论文部分内容阅读
目的 了解不同阶段骶髂关节 (SIJ)炎的病理变化 ,提高脊柱关节病 (SpA)的早期诊断水平。方法 8例强直性脊柱炎 (AS)及 5例未分化脊柱关节病 (uSpA)患者行CT导引下SIJ关节内激素治疗前 ,先取SIJ组织。所得标本行HE染色 ,普通光学显微镜观察。结果 CT 0～Ⅰ级SIJ炎的uSpA病人 ,SIJ可见滑膜炎症 (包括衬里层细胞肥大增生、疏松结缔组织炎症细胞浸润 ) ,局灶性软骨基质减少、变性、纤维化 ,软骨下骨板炎症细胞浸润。CTⅡ～Ⅲ级SIJ炎病理变化主要为软骨严重变性、破坏 ,血管翳形成 ,大量炎症细胞浸润 ,软骨下骨板破坏 ;CTⅣ级SIJ炎的病理改变则以软骨下骨板破坏 ,大量死骨形成 ,钙盐沉着为主要特点。 3份标本的滑膜和软骨下骨板可见嗜酸性粒细胞(EO)比例增高。结论 滑膜衬里细胞肥大增生、疏松结缔组织炎症细胞浸润等滑膜炎表现 ,局灶性软骨基质减少、变性、纤维化和软骨下骨板炎症细胞浸润、破坏 ,是早期SIJ炎的病理特点 ;在CT未出现改变以前 ,病理学检查有助于早期诊断。
Objective To understand the pathological changes of sacroiliac joint (SIJ) in different stages and to improve the early diagnosis of spondyloarthropathy (SpA). Methods Eight patients with ankylosing spondylitis (AS) and five patients with undifferentiated spondyloarthropathies (uSpA) underwent SIJ with CT guided intralesional SIJ. The specimens were HE staining, ordinary light microscope. Results In uSpA patients with CT 0 ~ Ⅰ grade SIJ inflammation, synovial inflammation (including hyperplasia of lining cells and inflammatory cell infiltration of loose connective tissue), reduction of focal cartilage matrix, degeneration, fibrosis and subchondral bone inflammation were observed in SIJ Cell infiltration. CT Ⅱ ~ Ⅲ grade SIJ inflammation pathological changes mainly cartilage degeneration, destruction, angiogenesis, a large number of inflammatory cell infiltration, subchondral bone plate destruction; CT Ⅳ grade SIJ inflammation pathological changes in subchondral bone plate destruction, a large number of dead bone formation , Calcium salt as the main feature. Three specimens of synovium and subchondral bone visible eosinophils (EO) increased. Conclusion The synovial lining cells hypertrophy, loose connective tissue infiltration of inflammatory cells such as synovitis, focal cartilage matrix reduction, degeneration, fibrosis and subchondral bone inflammatory cell infiltration and destruction, is the pathological features of early SIJ inflammation; Pathological examination is helpful for early diagnosis before CT changes.