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

English Keywords:High-frequency ultrasound  Tendon enthesitis  Ankylosing spondylitis  Inflammatory factor

English Abstract:

  【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.