^(99)Tc^m-MDP骨显像在类风湿关节炎骨痛中的应用

Application of ^(99)Tc^m-MDP bone scan in rheumatoid arthritis with bone erosion

目的探讨99 Tcm-羟基亚甲基二磷酸盐(99 Tcm-MDP)骨显像诊断类风湿关节炎(RA)骨痛的价值。方法回顾性分析40例确诊RA患者,均接受99 Tcm-MDP骨显像,同期测定血清类风湿因子(RF)、抗环瓜氨酸肽抗体(antiCCP)、抗突变型瓜氨酸波形蛋白抗体(anti-MCV)、葡萄糖-6-磷酸异构酶(GPI)、血沉(ESR)、C-反应蛋白(CRP)及免疫球蛋白G(LgG)。通过勾画ROI技术测出代谢最活跃关节的最高计数(Maxcount),以其作为因变量,采用线性逐步回归分析Maxcoun与RF、anti-CCP、anti-MCV、GPI、ESR、CRP、LgG的相关性。结果 anti-MCV对Maxcount具有显著性影响(Beta=0.414,P=0.008),且呈正相关(B=0.031,P=0.008),回归方程有统计学意义(F=7.862,P=0.008);其余6项血清测定值与Maxcount无明显相关(P均>0.05)。Pearson积距相关系数单侧检验显示anti-MCV与anti-CCP、ESR与CRP均显著正相关,且关系较密切(r均>0.50,P均<0.001)。结论 99 Tcm-MDP骨显像不仅可早期诊断RA患者软骨和(或)骨破坏,还可间接提示RA是否处于活动期。

Objective To explore the value of ^99Tcm-MDP bone scanning in diagnosis of rheumatoid arthritis （RA） with bone pain. Methods A total of 40 RA patients who underwent ^99Tcm-MDP bone scanning were retrospectively analyzed, and a series of serum assay, such as rheumatoid factors （RF）, anti-cyclic citrullinated peptide （anti-CCP）, anti-mutated citrullinated vimentin （anti-MCV）, glucose-6-phosphat isome-ras （GPI）, erythrocyte sedimentation rate （ESR）, C-reactive protein （CRP） and immuno-globulin G （IgG） were obtained and compared in the same period. The dependent variable maximum count （Maxcount） of joint with the highest metabolism were acquired by drawing ROI methods, and the correlation among Maxcount and RF, anti-CCP, anti-MCV, GPI, ESR, CRP, LgG were analyzed respectively with linear stepwise regression. Results anti-MCV had significant effect to Maxcount （Beta=0.414, P=0.008）. There was positive correlation between anti-MCV and Maxcount （B=0.031, P=0.008）, and the stepwise regression equation was statistically significant （F=7.862, P〈0.01）. However, there was no significant correlation among Maxcount and the remaining six serum assay （all P〉0.05）. Pearson correlation matrix showed significantly relatively strong positive relationship between anti-MCV and anti-CCP, ESR and CRP, respectively （both r〉0.50, P〈0.001）. Conclusion ^99Tcm-MDP bone scanning can not only be used for early diagnosis of bone erosion, but also for indirect prompt of RA activity.