影像学诊断对类风湿性关节炎的诊断、治疗及预后评估  

Research of Clinical Applications on Imaging Methods in Diagnosis and Treatment to Target of RA

作　　者：薛太平[1] 

机构地区：[1]四川省射洪县人民医院放射科,四川射洪629200

出　　处：《中国CT和MRI杂志》2015年第8期105-107,共3页Chinese Journal of CT and MRI

摘　　要：目的探讨影像学诊断方法在类风湿性关节炎(RA)患者临床早期诊断、治疗及预后评估中的应用。方法回顾性分析患者的临床资料,将其按照病程的不同分为两组且均符合RA分类标准,且均已完成RA相关的自身抗体检查,完成了MRI、CT等影像学检查,对MRI的图像按照类风湿核磁共振成像评分系统(RAMRIS)进行评分,对骨代谢的增加区进行感兴趣区(ROI)分析并计算其摄取率。结果治疗12个月后,ERA组的缓解数为44例,缓解率达80.0%;RA组的缓解数为37例,缓解率达56.9%。两组患者中274块骨中检出了骨髓水肿(BME),217块骨中检出了侵蚀。单侧MRI与双侧MRI的评分线性关系较好。本次研究中14例患者的自身抗体均表现为阴性;11例患者的Ig M-RF呈阳性,其余抗体呈阴性;3例患者的抗MCV抗体呈阳性,其余抗体呈阴性;2例患者的抗CCP呈阳性;而其余抗体的阳性率均低于这三种抗体。RA组的抗体检出率普遍高于ERA组。所有关节的CT标记物的平均摄取率是(1.27±0.24)。结论 MRI、自身抗体的滴度和CT的摄取率对于评价疾病的进展具有较大的临床意义。对RA的达标治疗时,可综合临床检查、实验室指标及影像学资料分析等方法。Objective To explore the clinical applications values of imaging in diagnosis and treatment and post-clinical remission assessments of RA via imaging methods of MRI and CT. Methods 120 patients were divided into two groups. Autoantibodies examination was tested and disease activity was assessed. Imagines such as MRI and CT were performed and MRI images were scored by the RAMRIS system. Bone metabolism increased was analyzed by calculation of uptake ratio of the regional area of interest（ROI）. Results Results The RAMRIS score system and correlation with clinical disease activity and autoantibodies. 40 cases of patients tested bilateral hand MRI examination. The remaining 80 patients＇ unilateral hand was tested. Synovitis, edema, erosion score had variance among MCV titer groups. Synovitis and erosion had significant differences among CCP groups. MRI examination revealed synovitis and BME. Tc-99m-MDP（1.59±0.26） uptake increased in 82 joints, and uptake ratio was higher than normal ones（1.15±0.09）. ConclusionsMRI, autoantibody titer and CT uptake ratio were meaningful to evaluate the disease progression. An integrated assessment such as clinical examination, laboratory indicators and the imaging methods could be more helpful to the treatment and slow disease progression.

关 键 词：类风湿性关节炎 诊断 治疗 预后评估 影像学 核磁共振 CT 

分 类 号：R593.22[医药卫生—内科学]