^(99)Tc^m-MDP骨关节显像诊断早期和活动期类风湿关节炎的临床应用

The clinical study of the diagnosis of early and active rheumatoid arthritis using bone imaging with 99 TcmMDP

目的探讨核素骨显像对早期和活动期类风湿关节炎（ＲＡ）的诊断价值。方法对１６８例确诊的ＲＡ患者进行９９Ｔｃｍ亚甲基二膦酸（ＭＤＰ）全身及手、足局部骨显像检查，其中１５０例在２周内根据关节疼痛部位摄Ｘ线片、１６６例进行血清类风湿因子（ＲＦ）定性测定、７５例测定血清Ｃ反应蛋白（ＣＲＰ）及１０４例检查红细胞沉降率（ＥＳＲ）。结果１６８例ＲＡ患者，骨显像阳性１４７例，诊断符合率８７５％，其中病程＜１、１～、５１～和＞１０ａ骨显像阳性率分别为８４４％、８４５％、９１４％和１００％，而在活动期阳性率为９８５％（１４０／１４２例）。在其骨显像阳性病例中，共检出５１８处骨关节病灶，对称性骨关节病变为４３２处，占８３４％，而单个骨关节病变８６处，占１６６％。骨关节病变部位以指间或掌指关节和腕关节居多，其次为跖趾关节、踝关节、肘关节、膝关节及腰椎和腰骶部。１５０例Ｘ线片中５５例显示ＲＡ改变，诊断符合率３６７％，病程＜１、１～、５１～和＞１０ａＸ线片阳性率分别为６１％、２００％、７１４％和８８２％。实验室检查ＲＦ、ＣＲＰ及ＥＳＲ阳性对ＲＡ诊断符合率分别为５１２％、６１３％和７４０％。ＲＡ活动期Ｒ?

Objective To explore the usefulness of 99 TcmMDP bone imaging in diagnosis of rheumatoid arthritis (RA) Methods 99TcmMDP whole body bone imaging, feet and hands regional bone imaging were performed in 168 patients with RA Among them, Xray film were taken in 150 cases, rheumatoid factor (RF) in 166 cases, Creactive protein (CRP) in 75 cases, and erythocyte sedimentation rate (ESR) in 104 cases Results Abnormal bone images were observed in 147 cases of RA, the total rate of coincidence was 875% Among them, based on different courses of disease, the abnormal rates of bone imaging in <1, 1, 5110, and >10 years groups were 844%, 845%, 914% and 100%, respectively, whereas in active RA was 985% In 518 joint lesions detected by bone images, 432 lesions (834%) were symmetric, 86 lesions (166%) were single The most frequently detected lesions were at metacarpophalangeal or interphalangeal and wrist joints (145 and 141, respectively), then, in metatarsophalangeal joints (76), ankle joints (63), elbow joints (46), knee joints(41), and lumber and sacral spine (6) The rates of coincidence with Xray film, RF, CRP and ESR were 367%, 512%, 613% and 740% respectively, and for the courses of disease abnormal rates of Xray in <1, 1, 5110, and >10 years groups were 61%, 200%, 714% and 882% respectively The abnormal rates of RF, CRP and ESR in active RA were (535%, 700% and 771%) significantly higher than those of catabatic RA (375%, 267%, 375% respectively, P <001) Conclusions 99TcmMDP bone imaging is a noninvasive, functional and sensitive method, in combination with clinical symptoms, joint signs and serological changes, it can elevate the detectability of early and active stage of RA