目 的 探讨人白细胞抗原 B27(HLA-B27)与CT、MRI联合诊断强直性 脊柱炎(AS)髋关节病变的价值。方法 回 顾性分析2013年9月-2015年9月医院47例 确诊为AS髋关节病变患者HLA-B27检测 及CT、MRI影像学资料，分析HLA-B27、 CT、MRI单独及三者联合诊断的准确率 及CT、MRI影像学表现。结果 本组41例 HLA-B27阳性(87.23%)；本组47例患者84 个髋关节受累，HLA-B27+CT+MRI联合诊 断的准确率为95.24%高于CT的79.76%、 MRI的84.71%(P＜0.05)。CT检查显示42 髋关节隙狭窄，22髋骨性关节面破坏， 38髋关节面或经关节面下骨破坏，67髋 髋臼、股骨头边缘硬化，骨赘形成，31 髋股骨滑膜附着处突出；31髋有关节腔 积液，11髋关节腔内肉芽组织增生。MRI 检查47髋关节间隙狭窄；48髋伴随骨骨 髓水肿，呈T1低信号，T2高信号，增强 扫描后中度强化；54髋软骨呈不规则增 厚、扭曲、变薄，41髋关节面破坏，55 髋关节囊明显扩张，可见液性信号影， 增强扫描可见关节囊增厚。结论 HLA-B27 与CT、MRI联合诊断可提高AS髋关节病变 诊断准确率，为临床诊治疾病提供丰富 信息。

Objective To investigate the value of human leucocyte antigen B27 (HLA-B27) combined with MRI and CT in diagnosis of ankylosing spondylitis (AS) with hip joint lesions. Methods The data of HLA-B27 detection, CT and MRI of 47 patients diagnosed with AS and hip joint lesions in the hospital between September 2013 and September 2015 were retrospectively analyzed. The accuracy of HLA-B27, CT, MRI alone and combined diagnosis and imaging findings of CT and MRI were analyzed. Results Among all subjects, 41 cases of HLA-B27 were positive (87.23%); In 47 cases, there were a total of 84 hip joints involved. The accuracy rate of HLA-B27 combined with CT and MRI diagnosis (95.24%) was higher than that of CT (79.76%) and MRI (84.71%) (P<0.05). CT scan showed 42 hip joints with space stenosis, 22 hips with articular surface damage, 38 hips with surface or bone destruction under hip surface, 67 hips with acetabulum and femoral head marginal sclerosis, osteophyte formation, 31 hips with extruding femoral synovial adherent sites, 31 hips with articular cavity effusion and 11 hips with intraarticular granulation tissue hyperplasia. MRI examination showed 47 hips with joint space stenosis, 48 hips with bone marrow edema, showing T1 low signal and T2 high signal. After enhanced scan, they was moderate enhancement; 54 hip cartilages showed irregular thickening, distortion and thinning. 41 hip joint articular surfaces were damaged. 55 hip joint capsules significantly expanded, with liquid signal shadow, and enhanced scan showed joint capsule thickening. Conclusion The combined diagnosis of HLA-B27, CT and MRI can improve the diagnostic accuracy of AS with hip joint disease, and provide rich information for clinical diagnosis and treatment.