测价值及其与炎症因子水平的关系。方法：选取2022年1月～2024年12月间于我院进行诊治的肌腱附着点炎患者122例作为研究对象，男97例，女25例，年龄36.05±5.35岁。根据是否患有AS将其分为肌腱附着点炎组（n=45）和AS组（n=77），并另选同期体检的健康体检者作为健康对照组（n=50）。收集比较三组研究对象的一般临床资料、高频超声参数（双侧股四头肌肌腱止点、双侧冈上肌肌腱止点、双侧髌腱起点、双侧髌腱止点、双侧跟腱止点、双侧足底筋膜止点和双侧肱二头肌长头腱止点厚度）和炎症因子水平[C-反应蛋白（C-reactive protein，CRP），肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α），白细胞介素-6（interleukin-6，IL-6）和IL-17]。对高频超声参数进行分层回归分析并对炎症因子和高频超声参数的相关性进行分析。Logistic回归分析模型探究研究对象进展为AS的危险因素。限制性立方样条（restricted cubic spline，RCS）曲线分析高频超声参数对AS进展的作用。受试者操作特征（receiver operating characteristic，ROC）曲线评价各参数及联合诊断的预测效能并统计联合诊断在不同性别及年龄下的预测效能。结果：三组研究对象间的AS家族史、红细胞沉降率（erythrocyte sedimentation rate，ESR）、双侧股四头肌肌腱止点厚度、双侧冈上肌肌腱止点厚度、CRP、TNF-α、IL-6和IL-17间存在显著性差异（P<0.05）。分层回归分析显示，双侧股四头肌肌腱止点厚度、双侧冈上肌肌腱止点厚度对ESR产生显著性正向影响（P<0.05），且炎症因子与上述高频超声参数间存在相关性（P<0.05）。Logistic回归分析显示，AS家族史、ESR、双侧股四头肌肌腱止点厚度、双侧冈上肌肌腱止点厚度、CRP、TNF-α、IL-6和IL-17为研究对象进展为AS的危险因素。RCS曲线显示，高频超声参数与AS进展间存在非线性的剂量-反应关系（χ2=20.526、21.491、21.521、19.223；P<0.001）。ROC曲线显示各参数均具有一定的预测效能，其中联合诊断的预测效能最佳。联合诊断在不同性别及年龄下的预测效能无明显差异。结论：高频超声参数（双侧股四头肌肌腱厚度及双侧冈上肌肌腱止点厚度）与炎症因子水平显著相关，联合应用高频超声参数可实现对肌腱附着点炎进展为强直性脊柱炎的有效预测。

英文摘要:

  【Abstract】　Objectives: To investigate the value of high-frequency ultrasound in predicting the progression of tendon enthesitis to ankylosing spondylitis(AS) and its relationship with the levels of inflammatory factors. Methods: A total of 122 cases of tendinitis patients diagnosed and treated in our hospital from January 2022 to December 2024 were selected as the study objects, including 97 males and 25 females, age 36.05±5.35 years old. According to whether they had AS, the patients were divided into tendon enthesitis group(n=45) and AS group(n=77), and healthy subjects who underwent physical examination during the same period were selected as the healthy control group(n=50). The general clinical data, high-frequency ultrasound parameters(thickness of bilateral quadriceps tendon insertion, bilateral supraspinatus tendon insertion, bilateral patellar tendon origin, bilateral patellar tendon insertion, bilateral Achilles tendon insertion, bilateral plantar fascia insertion and bilateral biceps tendon insertion) and inflammatory factor levels[C-reactive protein(CRP), tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) and IL-17] of the three groups were collected and compared. Stratified regression analysis was performed for high-frequency ultrasound parameters, and the correlation between inflammatory factors and high-frequency ultrasound parameters was analyzed. Logistic regression analysis model was used to explore the risk factors for developing AS. The effect of high-frequency ultrasound parameters on the progression of AS was analyzed by restricted cubic spline(RCS) curve. Receiver operating characteristic(ROC) curve was used to evaluate the predictive efficacy of each parameter and combined diagnosis, and analyze the predictive efficacy of combined diagnosis under different gender and age. Results: There were significant differences in family history of AS, erythrocyte sedimentation rate(ESR), bilateral quadriceps tendon insertion thickness, bilateral supraspinatus tendon insertion thickness, CRP, TNF-α, IL-6 and IL-17 among the three groups(P<0.05). Hierarchical regression analysis showed that bilateral quadriceps tendon insertion and bilateral supraspinatus tendon insertion thickness had a significant positive impact on ESR(P<0.05), and there was a correlation between inflammatory factors and the above high-frequency ultrasound parameters(P<0.05). Logistic regression analysis showed that the family history of AS, ESR, bilateral quadriceps tendon insertion thickness, bilateral supraspinatus tendon insertion thickness, CRP, TNF-α, IL-6 and IL-17 were the risk factors of progression to AS. RCS curve showed that there was a nonlinear dose-response relationship between high-frequency ultrasound parameters and AS progression(χ2=20.526, 21.491, 21.521, 19.223; P<0.001). ROC curve showed that each parameter had certain prediction efficiency, and the prediction efficiency of combined diagnosis was the best. There was no significant difference in the predictive efficacy of combined diagnosis between different genders and ages. Conclusions: The high-frequency ultrasound parameters(bilateral quadriceps tendon thickness and bilateral supraspinatus tendon insertion thickness) are significantly correlated with the levels of inflammatory factors. The combined use of high-frequency ultrasound parameters can effectively predict the progression of tendon enthesitis to ankylosing spondylitis.