摘要
目的 探讨类风湿关节炎（RA）手关节的磁共振成像（MRI）表现及与临床表现的相关性,从而评价其在RA诊断中的价值.方法 采用对比及相关性分析的方法,分析符合2009年美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR）诊断标准的25例RA患者双手X线片、MRI及临床特点.结果 25例RA患者在MRI扫描中均显示异常征象,而其中16例患者的X线平片未见异常,18例早期RA患者中有12例未出现X线平片改变.无论患者病程＜1年还是＞1年,MRI骨侵蚀在抗CCP抗体阳性与阴性组之间差异有统计学意义（P＜0.01）,RF-IgG阳性组出现滑膜炎的患者明显多于阴性组（P＜0.05）.血清RF-IgA浓度与骨髓水肿呈正相关（r=0.561,P＜0.05）.在早期患者中,RF-IgM阳性组出现滑膜炎的患者明显多于阴性组（P＜0.01）.VAS评分与骨髓水肿评分呈正相关（r=0.562,P＜0.01）.C反应蛋白（CRP）水平与MRI积液关节的数目呈正相关（r=0.457,P＜0.05）.结论 MRI对于早期RA的诊断价值要远远大于X线平片.早期RA的MRI改变最常见于腕关节.抗CCP抗体阳性时MRI更易出现骨侵蚀,RF-IgG阳性时MRI更易出现滑膜炎.MRI骨髓水肿评分是VAS评分的重要影响因素.CRP水平可反映有关节腔积液的关节数目.
Objective To study the features of rheumatoid arthritis （RA） on MRI of hands and wrists and compare MRI with clinical manifestations and laboratory tests of RA. Methods A total of 25 patients fulfilling the 2009 ACR/EULAR RA criteria were enrolled. MRI and plain films of hands and wrists and clinical data of swollen joints, tender joints, visual scale （VAS） score, DAS28 score, erythrocyte sedimentation rate （ ESR）, C-reactive protein （ CRP）, RF classification, anti-cyclic citrullinated peptide antibodies （anti-CCP antibodies） were obtained simultaneously. Results MRI revealed pathologic findings on the wrist and hand joints in all diagnosed RA patients. VAS had a positive correlation with bone marrow edema（ r=0. 562, P =0. 003）. Although the disease duration was less or more than 1 year, the difference of bone erosion had statistical significance between anti-CCP antibody-positive group and anti-CCP antibody negative group （ all P = 0. 000 ）. The serum concentration of RF-IgA had a positive correlation with bone marrow edema （r =0. 561, P =0. 041 ）. The synovitis score of MRI of RA was higher in the RF-IgG positive group than that in the RF-IgG negative group （ P =0. 035）. There was significant difference in MRI synovitis between the RF-IgG or RF-IgM positive and negative groups of patients with a disease course of under 1 year （ P = 0. 015, P = 0. 007 ）. The serum CRP level had a positive correlation with arthroedema（ r = 0. 457, P =0. 022）. Conclusion MRI is proved to be a valuable examination for an early diagnosis and assessment of RA.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2010年第43期3049-3053,共5页
National Medical Journal of China
基金
科技部十一五科技支撑计划项目（2008BA159801）
关键词
关节炎
类风湿性
磁共振成像
诊断
Arthritis, rheumatoid
Magnetic resonance imaging
Diagnosis
