【摘要】 目的 利用MRI探讨早期类风湿性关节炎(RA)手腕关节滑膜炎及骨质侵蚀的表现与血清学检查指标的相关性。方法对经临床诊断为早期RA的30例患者的手腕关节进行MRI平扫及增强扫描,对滑膜进行评分分级,并对骨质侵蚀进行计数,同时收集患者血清学(CRP、IgA、IgG、IgM)检查结果。结果 30例患者腕关节均出现不同程度的滑膜增厚、强化。掌指关节共有7例滑膜增厚。30例患者腕关节滑膜评分为4.0～9.0(2～3级),第2～5掌指关节滑膜评分为0～8.0 (0～3级)。MRI发现21例患者手腕关节出现共48处骨质侵蚀,其中掌指关节11例11处,腕关节18例共37处。发现手、腕关节总滑膜评分分值与临床血清检查结果(CRP、IgA、IgG、IgM)相关性均有统计学意义(P均<0.05)。对手、腕关节骨质侵蚀组与骨质正常组之间的临床血清学检查结果进行统计学分析,发现CRP、IgA、IgG的差异性具有统计学意义(P<0.05),而IgM的差异性没有统计学意义(P>0.05)。结论 MRI能清楚显示早期RA手腕部关节的滑膜炎及骨质改变,,可以利用MRI对早期RA的滑膜炎进行半定量化分级评分。早期RA的病理改变严重程度可以通过血清学检测CRP、IgA、IgG反映出来,且呈正相关,这为早期RA的诊断及活跃程度的深入研究提供了新的方法。更多还原

【Abstract】 Objective To observe the synovitis change and bone erosion of the early rheumatoid arthritis(RA) of the hand and wrist,and to explore the correlation between MRI imaging and serological testing index.Methods MR routine scan and enhanced scan of the hand and wrist were performed in 30 patients with clinically diagnosed early RA.Graded and scored synovitis on MRI,calculated the bone erosions on hand and wrist.At the same time,serology examinations including CRP,IgA,IgG and IgM were obtained.Results All the patients’ synovium in wrist joint and seven patients’ synovium in metacarpophalangeals(MCP) thickened and enhanced in varying degrees.Scored from 4.0 to 9.0(from two to three grade)of wrist and 0.0 to 8.0(from zero to three grade)of MCP.MRI found out that 21 patients 48 parts had bone erosion,including eleven in eleven patients ’ MCP,and thirty-seven in eighteen patients’ wrist joints.And the correlation between the scores of synovium in hand and wrist and the serological testing index in clinic(CRP,IgA,IgG,IgM) presented statistical significance(P<0.05).When took the statistical analysis to the serological testing in bone erosion group and the normal group,the results justified that the divergence of CRP,IgA,IgG showed statistical significance(P<0.05).But the divergence between IgM meant no statistical significance(P>0.05).Conclusion MRI can reveal synovitis and bone erosion of the hand and wrist with early RA.And can do semi-quantitive grade to early RA.The pathological changes extent of early RA can be reflected by the serological testing index,and are positive related.,which can provide a new method to do further diagnosis and research of its motion level of early RA.更多还原