摘要
目的探讨腕部磁共振成像(MRI)表现及实验室指标对早期类风湿关节炎(RA)的诊断价值。方法选择2016年3月至2019年10月在中国中医科学院望京医院风湿免疫科就诊的87例拟诊RA患者为研究对象,所有患者均进行腕部MRI及实验室检查,分析诊断RA的主要MRI征象(骨侵蚀、滑膜增厚、血管翳强化、骨髓水肿、关节积液、腱鞘炎)以及实验室指标[红细胞沉降率、类风湿因子(RF)、C反应蛋白]的灵敏度、特异度及其诊断符合率。分别选择灵敏性及特异性较高的实验室指标和MRI征象,采用并联试验进行联合检测。结果87例患者得到明确诊断者81例,其中符合RA诊断标准者74例,非RA者7例。MRI征象中血管翳强化和滑膜增厚诊断RA的灵敏性和特异性最高,血管翳强化诊断RA的灵敏度及特异度分别为97.3%、85.7%,滑膜增厚对于诊断RA的灵敏度和特异度分别为95.9%、71.4%。实验室指标中,RF阳性诊断RA的灵敏度、特异度相对较高,分别为79.7%、71.4%。RF阳性联合滑膜增厚较RF阳性、滑膜增厚单独检测诊断RA的特异度高(83.3%比71.4%、71.4%);RF阳性联合血管翳强化较RF阳性、滑膜增厚单独检测诊断RA的灵敏度、诊断符合率高(98.3%比79.7%、95.9%;97.0%比72.8%、96.3%)。结论血管翳强化和滑膜增厚等MRI征象对早期RA的诊断具有重要价值,与RF阳性联合检测可以作为诊断早期RA的重要参考指标。
Objective To explore the diagnostic value of wrist magnetic resonance imaging(MRI)and laboratory indexes for early rheumatoid arthritis(RA).Methods From Mar.2016 to Oct.2019,87 patients suspected with RA in the Department of Rheumatology and Immunology of Wangjing Hospital,Chinese Academy of Traditional Chinese Medicine were included in the study.All of the patients underwent wrist MRI and laboratory examination.The sensitivity,specificity and diagnostic coincidence rate of main MRI signs(bone erosion,synovium thickening,pannus strengthening,bone marrow edema,joint effusion,tenosynovitis)and laboratory indicators[erythrocyte sedimentation rate,rheumatic factor(RF)and C-reactive protein]of RA were analyzed.The sensitive and specific laboratory indexes and MRI signs were selected and tested by parallel test.Results There were 81 patients out of the 87 patients obtaining definite diagnosis,including 74 patients with RA and 7 patients without RA.The sensitivity and specificity of pannus enhancement and synovium thickening were 97.3%,85.7%and 95.9%,71.4%respectively,which were the highest among MRI signs.The sensitivity and specificity of RF positive RA were 79.7%and 71.4%,respectively,which were higher among the laboratory indicators.The specificity of RF positive combined with synovial thickening was higher than that of each alone(83.3%vs 71.4%,71.4%);the sensitivity and coincidence rate of RF positive combined with pannus enhancement were higher than those of RF positive or synovium thickening alone(98.3%vs 79.7%,95.9%;97.0%vs 72.8%,96.3%).Conclusion MRI features such as pannus enhancement and synovium thickening are of great value in the diagnosis of early RA,and combined detection with RF positive can be used as an important reference index in the diagnosis of early RA.
作者
孙轶
闫威
张伟
耿进朝
李光宇
SUN Yi;YAN Wei;ZHANG Wei;GENG Jinchao;LI Guangyu(Department of Radiology,Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100102,China;Department of Rheumatology and Immunology,Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100102,China)
出处
《医学综述》
2020年第17期3516-3521,共6页
Medical Recapitulate
关键词
类风湿关节炎
磁共振成像
类风湿因子
联合检测
Rheumatoid arthritis
Magnetic resonance imaging
Rheumatoid factor
Combined detection
