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目的 探讨核素骨关节显像对早期和活动期类风湿关节炎 (RA)诊断价值。方法 对 31例确诊为RA患者进行99mTC -羟基亚甲基二磷酸 (MDP)全身骨关节显像检查 ,全部RA患者根据关节疼痛部位摄X线平片 ,同时进行血沉 (ESR)、血清C反应蛋白 (CRP)、类风湿因子 (RF)滴度、关节压痛指数 (JTI)、关节肿胀指数 (JSI)测定。结果 31例RA患者骨显像阳性 2 9例 ,诊断符合率 93 5 %,而非RA关节炎 (AS和OA)组和正常人组核素骨关节显像率分别为 80 0 %和 10 5 %;在 2 2 6个有临床表现的关节中 ,核素显像阳性是 2 0 1个 ,总符合率为88 9%;在 2 0例早期RA(≤ 2年 )中 ,核素骨关节显像率 95 0 %,X线片RA改变符合率 2 0 0 %;病变关节摄取示踪剂程度与JTI、JSI、ESR、CRP呈正相关 (r为 0 4 5～ 0 5 2 ,P <0 0 5 )。结论 99mTC骨关节显像为骨关节无创伤性、功能性、灵敏度高但特异性不强的检查方法 ,结合临床症状、体征及血清免疫学改变 ,对提高早期和活动期RA的诊断及评估有帮助。
Objective To investigate the diagnostic value of radionuclide joint imaging in the early and active rheumatoid arthritis (RA). Methods Thirty-one patients with RA were examined by 99mTC-MDP. All RA patients underwent radiographic plain radiographs of joint pain and ESR, serum C-reactive protein (CRP), rheumatoid factor (RF) titers, joint tenderness index (JTI) and joint swelling index (JSI). Results In 31 RA patients, 29 cases were positive for bone imaging with a diagnostic coincidence rate of 93.5%. The rates of radionuclide joint imaging in RA and non-RA groups were 80% and 105% %. In 226 clinical manifestations, the number of radionuclide imaging was 201, with a total coincidence rate of 88.9%. In 20 early RA patients (≤2 years), radionuclide joint The imaging rate was 95 0%, and the radiographic change of RA was 200%. The level of tracer of pathological joint uptake was positively correlated with JTI, JSI, ESR and CRP (r = 0 45 ~ 0 5 2, P 0 0 5). Conclusion 99mTC bone and joint imaging is noninvasive, functional, sensitive and specific but not specific. Combined with clinical symptoms, signs and serum immunological changes, it is helpful to improve the diagnosis and evaluation of early and active RA help.