幼年特发性关节炎MRI特征与临床指标的相关性分析  

Correlation analysis of MRI features and clinical indexes in juvenile idiopathic arthritis

作　　者：冯贺新 潘诗农[1] 李鹏飞 FENG Hexin;PAN Shinong;LI Pengfei(Department of Radiology,Shengjing Hospital Affiliated to China Medical University,Shenyang 110000,China;Department of Radiology,Affiliated Hospital of Inner Mongolia Minzu University)

机构地区：[1]中国医科大学附属盛京医院国家儿童区域医疗中心放射科,沈阳110000 [2]内蒙古民族大学附属医院放射科

出　　处：《国际医学放射学杂志》2024年第5期512-518,共7页International Journal of Medical Radiology

基　　金：辽宁省教育厅基本科研项目(LJKM20221163);内蒙古自治区直属高校基本科研项目(GXKY23Z043)。

摘　　要：目的探讨幼年特发性关节炎(JIA)患儿不同临床亚型MRI影像特征的差异,并分析影像特征与临床指标的相关性。方法回顾性收集55例JIA患儿的MRI影像及临床资料,年龄1~14岁,平均(8.1±4.1)岁。患儿分为4个临床亚型,即全身型(12例)、多关节型(17例)、少关节型(16例)、附着点相关关节炎(ERA)型(10例)。观察4型患儿的大、小关节的滑膜增生及骨髓水肿等MRI特征,并对骨髓水肿和滑膜增生进行评分。采用单因素方差分析、Welch检验或卡方检验比较4组间临床资料和影像特征的差异,采用Pearson检验或Spearman检验评估影像学评分与临床指标的相关性。结果55例患儿中,滑膜增生35例,骨髓水肿33例。4型患儿间的红细胞沉降率(ESR)、人白细胞抗原B27(HLA-B27)和足/踝关节受累的差异均有统计学意义(P<0.05)。其中,少关节型患儿足/踝关节受累比例显著高于全身型和ERA型(均P<0.05),余各临床亚型均无特定关节受累倾向。多关节型与少关节型患儿滑膜增生发生率较高,ERA患儿骨髓水肿发生率较高,全身型患儿关节通常只有关节积液(均P<0.05)。比较4种临床亚型患儿的关节评分,ERA型大关节骨髓水肿评分较高,而多关节型和少关节型的小关节骨髓水肿评分较高(均P<0.05);但滑膜增生评分的差异无统计学意义(均P>0.05)。大关节中,骨髓水肿评分与ESR、C反应蛋白(CRP)、年龄呈正相关,滑膜增生评分与年龄、症状持续时间呈正相关(均P<0.05)。小关节中,骨髓水肿评分与ESR、CRP呈正相关(均P<0.05)。结论JIA患儿的受累关节和MRI影像特征在各临床亚型间存在差异,且关节病变评分与临床指标高度相关。Objective To explore the differences in MRI features among different clinical subtypes of children with juvenile idiopathic arthritis(JIA)and to analyze the correlation between MRI features and clinical scores.Methods MRI images and clinical data from 55 children with JIA,aged 1-14 years(mean age 8.1±4.1 years),were retrospectively collected.The children were divided into four clinical subtypes:systemic(12 cases),polyarthritic(17 cases),oligoarthritic(16 cases),and enthesities-related arthritis(ERA)(10 cases).MRI features,such as synovial hyperplasia and bone marrow edema in both large and small joints,were observed,and bone marrow edema and synovial hyperplasia were scored.One-way ANOVA,Welch test or Chi-square test were used to compare clinical data and imaging features among the four groups.Pearson test or Spearman test was used to evaluate the correlation between imaging features and clinical scores.Results Among the 55 children,35 had synovial hyperplasia and 33 had bone marrow edema.There were significant differences in erythrocyte sedimentation rate(ESR),HLA-B27,and foot/ankle involvement among the four subtypes(P<0.05).The oligoarthritic subtype had a significantly higher proportion of foot/ankle involvement compared to the systemic and ERA subtypes(all P<0.05),while other clinical subtypes did not show specific joint involvement.The incidence of synovial hyperplasia was higher in polyarthritic and oligoarthritic patients,while bone marrow edema was more common in the ERA patients.The systemic patients mostly showed only joint effusion(all P<0.05).Comparison of joint scores among the four subtypes revealed that ERA patients had higher bone marrow edema scores in large joints,while polyarthritic and oligoarthritic patients had higher scores for small joints(all P<0.05).However,there was no significant difference in synovial hyperplasia scores(all P>0.05).In large joint,the scores of bone marrow edema were positively correlated with ESR,C-reaction protein(CRP),and age,and the scores of synovial hyperplasia

关 键 词：幼年特发性关节炎 磁共振成像 滑膜增生 骨髓水肿 诊断 

分 类 号：R593.22[医药卫生—内科学] R445.2[医药卫生—临床医学]