Vosse D, van der Heijde D, Landewé R, Geusens P, Mielants H, Dougados M, van der Linden S
Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
Ann Rheum Dis. 2006 Jun;65(6):770-4. doi: 10.1136/ard.2005.044081. Epub 2005 Oct 11.
To determine clinical and radiographic determinants of hyperkyphosis in patients with ankylosing spondylitis.
Spinal hyperkyphosis was assessed by occiput to wall distance (OWD) in 135 patients participating in the OASIS cohort and defined as OWD >0. Disease activity was assessed by the Bath ankylosing spondylitis disease activity index (BASDAI). Wedging of the vertebrae was calculated as the Ha/Hp ratio. Structural damage of the spine was assessed by the modified Stoke ankylosing spondylitis spine score (mSASSS). Hip involvement was assessed by the Bath ankylosing spondylitis radiology index (BASRI) and defined as a score >2. Data were analysed by multiple regression analysis on van der Waerden-normal OWD values, with mean Ha/Hp ratio, mSASSS, hip involvement, and BASDAI as explanatory variables, and age, sex, and disease duration after diagnosis as covariates.
61 patients (45.2%) had an OWD >0 cm. Of these, 81% were male, v 57% in the group with normal OWD (p<0.001). Forty two patients had wedged thoracic vertebrae, and 27 of these (44%) had an increased OWD, compared with 15 of 74 with a normal OWD (20%) (p = 0.005). OWD was correlated with mean wedging of the thoracic spine (r = -0.45, p = 0.01), mSASSS (r = 0.56, p = 0.01), and hip involvement (r = 0.2, p = 0.05). Multivariate analysis showed that mSASSS (standardised beta (stbeta) = 0.52; p<0.001), wedging of the thoracic spine (stbeta = -0.28; p = 0.01), and BASDAI (stbeta = 0.15; p = 0.05) were independent determinants of OWD.
Radiological damage of the cervical and lumbar spine, thoracic wedging, and disease activity are determinants of hyperkyphosis in patients with ankylosing spondylitis. These findings could be important in determining treatment goals in this disease.
确定强直性脊柱炎患者脊柱后凸过度的临床和影像学决定因素。
对参与OASIS队列研究的135例患者通过枕墙距（OWD）评估脊柱后凸过度情况，OWD>0 cm定义为脊柱后凸过度。采用巴斯强直性脊柱炎疾病活动指数（BASDAI）评估疾病活动度。椎体楔形变通过Ha/Hp比值计算。采用改良斯托克强直性脊柱炎脊柱评分（mSASSS）评估脊柱结构损伤。采用巴斯强直性脊柱炎放射学指数（BASRI）评估髋关节受累情况，评分>2定义为髋关节受累。对经范德瓦尔登正态转换后的OWD值进行多元回归分析，以平均Ha/Hp比值、mSASSS、髋关节受累情况和BASDAI作为解释变量，年龄、性别和诊断后的病程作为协变量。
61例患者（45.2%）的OWD>0 cm。其中，81%为男性，而OWD正常组为57%（p<0.001）。42例患者胸椎有楔形变，其中27例（44%）的OWD增加，而74例OWD正常者中有15例（20%）出现OWD增加（p = 0.005）。OWD与胸椎平均楔形变（r = -0.45，p = 0.01）、mSASSS（r = 0.56，p = 0.01）和髋关节受累情况（r = 0.2，p = 0.05）相关。多变量分析显示，mSASSS（标准化β系数（stbeta）= 0.52；p<0.001）、胸椎楔形变（stbeta = -0.28；p = 0.01）和BASDAI（stbeta = 0.15；p = 0.05）是OWD的独立决定因素。
颈椎和腰椎的放射学损伤、胸椎楔形变和疾病活动度是强直性脊柱炎患者脊柱后凸过度的决定因素。这些发现对于确定该疾病的治疗目标可能具有重要意义。
