腕关节MR评估类风湿关节炎活动度的诊断价值研究

Diagnostic Value of Wrist MR in Evaluating Activity of Rheumatoid Arthritis

目的回顾性病例对照研究比较腕关节MR影像学指标、实验室指标对类风湿关节炎(RA)活动度的诊断价值。方法搜集就诊的连续性RA患者64例,按照RA28关节活动度评分(DAS28)进行分组,其中高活动度组47例,低活动度组17例;腕关节滑膜炎、骨髓水肿、骨侵蚀进行半定量评分,腱鞘炎进行定性评估。采用独立样本t检验比较两组间腕关节MR各影像指标评分和实验室指标;采用Spearman相关分析评价各参数与DAS28的相关性,采用ROC评价各参数鉴别两组的诊断效能。将独立样本t检验差异有统计学意义的参数作为自变量进行线性回归分析获得RA活动度的重要预测因素。结果观察者间评估影像特征(滑膜炎、骨髓水肿、骨侵蚀、腱鞘炎)和RAMRIS的一致性(滑膜炎:k=0.857;骨髓水肿:k=0.781;骨侵蚀:k=0.857;腱鞘炎:k=0.928;RAMRIS:k=0.783)。高活动度组与低活动度组腕关节MR的滑膜炎、骨侵蚀、RAMRIS及CRP、ESR差异有统计学意义(P<0.05),而骨髓水肿、腱鞘炎、性别、年龄、RF及抗CCP抗体差异均无统计学意义(P>0.05)。RA活动度与腕关节RAMRIS、滑膜炎、骨髓水肿评分呈正相关(r=0.463,0.420,0.345;P<0.001)。RA活动度与病程、抗CCP抗体、腱鞘炎无明显相关(P>0.05)。RAMIRS、滑膜炎、骨侵蚀、骨髓水肿评分判断RA活动性的ROC曲线下面积分别为0.737、0.706、0.701、0.608;回归分析显示RAMRIS是活动度的重要预测因素。结论腕关节MR滑膜炎、骨侵蚀、RAMRIS指标为评估类风湿关节炎活动度有价值的指标,RAMRIS是RA活动度的重要预测因素。

Objective A retrospective study was conducted to compare the diagnostic value of wrist MR imaging and laboratory indicators for rheumatoid arthritis(RA)activity.Methods A total of 64 patients with continuous RA treated were divided into two groups according to the degree of activity score of 28 joints(DAS28),including 47 cases in the high activity group and 17 cases in the low activity group.Semi-quantitative scoring was done according to the degree and extent of synovium enhancement of wrist joint,synovitis,bone marrow edema and bone erosion.Tenosynovitis was qualitatively evaluated.Independent sample t-test was used to compare the wrist MR imaging and laboratory index between the two groups.Spearman correlation analysis was used to evaluate the correlation between each parameter and DAS28.ROC was used to evaluate the diagnostic efficacy of each parameter between the two groups.The independent sample t-test parameters with statistically significant differences were used as independent variables for linear regression analysis to obtain the important predictors of RA disease activity.Results The consistency of imaging characteristics(synovitis,marrow edema,bone erosion,tenosynovitis)and RAMRIS(synovitis:k=0.857;bone marrow edema:k=0.781;bone erosion:k=0.857;tenosynovitis:k=0.928;RAMRIS:k=0.783).There were statistically significant differences in synovitis,bone erosion,RAMRIS,CRP and ESR between the high-activity group and the low-activity group(P<0.05),but no statistically significant differences in bone marrow edema,tenosynovitis,gender,age,RF and anti-ccp antibody(P>0.05).DAS28 was positively correlated with wrist RAMRIS,synovitis and bone marrow edema scores(r=0.463,0.420,0.345,P<0.001).DAS28 was not significantly correlated with disease course,anti-ccp antibody and tenosynovitis(P>0.05).The area under ROC of RAMIRS,synovitis score,bone erosion and marrow edema to determine RA activity was 0.737,0.706,0.701 and 0.608.Regression analysis shows that RAMRIS is an important predictor of activity.Conclusion Synovitis of the wrist joint,bone erosion and RAMRIS are valuable indicators to evaluate the degree of activity of rheumatoid arthritis,and RAMRIS is an important predictor of RA degree of activity.