RA患者骨髓水肿、骨侵蚀影像学评分与治疗反应性的关系

Relationship between imaging scores of bone marrow edema,bone erosion and treatment responsiveness in RA patients

目的:探究类风湿性关节炎(RA)患者经影像学检查的相关骨髓水肿、骨侵蚀评分与其治疗反应性的关系。方法:选取RA患者85例,根据28个关节的疾病活动评分划分为高活动度组(n=19)、中活动度组(n=45)和低活动度组(n=21)。85例患者均行CT、MRI检查,比较影像学检查结果,采用Logistic回归分析骨髓水肿、骨侵蚀评分与治疗反应性的关系。结果:治疗前,高、中、低活动度3组患者的MRI骨髓水肿评分分别为(2.34±0.32)分、(2.11±0.29)分、(1.85±0.24)分,MRI骨侵蚀评分分别为(8.21±1.09)分、(7.76±0.83)分、(7.44±0.89)分,CT关节间隙狭窄评分分别为(0.80±0.19)分、(0.72±0.15)分、(0.65±0.14)分,CT关节侵蚀评分分别为(0.75±0.20)分、(0.66±0.17)分、(0.58±0.15)分;治疗后,3组患者的MRI骨髓水肿评分分别为(1.33±0.22)分、(1.16±0.19)分、(1.02±0.13)分,MRI骨侵蚀评分分别为(5.18±0.69)分、(4.88±0.53)分、(4.51±0.46)分,CT关节间隙狭窄评分分别为(0.54±0.11)分、(0.46±0.17)分、(0.38±0.12)分,CT关节侵蚀评分分别为(0.46±0.22)分、(0.37±0.15)分、(0.31±0.14)分。随着RA活动度增加,治疗前与治疗后的MRI骨髓水肿评分、MRI骨侵蚀评分、CT关节间隙狭窄评分和CT关节侵蚀评分逐渐升高,差异均有统计学意义(P值分别为<0.001、0.031、0.014、0.010)。MRI骨髓水肿评分、骨侵蚀评分与RA活动度呈正相关关系(P均<0.001)。无应答者的治疗前MRI骨髓水肿评分、MRI骨侵蚀评分、CT关节间隙狭窄评分和CT关节侵蚀评分分别为(2.30±0.33)分、(8.23±1.06)分、(0.78±0.18)分、(0.74±0.189)分,临床应答者的治疗前MRI骨髓水肿评分、MRI骨侵蚀评分、CT关节间隙狭窄评分和CT关节侵蚀评分分别为(1.90±0.29)分、(7.38±1.01)分、(0.67±0.14)分、(0.589±0.166)分;无应答者的治疗前MRI骨髓水肿评分、MRI骨侵蚀评分、CT关节间隙狭窄评分和CT关节侵蚀评分均高于临床应答者,差异均有统计学意义(P值分别为<0.001、0.002、0.007、0.001)。Logistic分析结果显示,MRI骨髓水肿评分、骨侵蚀评分及CT关节间隙狭窄评分、关节侵蚀评分升高均为无应答的独立危险因素(P<0.05)。ROC曲线分析结果显示,MRI骨髓水肿评分、骨侵蚀评分及CT关节间隙狭窄评分、关节侵蚀评分联合预测治疗反应性的敏感度为83.33%,特异度为91.04%。结论:RA患者MRI、CT检查的相关骨髓水肿、骨侵蚀评分越低,其治疗反应性越高。

Objective:To investigate the relationship between imaging scores of bone marrow edema,bone erosion and treatment responsiveness in patients with rheumatoid arthritis(RA).Methods:A total of 85 patients with RA were selected and divided into high activity group(n=19),medium activity group(n=45),and low activity group(n=21)according to the disease activity scores of 28 joints.All 85 patients underwent CT and MRI examinations.The imaging results were compared,and the relationship between bone marrow edema,bone erosion score,and treatment responsiveness was analyzed by Logistic regression.Results:Before treatment,the MRI score of bone marrow edema in patients with high,medium,and low activity groups were(2.34±0.32),(2.11±0.29),(1.85±0.24)points,and the MRI score of bone erosion were(8.21±1.09),(7.76±0.83),and(7.44±0.89)points,respectively.The joint space stenosis scores on CT were(0.80±0.19),(0.72±0.15),and(0.65±0.14)points,and the joint erosion scores on CT were(0.75±0.20),(0.66±0.17),and(0.58±0.15)points,respectively.After treatment,the bone marrow edema scores in the three groups of patients were(1.33±0.22),(1.16±0.19),and(1.02±0.13)points,and the bone erosion scores were(5.18±0.69),(4.88±0.53),and(4.51±0.46)points,respectively.The joint space stenosis scores were(0.54±0.11),(0.46±0.17),and(0.38±0.12)points,and the joint erosion scores were(0.46±0.22),(0.37±0.15),and(0.31±0.14)points,respectively.As RA activity increased,scores of bone marrow edema,bone erosion,joint space narrowing,and joint erosion gradually increased before and after treatment,with statistical significance(P<0.001,P=0.031,0.014,and 0.010,respectively).Scores of bone marrow edema and bone erosion were positively correlated with RA activity(all P<0.001).The scores of bone marrow edema,bone erosion,joint space stenosis,and joint erosion of non-responders were(2.30±0.33),(8.23±1.06),(0.78±0.18),and(0.74±0.189)points,and the scores of clinical responders before treatment were(1.90±0.29),(7.38±1.01),(0.67±0.14),and(0.589±0.166),respectively.Non-responders had higher scores of bone marrow edema,bone erosion,joint space stenosis and joint erosion than clinical responders,with statistically significant differences(P<0.001,P=0.002,0.007,0.001,respectively).Logistic analysis showed that bone marrow edema,bone erosion score,joint space narrowing,and joint erosion scores were independent risk factors for non-response(P<0.05).The ROC curve analysis showed that the combined sensitivity of bone marrow edema,bone erosion,joint space narrowing,and joint erosion scores to predict treatment responsiveness was 83.33%,and the specificity was 91.04%.Conclusion:The lower the scores of bone marrow edema and bone erosion on MRI and CT,the higher treatment responsiveness in RA patients.