基于磁共振成像T_(2)弛豫时间图技术评价皮肌炎/多发性肌炎病情的相关研究

Magnetic resonance imaging T_(2) mapping could reflect disease status in patients with dermatomyositis or polymyositis

探讨磁共振成像(MRI)T_(2)弛豫时间图(T_(2)mapping)在皮肌炎(DM)、多发性肌炎(PM)病情评估中的运用价值。选2016年10月至2017年12月昆明医科大学第一附属医院风湿免疫科确诊的DM或PM患者33例(肌炎组),另选同期健康志愿者8例(健康对照组)。检测肌炎组患者血清肌酸激酶(CK)、红细胞沉降率(ESR)、C反应蛋白(CRP)、补体C3、补体C4。采用炎性肌病活动评价工具-肌肉(MDAAT-muscle)、炎性肌病活动评价工具-整体(MDAAT-all)、健康评估量表(HAQ)、生活质量量表-36(SF-36)、徒手肌力测定(MMT-8)评分及MRI T_(2)弛豫时间图肌肉(骨盆和大腿22块肌肉)T_(2)值评价疾病状态。结果显示,肌炎组患者CK为457.2(165.6,1229.2)IU/L,ESR为20(10,42)mm/1h,CRP为3.25(2.38,10.07)mg/L,补体C3为0.90(0.83,1.06)g/L,补体C4为0.18(0.14,0.23)g/L。MMT-8评分为(57.12±16.23)分,MDAAT-muscle为5.34(4.00,6.00)分,MDAAT-all为(34.63±12.62)分,HAQ为1.55(0.66,2.59)分,SF-36为(44.66±7.98)分。与健康对照组总肌肉T_(2)值比,肌炎组T_(2)值升高[(54.99±11.60)ms比(36.62±1.66)ms,P<0.001],其中缝匠肌、髂腰肌、梨状肌、臀小肌、臀中肌受累较重。肌炎组总肌肉T_(2)值与CK、MDAAT-muscle、MDAAT-all、HAQ呈正相关(r值分别为0.461、0.506、0.347、0.510,均P<0.05);与补体C4、SF-36、MMT-8评分呈负相关(r值分别为-0.424、-0.549、-0.686,均P<0.05)。提示MRI T_(2)弛豫时间图能客观反映DM/PM患者病情。

This study aimed to explore the value of magnetic resonance imaging(MRI)T_(2) mapping in the assessment of dermatomyositis(DM)and polymyositis(PM).Thirty-three confirmed cases(myosin group)and eight healthy volunteers(healthy control group)at the Department of Rheumatology and Immunology,the First Affiliated Hospital of Kunming Medical University,from October 2016 to December 2017,were collected and analyzed.Multiple parameters of the myosin group were quantified,including creatine kinase(CK),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),complement C3,and complement C4.Disease status was evaluated using a panel of tools:myositis disease activity assessment tool-muscle(MDAAT-muscle),myositis disease activity assessment tool-whole(MDAAT-all),health assessment questionnaire(HAQ),medical outcomes study health survey short form-36 item(SF-36),hand muscle strength test(MMT-8)score,and MRI T_(2) mapping of muscle(22 muscles in the pelvis and thighs)T_(2) values.The results showed that in the myositis group,the measurements for CK,ESR,CRP,complement C3,and complement C4 were 457.2(165.6,1229.2)IU/L,20(10,42)mm/1h,3.25(2.38,10.07)mg/L,0.90(0.83,1.06)g/L,and 0.18(0.14,0.23)g/L,respectively.The scores for MMT-8,MDAAT-muscle,MDAAT-all,HAQ,and SF-36 were 57.12±16.23,5.34(4.00,6.00),34.63±12.62,1.55(0.66,2.59),and 44.66±7.98,respectively.T_(2) values were significantly higher in all 22 muscles of the pelvis and thighs of patients with DM or PM compared with the healthy controls[(54.99±11.60)ms vs.(36.62±1.66)ms,P<0.001],with the most severe lesions in the satrorius,iliopsoas,piriformis,gluteus minimus,and gluteus medius muscles.The total muscle T_(2) value in the myositis group was positively correlated with CK,MDAAT-muscle,MDAAT-all,and HAQ(r=0.461,0.506,0.347,and 0.510,respectively,all P<0.05).There was a negative correlation between complement C4,SF-36,and MMT-8 scores(r=-0.424,-0.549,and-0.686,respectively,all P<0.05).Collectively,the findings from this study suggest that MRI T_(2) mapping can objectively reflect the disease status of DM and PM.