动态增强磁共振滑膜最大强化斜率对手未分化性关节炎转归的预测价值  

Predictive value of dynamic enhanced MR synovial wash in rate in progression to rheumatoid arthritis in patients with undifferentiated arthritis

作　　者：李会侠[1] 屈瑾[1] 展影[1] 雷新玮[1] 

机构地区：[1]天津市第一中心医院放射科,300193

出　　处：《中华医学杂志》2016年第41期3315-3318,共4页National Medical Journal of China

基　　金：天津市卫生计生委科技基金（14KG102）

摘　　要：目的探讨动态增强磁共振（MR）滑膜的最大强化斜率（WASHIN）对手未分化性关节炎（uA）向类风湿性关节炎（RA）转归的预测价值。方法对2014年10月至2016年1月天津市第一中心医院风湿免疫科33例UA患者的手动态增强MR滑膜WASHIN与C一反应蛋白（CRP）资料进行回顾分析，观察两项指标相关性；按CRP〉8mg／L者为CRP阳性组（18例），CRP≤8mg／L者为CRP阴性组（15例）分为两组，两组滑膜WASHIN行秩和检验；用受试者工作特征（ROC）曲线下面积（AUC）评价滑膜WASHIN的诊断价值。结果33例UA患者，滑膜WASHIN与CRP行相关性分析，r=0．767，P〈0．01，呈正相关；阳性组滑膜WASHIN（49．51±19．79）／s与阴性组滑膜WASHIN（19．90±14．51）／s比较，差异有统计学意义（P〈0．01）；随访中临床确诊RA9例，其中8例为CRP阳性组，1例为CRP阴性组；滑膜WASHIN的ROC曲线下面积为0．944，最大Youden指数为0．85，敏感度为100．0％，特异度为87．5％。随访中临床确诊骨性关节病2例，滑膜WASHIN分别为18．42、21．48／s。结论滑膜WASHIN对预测uA向RA转归具有很高的临床价值，对临床早期诊断、早期治疗有重要指导意义。Objective To investigate the predictive value of dynamic enhanced MR synovial wash in rate （WASHIN） in progression to rheumatoid arthritis （RA） in patients with undifferentiated arthritis （UA）. Methods The data of dynamic enhanced MR synovial WASHIN and C- reactive protein （CRP） of 33 patients with UA were analyzed between October 2014 and January 2016 from Tianjin First Center Hospital, so as to evaluate the correlation between the two indicators. According to the value of CRP, the patients were divided into two groups, the CRP 〉 8 mg/L for CRP positive group （ 18 cases）, CRP ≤8 mg/L for CRP negative group （ 15 cases ）. Ranked sum test was used to compare the difference of WASHIN between two groups. The ROC curve analysis was carried out to test the diagnostic power of WASHIN. Results In 33 patients with UA, the correlation between WASHIN and CRP was positive, r = 0. 767, P 〈 0. 01 ; as for the WASHIN, there was significant difference between CRP positive group （49. 51 ± 19. 79 ）/s and CRP negative group（ 19.90 ± 14. 51 ）/s （P 〈0. 01 ）. 9 cases were clinically diagnosed with RA during follow-up, of which 8 cases for CRP positive group and 1 case for CRP negative group. The biggest area under the ROC curve of synovial WASHIN was 0. 944, the biggest Youden index was 0. 85, sensitivity was 100. 0%, specificity was 87. 5%. 2 cases were clinically diagnosed with osteoarthrosis during follow-up, synovial WASHIN respectively of 18.42 and 21.48 /s. Conclusion Synovial WASHIN can improve the sensitivity and specificity to predict the prognosis from UA to RA, and can provide certain guiding significance for clinical work.

关 键 词：关节炎 类风湿 C反应蛋白质 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R593.22[医药卫生—诊断学]