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目的探讨双手MRI在早期RA的诊断及骨与关节损伤中的价值。方法收集2011年1月—2014年10月安徽医科大学第一附属医院风湿科门诊及住院的111例早期RA(≤1年)患者的资料,记录患者临床及实验室指标,测定其股骨和腰椎部位BMD;所有患者行双手X线检查并行Sharp评分,其中37例患者行双手MRI检查并计算相关项目积分。结果 (1)X线及MRI的表现:X线分期结果提示:Ⅰ期73.87%,Ⅱ期26.13%,所有患者Sharp评分都在10分以下;其中行MRI的结果显示:骨侵蚀33例、滑膜炎31例、骨髓水肿21例、肌腱炎11例,4项指标中任一项阳性者有36例。(2)MRI各指标间的相关分析显示:骨髓水肿、滑膜炎分别与肌腱炎均呈正直线相关(P<0.05)。(3)MRI与各临床指标、BMD及Sharp评分间的相关性分析显示:MRI骨侵蚀评分与Sharp评分呈正直线相关(P<0.05);与大转子(P<0.05)和总股骨区(P<0.05)BMD呈负相关,MRI肌腱炎评分与CRP(P<0.05)、关节肿胀数(P<0.05)、关节压痛数(P<0.05)呈正直线相关。结论 MRI在早期RA中显示出更高于X线改变的阳性率,具有较好的诊断价值,且与BMD及Sharp评分具有相关性;MRI上肌腱炎的表现可能具有一定的诊断价值。
Objective To explore the value of two-hand MRI in the diagnosis of early RA and the bone and joint damage. Methods The data of 111 patients with early RA (≤ 1 year) from outpatients and hospitalizations of rheumatology department of the First Affiliated Hospital of Anhui Medical University from January 2011 to October 2014 were collected. The clinical and laboratory parameters of the patients were recorded and their femur and lumbar spine were measured Site BMD; all patients underwent X-ray examination of both hands parallel Sharp score, of which 37 patients underwent MRI examination of both hands and calculate the relevant project points. Results (1) X-ray and MRI findings: X-ray staging showed that 73.87% of the patients in stage Ⅰ and 26.13% of patients in stage Ⅱ had Sharp scores of less than 10 points in all cases. Among them, MRI showed 33 cases of bone erosion, There were 31 cases of membranous inflammation, 21 cases of bone marrow edema and 11 cases of tendinitis. There were 36 cases of any of the 4 indicators. (2) Correlation analysis of MRI indexes showed that there was a positive correlation between bone marrow edema and synovitis and tendonitis (P <0.05). (3) The correlation between MRI and each clinical index, BMD and Sharp score showed that there was a positive correlation between MRI score and Sharp score (P <0.05) (P <0.05). There was a positive correlation between MRI tendonitis score and CRP (P <0.05), joint swelling (P <0.05) and joint tenderness (P <0.05) Conclusion MRI showed a higher positive rate in early RA than X-ray, which has a good diagnostic value and is related to BMD and Sharp score. The performance of tendonitis on MRI may have some diagnostic value.