侵蚀性手骨关节炎的临床及影像学特征分析  

The clinical and radiographic characteristics of erosive hand osteoarthritis

作　　者：张晓盈[1] 郅新 穆荣[1] 任立敏[1] 吴楠[2] 杨月[1] 周云杉[1] 姚海红[1] 洪楠[2] 栗占国[1] Zhang Xiaoying Zhi Xin Mu Rong Ren Limin Wu Nan Yang Yue Zhou Yunshan Yao Haihong Hong Nan Li Zhanguo(Department of Rheumatology, People ＇s Hospital of Peking University, Beijing 100044, China)

机构地区：[1]北京大学人民医院风湿免疫科,100044 [2]北京大学人民医院放射科,100044

出　　处：《中华风湿病学杂志》2017年第7期455-460,I0002,共7页Chinese Journal of Rheumatology

摘　　要：目的通过对侵蚀性手骨关节炎（EOA）患者进行影像学评估以及关节功能评价，研究其影像学、血清学以及临床特征，以提高对该疾病的认识。方法调查我院就诊的312例手骨关节炎（HOa）患者，依据国际常用诊断标准定义EOA患者共19例，记录患者临床资料相关信息，应用澳大利亚/加拿大HOA评分指数（AUSCAN）、HOA功能指数（FIHOA）量表评估关节功能，采用Kellgren-Lawrence（K-L）分级以及针对关节侵蚀性病变的Verbruggen-Veys系统进行影像学评价。按1：4比例随机选取76例非EOA的HOA患者作为对照组。所有数据采用SPSS23．0软件进行统计学处理，采用t检验、Mann-WhitnevU检验，χ2检验、Fisher检验以及Spearman相关性分析对数据进行分析。结果EOA患者占HOA患者比例为6．1％（19／312），其中大多数为女性（18／19），平均发病年龄（56±8）岁，病程56（12～120）个月。19例EOA患者中共39个关节出现中心性骨侵蚀表现，31％（12／39）表现软骨下骨侵蚀，69％（27／39）表现为软骨下骨重塑，其中18％（7／39）呈特征性EOA的“鸥翼”样改变。87％（34／39）的EOA患者为远端指间关节受累。所有EOA患者均存在关节功能受损，且病程长于对照组（Z=2．610，P=0．009）。与对照组相比，EOA患者具有AUSCAN总分（28±6与21±7，t=3．781，P〈0．01）、功能评分（18±6与12±6，t=4．042，P〈0．01）增加的特点。EOA患者K-L（0-80）评分高于对照组（44±11与26±7，t=7．134，P〈0．01）。除39个侵蚀关节外，EOA患者其他关节增生、关节间隙狭窄表现重于对照组（χ2=149．895，P〈0．01）。EOA患者ESR及CRP与对照组相比差异无统计学意义。结论EOA患者典型影像学表现为远端指间关节的中心性骨侵蚀，伴有软骨下骨侵蚀和（或）软骨下骨重塑，特征性表现为“鸥翼”样改变。除关节侵蚀表现外，关节增生、间隙�Objective To evaluate the clinical and radiographic characteristics and fimction of erosive hand osteoarthritis （EOA） patients. Methods Data were obtained from 19 patients with EOA, including their social conditions, clinical conditions, radiographic scores and hand function evaluation. The number of hand osteoarthritis （HOA） patients was 312. The control group consisted of non-EOA patients with hand osteoarthritis with a ratio of 4：1 to EOA patients. A non-parameter test analysis was performed. All data were analyzed by SPSS 23.0 statistical analysis, t test,χ2 test, Fisher exact probility and Spearman＇s correlations analysis were used for statistical analysis. Results Totally data of 19 patients were collected. Eighteen were female. Onset age was （56±8）. Average duration was 56 （12-120） months. FIHOA scores of all the EOA patients were at least 5. All the erosions of 39 joints were characteristically central and erosive changes in 7 joints （18%） showed up as ＂gull-wing＂. Among 39 erosive joints, including 12 （31%） E and 27 （69%） R, 34 （87%） distal interphalangeal joints were involved. Data analysis found out that EOA patients had longer disease duration （Z=2.610, P=0.009）, more severe K-L level （44±11 vs 26±7, t=7.134, P〈0.01）, higher AUSCAN total score （28±6 vs 21±7, t=3.781, P〈0.01） and higher AUSCAN function score （18±6 vs 12±6, t=4.042, P〈0.01）. The differences of ESR and CRP were not significant between EOA and non-EOA patients. Conclusion Erosions seen in EOA patients are centrally located ＂gull-wing＂ in the DIP joints. EOA patients have longer duration, more severe radiographic damage and worse joint function.

关 键 词：骨关节炎 手骨 影像学 现况调查 

分 类 号：R684.3[医药卫生—骨科学]