MRI评价幼年特发性关节炎髋关节病变评分方法的改良研究

Development and preliminary validation of the MRI scoring methods for the hip in juvenile idiopathic arthritis

目的总结并比较既往对幼年特发性关节炎髋关节病变的MRI评分方法,结合临床指标对既往方法进行改良,为更准确评估髋关节受累的严重程度提供依据。材料与方法通过万方和PubMed等数据库,对既往报道的JIA髋关节受累的MRI评分方法进行总结,分析和比较。提出髋关节MRI改良评分方法。利用改良后的方法回顾性分析2011年1月至2014年6月间确诊的92例JIA患儿髋关节增强MRI图像,采用组内相关系数验证改良后MRI评分方法,并利用改良评分方法对不同MRI征象间的关系进行分析。P〈0.05为差异有统计学差异。结果仅5篇文献与JIA髋关节MRI评分相关。除关节积液、髋关节总得分外,改良的MRI评分方法具有良好的一致性（ICC〉0.60,P〉0.05）。通过分析MRI征象间的相关性,总结出滑膜炎、骨髓水肿、关节积液为可逆性MRI征象,而骨侵蚀、关节软骨受损、骨骺受损、关节狭窄为不可逆性MRI征象。JIA各亚型MRI评分间差异不具有统计学意义（P〉0.05）,少关节型6例（0-17分）,全身型5例（0-21分）,RF（-）多关节型7例（1-19分）,RF（＋）多关节型8例（1-15分）,附着点炎型4例（2-5分）。在ACR的治疗分组中,髋关节MRI能比剩余临床指标更早的发现预后不良指征,尤其在≤4个关节炎组（χ^2=16.80,P〈0.01）和≥5个关节炎组（χ^2=4.792,P=0.029）中。结论改良后MRI评分方法较既往方法更具有简单性、可靠性、实用性,是一种有效评估受累程度的方法。

Objective： To evaluate and develop MRI scoring system for the hip in juvenile idiopathic arthritis. Materials and Methods： We used Wanfang and PubMed to identify relevant published articles. We proposed a new MRI scoring method for the hip in JIA based on relevant articles. Retrospective studies of 92 JIA patients with hip involvement were analysed from January 2011 to June 2014. The intra-reader and inter-reader agreement（evaluated by intra-class correlation coefficients, ICCs） were determined for scores of MRI. Results： Only 5 literatures were qualified. Except joint effusion and total scores, Other lesions of developed MRI scoring method had good reliability, ICC〉0.60, P〉0.05. We got reversible and irreversible MRI signs.Reversible MRI signs： synovial hypertrophy, joint effusion, bone edema. Irreversible MRI signs： bony erosion, cartilage loss, epiphysis lesion, joint space narrowing,muscular inflammation. There was no differences between subtypes of JIA in hip MRI scorings, oligoarticular JIA scorings were 6（0—17）, systemic JIA scorings were 5（0—21）, polyarticular（rheumatoid factor negative） scorings were 7（1—19）,polyarticular（rheumatoid factor positive） scorings were 8（1—15）, enthesitis related JIA scorings were 4（2—5）. Arthritis or subclinical-arthritis of hips could be detected much earlier. Especially in history of arthritis of 4 or fewer joints group（χ^2=16.80, P〈0.01） and in history of arthritis of 5 or more joints group（χ^2=4.792, P=0.029）.Conclusions： Developed MRI scoring method proved to be a simple and highly reliable assessment score in the evaluation of JIA disease of the hips.