双手MRI在早期类风湿关节炎诊断及骨与关节损伤中的价值

目的 探讨双手MRI在早期RA的诊断及骨与关节损伤中的价值。 方法 收集2011年1月-2014年10月安徽医科大学第一附属医院风湿科门诊及住院的111例早期RA(≤ 1年)患者的资料,记录患者临床及实验室指标,测定其股骨和腰椎部位BMD;所有患者行双手X线检查并行Sharp评分,其中37例患者行双手MRI检查并计算相关项目积分。 结果 ①X线及MRI的表现:X线分期结果提示:Ⅰ期73.87%,Ⅱ期26.13%,所有患者Sharp评分都在10分以下;其中行MRI的结果显示:骨侵蚀33例、滑膜炎31例、骨髓水肿21例、肌腱炎11例,4项指标中任一项阳性者有36例。②MRI各指标间的相关分析显示:骨髓水肿、滑膜炎分别与肌腱炎均呈正直线相关(P<0.05)。③MRI与各临床指标、BMD及Sharp评分间的相关性分析显示:MRI骨侵蚀评分与Sharp评分呈正直线相关(P<0.05);与大转子(P<0.05)和总股骨区(P<0.05) BMD呈负相关,MRI肌腱炎评分与CRP(P<0.05)、关节肿胀数(P<0.05)、关节压痛数(P<0.05)呈正直线相关。 结论 MRI在早期RA中显示出更高于X线改变的阳性率,具有较好的诊断价值,且与BMD及Sharp评分具有相关性;MRI上肌腱炎的表现可能具有一定的诊断价值。 

Value of MRI of hands in diagnosis of early rheumatoid arthritis and bone joint injury

Objective To explore the value of MRI of both hands in the diagnosis of early RA,bone and joint damage in RA. Methods A total of 111 patients with early RA (disease duration less than 1 year) was recruited.All the clinical and laboratory parameters in all the patients were recorded.BMD of femur and lumbar vertebrae in RA were detected.Radiographs for two hands were evaluated according to the Sharp's method.MRI of hands was executed in early RA patients and MRIS were used to assess changes of MRI in 37 patients. Results ①Results of X-ray examination and MRI of both hands scan showed:according to classification standard of X-ray examination,73.87% with RA was classified as Ⅰ stage and 26.13% as Ⅱ stage,whose sharp scores were all within 10 score.The manifestation of 37 patients with early RA patients on MRI scan for two hands demonstrated bone erosion in 33 cases,synovitis in 31 cases,bone marrow edema in 21 cases and tendinitis in 11 cases.Positive rate of either indicator among above manifestations on MRI was 36 cases.②Results of bivariable correlation analysis showed that tendinitis score was positively correlated with bone marrow edema score (P<0.05) and synovitis score (P<0.05).③Correlation analysis found bone erosion score of MRI scan positively correlated with sharp score (P<0.05) and negatively correlated with BMD at greater trochanter (P<0.05),total hip (P<0.05).Tendinitis score of MRI scan positively correlated with CRP (P<0.05),swollen joint count (P<0.05) and tender joint count (P<0.05). Conclusion The positive rate is higher on MRI scan than that in X-ray examination.MRI scan has good diagnostic value in early RA.Manifestations of MRI scan are correlated with BMD and sharp score,and tendinitis on MRI scan may have a certain diagnostic value.