磁共振成像联合血清RANKL、OPG水平诊断早期类风湿关节炎及骨关节损伤的价值

The value of MRI combined serum RANKL and OPG levels in the diagnosis of early rheumatoid arthritis and joint injury

目的探讨磁共振成像(magnetic resonance imaging,MRI)联合血清破骨细胞抑制因子(osteoclastogenesis inhibitory factor,OPG)、核因子κB受体活化因子配体(receptor activator for nuclear factor-κB ligand,RANKL)水平诊断早期类风湿(rheumatoid arthritis,RA)及骨关节损伤的临床价值。方法选择2014年1月-2015年12月我院收治住院的RA患者241例,其中早期RA 118例,非早期RA 123例,另选择100例正常人为对照组;抽取各组晨空腹静脉血并测定血清RANKL、OPG水平;采用GE3.0OHDXT仪器评估滑膜炎、骨髓水肿、骨侵蚀等关节损伤表现,采用RAMRIS系统进行评估。结果 3组RANKL水平逐渐上升,早期RA组OPG明显低于对照组及非早期RA组,而非早期RA组又高于对照组,差异均有统计学差异(P<0.05)。MRI肌腱炎与骨髓水肿及滑膜炎均呈正相关(r=0.385,P<0.05;r=0.385,P<0.05),OPG下降或MRI显示骨侵蚀阳性率为92.87%,骨髓水肿阳性率为73.14%,滑膜炎阳性率为88.36%,肌腱炎阳性率为57.24%,RAMRIS 3项或4项高于0分及OPG下降均为100%。RANKL上升或MRI显示骨侵蚀阳性率为91.25%,骨髓水肿阳性率为73.68%,滑膜炎阳性率为88.42%,肌腱炎阳性率为58.49%,RAMRIS 3项或4项高于0分、OPG上升均为97.48%。结论 MRI联合血清OPG、RANKL水平可明显提高早期RA骨关节损伤诊断水平。

Objective To research the value of MRI combined with serum RANKL and OPG levels in the diagnosis of early rheumatoid arthritis（ RA） and joint injury.Methods 118 patients with early RA,123 cases of late RA,and 100 normal people as control group were selected from January 2014 to December 2014 in our hospital.Serum RANKL and OPG levels were detected with fasting venous blood in patients.Synovitis,bone marrowedema and bone erosion,and joint damage performance were evaluated using GE3.0 OHDXT instrument and RAMRIS system.Results RANKL level increased gradually in 3 groups.OPG in early RA group was obviously lower than that in control group and the late RA group,with statistical significance（ P〈0.05）.MRI tendonitis was positively correlated with bone marrowedema and synovitis（ r = 0.385,P〈0.05,and r = 0.385,P〈0.05）.OPG decrease or MRI showed positive bone erosion rate was 92.87%,positive bone marrowedema rate was 73.14%,positive synovitis rate was 88.36%,and positive tendinitis rate was 57.24%.The 3 or 4 items of RAMRIS above 0 or OPG decline was100%.RANKL increase or MRI showed positive bone erosion rate was 91.25%,positive bone marrowedema rate was 73.68%,positive synovitis rate was 88.42%,and positive tendinitis rate was 58.49%.The 3 or 4 items of RAMRIS above 0 or OPG increase was 97.48%.Conclusion MRI combined with serum OPG and RANKL levels can obviously improve the diagnosis value of early RA and joint injury.