MRI结合血清、关节液中NO、MMP3水平在膝关节类风湿与骨性关节炎的诊断价值

目的探讨磁共振成像(magnetic resonanceimaging,MRI)联合血清及关节液中一氧化氮(Nitric Oxide,NO)、基质金属蛋白酶-3(matrix metalloproteinase-3,MMP-3)水平鉴别诊断膝类风湿性关节炎(rheumatoid arthritis,RA)、骨关节炎(osteoarthritis,OA)的价值及影像特点分析。方法选取2017年10月-2018年10月本院收治的40例RA患者作为RA组,同期收治的44例OA患者作为OA组。比较两组MRI影像特点,血清及关节液中NO、MMP3水平,分析MRI、血清及关节液中NO、MMP3水平单独诊断及联合诊断的效能。结果 RA组内侧胫骨关节骨髓水肿率与OA组无明显差异(P>0.05),RA组内侧胫骨关节囊性坏死率显著高于OA组(P<0.05),RA组外侧胫骨骨关节骨髓水肿、囊性坏死率均显著高于OA组(P<0.05),RA组内侧、外侧II^III级半月板损伤率均显著高于OA组(P<0.05),RA组滑膜增生率显著高于OA组(P<0.05);RA组血清和关节液NO、MMP-3水平均显著高于OA组(P<0.05);经受试者工作特征曲线(receiver operating characteristic curve,ROC)分析,MRI联合血清和关节液中NO、MMP3诊断价值高于各单项检查指标。结论 RA和OA的MRI影像学图像存在一定差异,MRI联合血清和关节液NO、MMP-3指标诊断,可进一步提高两者鉴别诊断价值。

The Diagnostic Value of MRI Combined with Serum and Fluid Levels of NO and MMP3 in the Diagnosis of Rheumatoid Arthritis and Osteoarthritis of the Knee

Objective To investigate the value of magnetic resonance imaging(MRI) combined with levels of nitric oxide(NO) and matrix metalloproteinase-3(MMP-3) in serum and synovial fluid for the differential diagnosis of rheumatoid arthritis(RA), osteoarthritis(OA) and analysis of image features. Methods 40 patients with RA admitted to the hospital from October 2017 to October 2018 were enrolled in the RA group. 44 patients with OA admitted in the same period were enrolled in the OA group. The images features of MRI, the levels of NO and MMP3 in serum and synovial fluid were compared between the two groups. The diagnostic efficiency of separate diagnosis and combined diagnosis with MRI and levels of NO, MMP3 in serum and synovial fluid were analyzed. Results There was no significant difference in the bone marrow edema rate of medial tibial joint between the OA group and the RA group(P>0.05). The cystic necrosis rate of the medial tibial joint in the RA group was significantly higher than that in the OA group(P<0.05). The bone marrow edema rate and cystic necrosis rate of lateral tibial joint in the RA group were significantly higher than those in the OA group(P<0.05). The II^III meniscus injury rates of lateral and medial tibial joint in the RA group were significantly higher than those in the OA group(P<0.05). The synovial hyperplasia rate in the RA group was significantly higher than that in the RA group(P<0.05). the levels of NO and MMP-3 in the serum and synovial fluid of the RA group were significantly higher than those in the OA group(P<0.05). The receiver operating characteristic curve(ROC) analysis showed that the diagnostic value of MRI combined with NO and MMP3 in serum and synovial fluid is higher than that of each separate examination index. Conclusion The MRI imaging images of RA and OA are different. The diagnosis of MRI combined with NO and MMP-3 in serum and synovial fluid can further improve the differential diagnosis value.