利用van der Heijde评分对类风湿关节炎双手的 X线表现分析  

X-ray analysis of rheumatoid arthritis of the hands with van der heijde score

作　　者：林志谦[1] 许建荣[1] 刘晓晟[1] 华佳[1] 张科蓓[1] 李磊[1] 

机构地区：[1]上海交通大学医学院附属仁济医院放射科,上海200127

出　　处：《实用放射学杂志》2012年第8期1238-1240,1257,共4页Journal of Practical Radiology

基　　金：国家自然科学基金资助项目（81171325）;上海市重点学科建设项目（S30203）;上海交通大学医学院重点学科建设项目;上海市科委医学引导项目（114119a0900）.

摘　　要：利用van der Heijde评分来分析类风湿关节炎（RA）患者的双手X线表现特点和预后情况。方法 回顾分析139例经临床证实的RA患者的双手X线正位平片资料,选用van der Heijde评分来对治疗前后的RA病情严重程度进行量化评分,并对其进行统计学分析。结果 RA右手侵蚀情况较左手明显,双手侵蚀评分间有统计学差异（P=0.0327〈0.05）,而两手关节狭窄情况差异不大（P=0.08）。RA患者腕关节侵蚀性改变最严重,其次是近侧指间关节,掌指关节及第1掌骨近端侵蚀性改变最轻。近侧指间关节间隙狭窄最严重,腕关节间隙狭窄程度紧随其后,而掌指关节间隙狭窄最轻。治疗前后RA侵蚀评分均值分别为36.65和35.57,治疗前后RA侵蚀评分间无明显差异（P=0.0586〉0.05）。治疗前后RA狭窄评分均值分别为33.40和34.12,治疗前后RA狭窄评分间有统计学差异（P=0.0276〈0.05）。说明治疗后双手侵蚀改变好转不够明显,而狭窄情况则有加重趋势。治疗前RA患者的van der Heijde评分值为70.05,治疗前后van der Heijde评分差值为0.36,两者间有显著相关性（r=0.3226;P=0.0001〈0.05）。说明治疗前RA患者的van der Heijde评分值越高,治疗后的好转程度就更大。结论 通过van der Heijde评分能分析RA双手X线表现特点,并提示治疗后可以有所好转。Objective To observe the X-ray findings of rheumatoid arthritis （RA） of the hands with van der Heijde score. Methods X ray data of the hands in 139 patients with RA were analysed with van der Heijde score before and after treatment. Results In RA, the bony corrosion in left hand was serious eontrat to right hand, there were significant differences of van der Heijde scores between bilateral hands（P= 0. 0327〈0.05）, but no significant difference of van der Heijde score in stenosis of the joints could be seen between bilateral hands（P= 0.08）. The most severity of bony corrosion consisted in wrist, and the most severity of joint stenosis＂ consisted in proximal interphalangeal joint. There was no significant difference of van der Heijde score in bony corrosion before and after therapy （36.65 and 35.57,P=0. 058}, but significant difference of van der Heijde score in joint stenosis existed before and after therapy（P=0. 027 6〈0. 05 ）. The stenosis of the joint was more serious after therapy. The mean van der Heijde score before therapy was 70.05, and the mean different value of van der Heijde score before and after therapy was 0.36, there was correlation be . tween them（r=0. 322 6,P =0. 000 1〈0.05）. Conclusion Analysis of X-ray findings of hands in RA with van der Heijde score is useful for evaluation of prognosis of this disease.

关 键 词：X线摄影 手 VAN der Heijde评分 类风湿关节炎 

分 类 号：R814.41[医药卫生—影像医学与核医学] R593.22[医药卫生—放射医学]