^(99m)TC-MDP骨关节显像在早期类风湿关节炎中的临床价值

Value of ^(99m)Tc-MDP bone imaging in early rheumatoid arthritis

目的 探讨核素骨关节显像对早期和活动期类风湿关节炎 (RA)诊断价值。方法 对 31例确诊为RA患者进行99mTC -羟基亚甲基二磷酸 (MDP)全身骨关节显像检查 ,全部RA患者根据关节疼痛部位摄X线平片 ,同时进行血沉 (ESR)、血清C反应蛋白 (CRP)、类风湿因子 (RF)滴度、关节压痛指数 (JTI)、关节肿胀指数 (JSI)测定。结果 31例RA患者骨显像阳性 2 9例 ,诊断符合率 93 5 %,而非RA关节炎 (AS和OA)组和正常人组核素骨关节显像率分别为 80 0 %和 10 5 %;在 2 2 6个有临床表现的关节中 ,核素显像阳性是 2 0 1个 ,总符合率为88 9%;在 2 0例早期RA(≤ 2年 )中 ,核素骨关节显像率 95 0 %,X线片RA改变符合率 2 0 0 %;病变关节摄取示踪剂程度与JTI、JSI、ESR、CRP呈正相关 (r为 0 4 5～ 0 5 2 ,P <0 0 5 )。结论 99mTC骨关节显像为骨关节无创伤性、功能性、灵敏度高但特异性不强的检查方法 ,结合临床症状、体征及血清免疫学改变 ,对提高早期和活动期RA的诊断及评估有帮助。

Objectives To investigate the clinic value of 99 Tc-MDP in the diagnosis of rheumatoid arthritis(RA).Methods The whole body bone imaging of 99 Tc-MDP were performed in 31 patients with RA and 20 controls with other arthritis(AR group) and 19 normal controls.X-ray,rheumatoid factor(RF),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),joint tender index and joint swollen index were detected in RA patients.Results Abnormal bone images were observed in 29 out of 31 patients, with a 93.5 % of coincidence in RA group, 80% and 10.5% of in AR group and normal group. 201 out of 226 (88.9%) patients with joint symptoms showed abnormal bone images. 95% abnormal bone image rate and 20% abnormal X ray rate were found in 20 early RA patients. The joint radiopharmaceutical uptake score correlated positively with JTI, JSI, CRP and ESR. Conclusions 99m Tc MDP bone imaging is a sensitive, functional, noninvasive but unspecific method in detecting RA. And in combination with clinical symptoms, signs and serological changes, it is of value to the diagnosis of early RA.