腕关节MR成像及临床诊断指标对于鉴别早期类风湿关节炎的研究

THE DIAGNOSTIC VALUE OF MRI FINDINGS OF WRIST AND CLINICAL FEATURES IN DIFFERENTIATING EARLY RHEUMATOID ARTHRITIS

目的 研究MRI表现及临床症状、实验室检查等指标对于鉴别早期类风湿关节炎（rheumatoid arthritis，RA）及非类风湿关节炎的诊断价值，提高早期类风湿关节炎诊断的准确率。方法 选择临床怀疑早期RA而未确诊的患者103例，男性34例，女性69例，年龄19～78岁。对研究对象进行平片及MRI平扫和增强扫描。分析各种主要MRI征象及临床症状、实验室检查的指标，观察RA与非RA组之间的差异性。结果 依据美国风湿病协会1987年修订的关于RA诊断标准，对103例患者进行随访直至临床明确诊断者97例。符合RA临床诊断标准者78例，非RA者19例。晨僵、对称性关节肿胀、类风湿因子（rheumatoid factor，RF）阳性、血沉（erythrocyte sedimentation rate，ESR）增快、C反应蛋白（C-reactive protein，CRP）值升高诸指标在RA组与非RA组之间具有显著差异性。MRI各主要征象中滑膜增厚、血管翳强化、骨髓水肿、骨侵蚀诸指标RA组与非RA组之间具有显著差异性。结论 以晨僵、对称性关节肿胀、ESR增快、RF阳性、CRP值升高、血管翳强化、滑膜增厚、骨侵蚀、骨髓水肿为指标时对于鉴别早期RA与非RA具有一定诊断价值。

Objective To study the magnetic resonance imaging（MRI） appearances of the wrist in early stage of rheumatoid arthritis（RA） and to evaluate the diagnostic value of MRI and clinical symptom and laboratory test in the differentiating diagnosis of early RA and non-RA. Methods One hundred and three patients who were suspected as RA clinically were selected. Among them, 34 were male and 69 female; with age ranging from 19 to 78 years old, All the patients underwent radiography and pre-contrast and post-contrast MR examination. MRI features, clinical features and laboratory test were analysed in the differentiating diagnosis of early stage RA and non-RA. Results According to 1987 American Rheumatism Assosiation （ARA） revised criteria, finally diagnosis was reached in 97 cases. Among them, 78 were finally diagnosed as RA and 19 were non-RA. There were significant differences between RA and nonRA groups in morning stiffness, symmetric arthritis, rheumatoid factor （RF） positivity, erythrocyte sedimentation rate （ ESR）, C-reactive protein （CRP） and synovial hyperplasia, enhanced pannus, bone marrow edema as well as bone erosion. Conclusion Morning stiffness, symmetric arthritis, RF positivity, ESR,CRP and synovial hyperplasia, enhanced pannus, bone marrow edema and bone erosion have certain differentiating diagnosis value between early RA and non-RA.