动态增强磁共振成像及CRP/Alb、NLR对类风湿性关节炎活动性的评价

Evaluation of rheumatoid arthritis activity by dynamic enhanced magnetic resonance imaging and CRP/Alb,NLR

目的探究动态增强磁共振成像(DCE-MRI)及C-反应蛋白/白蛋白比值(CRP/Alb)、中性粒细胞/淋巴细胞比值(NLR)对类风湿性关节炎(RA)活动性的评价。方法选取2022年4月至2023年4月在郑州市骨科医院收治的RA患者62例临床资料开展回顾性分析,按28个关节疾病活动度(DAS28)评分评估患者活动度,可分为缓解期21例,活动期41例,其中低度活动期10例、中度活动期14例、高度活动期17例。比较活动期、缓解期RA患者DCE-MRI参数达峰时间(TTP)、早期强化率(EER)、最大强化率(MER)、CRP/Alb、NLR的差异,并通过ROC曲线分析DCE-MRI参数(TTP、EER、MER)、CRP/Alb、NLR诊断RA患者活动期的效能。比较不同疾病活动期程度RA患者DCE-MRI参数联合、CRP/Alb、NLR、DAS28评分的差异,并分析DCE-MRI参数联合、CRP/Alb、NLR与疾病活动度不同程度的相关性。结果活动期RA患者TTP低于缓解期RA患者,但EER、MER均高于缓解期RA患者(P<0.05)。活动期RA患者CRP/Alb、NLR均高于缓解期RA患者(P<0.05)。采用ROC分析血清DCE-MRI参数(TTP、EER、MER)、CRP/Alb、NLR诊断RA患者活动期的AUC、敏感度、特异度,AUC分别为0.777、0.795、0.793、0.874、0.787,DCE-MRI参数联合、五项联合诊断RA患者活动期的AUC为0.915、0.988。各组TTP、EER、MER、CRP/Alb、NLR、DAS28评分比较差异存在统计学意义(P<0.05),高度活动期TTP<中度活动期<低度活动期;而EER、MER、CRP/Alb、NLR、DAS28评分>中度活动期>低度活动期(P<0.05)。Person相关性分析显示,TTP与疾病活动度程度呈负相关(r=-0.403,P<0.05),EER、MER、CRP/Alb、NLR与疾病活动度程度呈正相关(r=0.648、0.664、0.715、0.710,P<0.05)。结论DCE-MRI定量参数、CRP/Alb、NLR诊断RA患者疾病活动期均具有一定价值,联合诊断价值更好,且与疾病活动程度相关密切。

Objective To explore the evaluation of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI),C-reactive protein/albumin ratio(CRP/Alb),and neutrophil/lymphocyte ratio(NLR)on the activity of rheumatoid arthritis(RA).Methods A retrospective analysis was conducted on the clinical data of 62 RA patients admitted to Zhengzhou Orthopedic Hospital from April 2022 to April 2023.According to the evaluation of 28 joint disease activity(DAS28)scores,the patient's activity can be divided into remission stage 21 and activity stage 41,including low activity stage 10,moderate activity stage 14,and high activity stage 17.Compare the differences in DCE-MRI parameters(TTP,EER,MER),CRP/Alb,and NLR between active and remission RA patients,and analyze the effectiveness of DCE-MRI parameters(TTP,EER,MER),CRP/Alb,and NLR in diagnosing active RA patients through ROC curves.Compare the differences in DCE-MRI parameter combinations,CRP/Alb,NLR,and DAS28 scores among RA patients with different degrees of disease activity,and analyze the correlation between DCE-MRI parameter combinations,CRP/Alb,NLR,and different degrees of disease activity.Results The TTP of active RA patients was lower than that of remission RA patients,but the EER and MER were higher than those of remission RA patients(P<0.05).The CRP/Alb and NLR of active RA patients were higher than those of remission RA patients(P<0.05).The AUC,sensitivity,and specificity of serum DCE-MRI parameters(TTP,EER,MER),CRP/Alb,and NLR in the active phase of RA patients were analyzed using ROC.The AUC values were 0.777,0.795,0.793,0.874,and 0.787,respectively.The AUC values for the combined and five combined diagnosis of DCE-MRI parameters in the active phase of RA patients were 0.915 and 0.988,respectively.There was a statistically significant difference in TTP,EER,MER,CRP/Alb,NLR,and DAS28 scores among each group(P<0.05),with high activity TTPmoderate activity>low activity(P<0.05).Person correlation analysis showed that TTP was negatively correlated with disease activity(r=-0.403,P<0.05),while EER,MER,CRP/Alb,NLR were positively correlated with disease activity(r=0.648,0.664,0.715,0.710,P<0.05).Conclusion The quantitative parameters of DCE-MRI,CRP/Alb,and NLR have certain value in diagnosing the active phase of RA patients,and the combined diagnostic value is better,and is closely related to the degree of disease activity.