血清RANKL、OPG联合MRI在早期RA诊断与骨关节损伤中的价值  

Serum of RANKL and OPG combined with MRI in diagnosis of early rheumatoid arthritis and bone joint injury

作　　者：彭丽萍[1] 徐胜前[1] 齐姗[1] 吴颖[1] 刘文[1] 肖会[1] 徐建华[1] 

机构地区：[1]安徽医科大学第一附属医院风湿免疫科,合肥230022

出　　处：《安徽医科大学学报》2016年第2期272-276,共5页Acta Universitatis Medicinalis Anhui

基　　金：安徽省自然科学基金(编号:1308085MH163);国家自然科学青年基金(编号:81302587)

摘　　要：目的探讨血清核因子-κB受体活化因子配体(RANKL)和护骨素(OPG)水平联合MRI在早期类风湿关节炎(RA)诊断和骨关节损伤中的价值。方法收集RA患者232例,其中早期RA(病程≤1年)111例,非早期RA(病程>1年)121例,选择121例正常人为对照组。详细记录RA患者各临床及实验室指标,采用双能X线骨密度仪测定其股骨区和腰椎部位的骨密度(BMD)。所有RA患者摄双手X线并进行Sharp评分,早期RA患者行双手MRI检查并进行RAMRIS积分。采用ELISA法检测RA患者和正常人外周血RANKL、OPG水平。结果 1对照组、早期RA组、非早期RA组血清OPG、RANKL水平差异有统计学意义(P<0.05);2对照组、早期RA组、非早期RA组在股骨区和腰椎的BMD差异有统计学意义(P<0.000 1),3组骨质疏松的发生率分别为13.92%、23.39%、35.69%(χ2=42.137,P<0.000 1)。3早期RA患者MRI上骨侵蚀、骨髓水肿、滑膜炎、肌腱炎的阳性率分别为89.19%、56.76%、83.78%、29.73%;MRI各指标之间相关分析显示:肌腱炎与骨髓水肿(r=0.391,P<0.05)、滑膜炎(r=0.330,P<0.05)呈正相关。4早期RA组MRI各指标与OPG、RANKL、RANKL/OPG比值间无相关性;早期RA组MRI骨侵蚀评分与大转子和总股骨区的BMD呈负相关(P<0.05),与Sharp评分呈正相关(P<0.05);MRI肌腱炎评分与关节肿胀数、关节压痛数、C反应蛋白(CRP)呈正相关(P<0.05)。5血清OPG水平与多项临床和实验室指标呈正相关(P<0.05);血清RANKL水平与各部位BMD、临床指标、Sharp评分无相关性。结论 RA中MRI的阳性率高于X线,RAMRIS评分异常在早期RA诊断中具有较好的诊断价值,单项以骨侵蚀阳性率最高,且与BMD及Sharp评分有相关性;双手MRI表现联合血清OPG、RANKL异常改变能提高早期RA的诊断率。Objective To explore the value of combined detection of serum RANKL/OPG level and MRI of both hands in the diagnosis of early rheumatoid arthritis （RA） and early evaluation of bone and joint damage in RA. Methods Two hundred and thirty-two cases of RA patients were recruited, including 111 cases of early RA （ disease duration≤1 year） and 121 cases of established RA （disease duration 〉 1 year）, and the control group contained 121 normal individuals. Bone mineral density （BMD） in the femur and lumbar spine was measured by dualenergy X-ray absorptiometry. Radiographs for two hands in all patients with RA were evaluated according to the Sharp＇ s method. MRI of hands was executed in early RA patients and RAMRIS were used to assess the change of MRI. Serum levels of RANKL and OPG in RA and beahhy controls were detected by ELISA. We kept a record of all the clinical and laboratory indexes simultaneously. Results ① The differences of serum levels of RANKL and OPG among the control group were statistically significant （P 〈 0.05 ）. ②There were significant differences about BMD at femur and lumbar spine among the control group, early group and established group （ P 〈 0. 0001 ）. Furthermore, incidences of osteoporosis among the three groups were significantly different （ 13.92% vs 23.39% vs 35.69% , X2 =42. 137, P 〈0. 000 1 ）. ③Positive rates of bone erosion, bone marrow edema, synovitis, tendinitis on MRI in early RA were 89. 19%, 56.76%, 83.78% and 29.73% respectively, while tendinitis was positively correlated with bone marrow edema （ r = 0. 391, P 〈 0. 05 ） and synovitis （ r = 0. 330, P 〈 0. 05 ）. ④Each index on MRI in patients with early RA had no any correlations with serum OPG, RANKL levels and the ratio of RANKL/ OPG. Bone erosion score of MRI scan in early RA was negatively correlated with BMD in greater trochanter, total hip （P 〈 0. 05 ） and positively correlated with sharp score （ P 〈 0.05 ）. Tendinitis score of MRI scan was positively correla

关 键 词：类风湿关节炎 核因子-ΚB受体活化因子配体 护骨素 磁共振 骨质疏松 

分 类 号：R593.22[医药卫生—内科学]