类风湿关节炎手腕部骨侵蚀的磁共振定量分析

MRI quantitative analysis of bone erosions in wrists and hands in patients with rheumatoid arthritis

目的:通过类风湿关节炎手腕部骨侵蚀MRI表现及临床指标对照研究,探讨两者在评价类风湿关节炎诊断及预后中的价值。方法:随机选取行手腕部MRI扫描的患者80例,患者均在1周内行相关实验室检查,其中符合类风湿诊断标准的入选为研究对象。采用OMERACT的RA评分系统为类风湿关节炎骨质破坏的评分标准,对磁共振图像进行分析及评分。分别按性别、年龄、病程、晨僵、类风湿因子(RF)、抗环瓜氨酸肽(抗CCP)、抗"O"(ASO)、C反应蛋白(CRP)、血沉(ESR)予以分组,使用Mann-Whitney方法分析各组间骨侵蚀的差异。结果:符合RA诊断标准的共54例,共发现238处骨质侵蚀,最多的1例累及13处骨质。腕部骨侵蚀最常累及三角骨(36/54),其次为头状骨(31/54);手部最常累及第三掌骨头(7/54),其次为第二掌骨头(6/54)。早期/中晚期RA组、CRP阳/阴性组、ESR阳/阴性组间骨侵蚀评分差异具有高度统计学意义(P<0.01)。抗CCP阳/阴性组间的骨侵蚀评分差异具有统计学意义(P<0.05)。性别、年龄、晨僵、RF、ASO的组间骨侵蚀评分差异无统计学意义(P>0.05)。结论:MRI可为骨侵蚀的诊断及评估预后提供最直观的依据,抗CCP抗体、CRP、ESR可在一定程度上提示骨侵蚀。

Objective：To evaluate MRI,clinical manifestations and laboratory examination in the diagnosis and prognosis of rheumatoid arthritis.Methods：80 patients with hand or wrist pain were selected randomly in this study.All patients had laboratory examinations in a week before or after they accepted MRI examinations.Patients who met the diagnostic criteria would be scored corresponding to OMERACT system.Patients were divided by gender,age,disease duration,morning stiffness,RF,ACCP,ASO and ESR respectively.Bone erosion scores were analyzed using Mann-Whitney.Results：There were 238 bone erosions in 54 cases with RA.13 bone erosions were found in the most severe cases.The most common bone erosion in wrist is triangular bone,followed by capitates;in hand is the head of the metacarpal bone,followed by the second metacarpal bone.Statistic differences were found in the age,duration,ACCP,ASO and ESR.Conclusion：MRI provides the intuitive diagnostic evidence of bone erosion in RA,while ACCP,ASO and ESR indicate bone erosion in a certain degree.