摘要
目的探讨初诊类风湿关节炎(RA)患者临床及磁共振成像(MRI)影像特征和手腕关节MRI简易评分与疾病活动度的关系。方法选取2023年1月—10月本院收治的116例初诊RA患者为研究对象,根据基于C反应蛋白的28个关节疾病活动度评分(DAS28-CRP)分为疾病低活动度组28例(DAS28-CRP<3.2)和中高活动度组88例(DAS28-CRP≥3.2)。分析患者临床及影像特征,根据两组MRI影像特征分析结果,设计RA患者手腕关节MRI简易评分。并分析其与疾病活动度的关系。结果RA患者疾病中高活动度组相较于低活动度组初诊年龄较大、病程较长、血红蛋白含量较低,类风湿因子、血小板数、超敏C反应蛋白、红细胞沉降率、白介素-6、铁蛋白含量较高,合并贫血比例更大,差异具有统计学意义(P<0.05)。初诊RA患者病程中关节疼痛最主要累及手(n=106,91.38%)、腕关节(n=64,55.17%),亦可累及肩(n=49,42.24%)、踝(n=32,27.59%)、肘(n=30,25.86%)、足(n=24,20.69%)、膝关节(n=24,20.69%)。疾病中高活动度组相比于低活动度组,肩关节受累率高,足关节受累率低,差异具有统计学意义(P<0.05);腕关节受累率可能更高,但差异无统计学意义(P=0.052)。两组在手、踝、肘、膝关节受累情况相比,差异无统计学意义(P>0.05)。疾病中高活动度组患者骨侵蚀发生率、关节腔狭窄率、每例患者受累滑膜关节数量和骨侵蚀数量均高于疾病低活动度组,差异具有统计学意义(P<0.05);软组织肿胀率较低活动度组有所升高,但差异无统计学意义(P=0.058)。MRI关节滑膜受累数量、骨侵蚀数量、关节腔狭窄及软组织肿胀情况与DAS28-CRP评分呈正相关(r=0.320、0.188、0.288、0.186,均P<0.05)。两组手腕关节MRI简易评分比较,疾病中高活动度组评分明显高于低活动度组,差异具有统计学意义(P<0.05)。手腕关节MRI简易评分与DAS28-CRP评分呈正相关(r=0.376,P<0.05)。结论结合初诊RA患者临床指标及特征,其受累关节数量、部位、骨侵蚀数、关节腔狭窄及软组织肿胀情况均与RA疾病活动度相关,关节MRI简易评分与RA疾病活动度呈正相关,有望成为RA患者疾病活动度评估指标。
Objective To explore the clinical and MRI features of newly diagnosed patients with rheumatoid arthritis(RA)and the relationship between simple MRI score of wrist joint and disease activity.Methods 116 newly diagnosed RA patients admitted to our hospital from January 2023 to October 2023 were included.According to the DAS28-CRP score,the subjects were further divided into low activity group(DAS 28<3.2)and middle activity group(DAS28≥3.2).The clinical and imaging features of patients were analyzed.According to the analysis results of MRI image features of two groups,the simple MRI score of wrist joints of RA patients was designed.Analyze the relationship between it and the activity of the disease.Results Compared with the low activity group,the high activity group of RA patients had older age at first diagnosis,longer course of disease,lower hemoglobin content,higher contents of rheumatoid factor,platelet count,high-sensitivity C-reactive protein,erythrocyte sedimentation rate,interleukin-6 and ferritin,and a larger proportion of anemia,with statistical significance(P<0.05).In the middle and high mobility group,joint pain mainly involved hands(n=106,91.38%),wrists(n=64,55.17%),shoulders(n=49,42.24%),ankles(n=32,27.59%)and elbows(n=64,55.17%).Compared with the low mobility group,the high mobility group may have a higher rate of wrist involvement,with no statistical significance(P=0.052).Compared with the low mobility group,the high mobility group had higher shoulder joint involvement rate and lower foot joint involvement rate,and the difference was statistically significant(P<0.05).There was no significant difference between the two groups in terms of hand,ankle,elbow and knee joint involvement(P>0.05).The incidence of bone erosion and the rate of joint cavity stenosis in patients with middle and high activity were higher than those in patients with low activity,and the difference was statistically significant(P<0.05).The number of synovial joints and bone erosion in each patient in the disease with high activity group were higher than those in the disease with low activity group,and the difference was statistically significant(P<0.05).The swelling rate of soft tissue in patients with high activity may be higher than that in patients with low activity,and the difference is not statistically significant(P=0.058).The number of synovial involvement,bone erosion,joint cavity stenosis and soft tissue swelling in MRI were positively correlated with DAS28 score(r=0.320,0.188,0.288,0.186,P<0.05).Comparing the simple MRI scores of wrist joints between the two groups,it was found that the score of high activity group was significantly higher than that of low activity group,and the difference was statistically significant(P<0.05).The simple MRI score of wrist joint was positively correlated with DAS28-CRP score(r=0.376,P<0.05).Conclusion Combined with the clinical indicators and characteristics of patients with RA,the number and location of affected joints,the number of bone erosion,joint cavity stenosis and soft tissue swelling are all related to the disease activity of RA,and the simple joint MRI score can reflect the disease activity of RA,which is expected to be an index for evaluating the disease activity of RA patients.
作者
邹浩
杨智
顾维杰
郑冰
龙义添
潘舒月
ZOU Hao;YANG Zhi;GU Weijie;ZHENG Bing;LONG Yitian;PAN Shuyue(Department of Rheumatology,Chengdu Fifth People's Hospital,Chengdu 611130,China;Department of Radiology,Chengdu Fifth People's Hospital,Chengdu 611130,China)
出处
《西部医学》
2025年第3期425-430,共6页
Medical Journal of West China
基金
成都市卫生健康委员会课题(2022430)。
