目的：比较寒湿痹阻及湿热痹阻型类风湿性关节炎（Rheumatoid arthritis，RA）的腕关节在MRI上表现的差异，为RA的中医辨证提供较为客观的依据。方法：收集70例辨证属寒湿痹阻型或湿热痹阻型RA的患者，并分为早期组（病程≤24月）及中晚期组（病程>24月），以MRI检查观察腕关节的滑膜增厚、血管翳强化、骨侵蚀、骨髓水肿、关节积液及腱鞘炎的发现情况，并进行比较。结果：湿热痹阻型RA早期组血管翳强化及骨侵蚀的发生率较寒湿痹阻型早期组显著增高（P均<0.01），而滑膜增厚、骨髓水肿、关节积液及腱鞘炎的发生率间的差异无统计学意义（P均>0.05）；寒湿痹阻型及湿热痹阻型RA中晚期组滑膜增厚、血管翳强化、骨侵蚀、骨髓水肿、关节积液及腱鞘炎的发生率间的差异均无统计学意义（P均>0.05）。寒湿痹阻型及湿热痹阻型RA早期组及中晚期组上述指标间比较均无统计学差异（P均>0.05）。结论：MRI检查RA早期患者腕关节的血管翳及骨侵蚀在一定程度上可以为中医辨证寒湿痹阻型及湿热痹阻型RA提供参考依据。
Abstract
Objective: To compare the differences of wrist joint magnetic resonance imaging(MRI) manifestations of rheumatoid arthritis(RA) with syndrome of stagnation of damp-heat and RA with syndrome of stagnation of cold-damp, so as to provide objective basis for TCM syndrome differentiation of rheumatoid arthritis. Methods: Seventy cases of RA patients with syndrome of stagnation of damp-heat or syndrome of stagnation of cold-damp were collected, both two group patients were seperately divided into early stage group(≤24 months) and middle-late group(>24 months). MRI was applied to detect and compare the changes of MRI feathers, such as polyarticular synovial hyperplasia, pannus enhancement, bone erosion, bone marrow edema, joint effusion and tenosynovitis． Results: The occurrence of pannus enhancement and bone erosion were significantly higher in early stage of hot syndrome than that in early stage of cold syndrome(both P<0.01)． While, there was no statistical difference in the incidence of polyarticular synovial hyperplasia and bone marrow edema, joint effusion and tenosynovitis between the two groups(all P>0.05)． There was no statistical difference in the incidence of polyarticular synovial hyperplasia and pannus enhancement, bone erosion and bone marrow edema, joint effusion and tenosynovitis between the two groups in middle-late stage(all P>0.05)． There was no statistical difference in the above indexes between the early stage and middle-late stage of those two syndrome of RA(all P>0.05)． Conclusion: MRI features changes such as pannus enhancement and bone erosion on wrist in the early stage of RA can provide references for differentiation of stagnation of damp-heat and stagnation of cold-damp in Chinese medical syndrome．
关键词
关节炎 /
类风湿 /
腕关节 /
磁共振成像
Key words
Arthritis, rheumatoid /
Wrist joint /
Magnetic resonance imaging
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参考文献
[1]郑筱萸． 中药新药临床研究指导原则（试行）[S]． 北京：中国医药科技出版社，2002：115-117．
[2]Peterfy CG. MRI of the wrist in early rheumatoid arthritis[J]． Ann Rheum Dis, 2004, 63(5): 473-477．
[3]McQueen FM, Stewart N, Crabbe J, et al. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement[J]. Ann Rheum Dis, 1999, 58(3): 156-163．
[4]McQueen FM, Stewart N, Crabbe J, et al. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals a high prevalence of erosions at four months after symptom onset[J]． Ann Rheum Dis, 1998, 57(6): 350-356．
[5]侯雷，马武开． 类风湿关节炎中医证候分类临床文献研究[J]. 中国中西医结合杂志，2014，34（3）：279-283．
[6]任丽香，吴昆华，张虹，等． MRI定性定量分析类风湿关节炎患者手腕部骨关节改变[J]. 中国介入影像与治疗学，2017，14（10）：632-635.
[7]Scott DL． The diagnosis and prognosis of early arthritis: rationale for new prognostic criteria[J]． Arthritis Rheum, 2002, 46(2): 286-290．
[8]李河北，杜湘珂，贾园，等． 手及腕关节MRI对类风湿性关节炎的早期诊断价值[J]. 中华放射学杂志，2004，38（4）：360-364．
[9]贾园，李河北，栗占国． 磁共振成像在类风湿关节炎早期诊断中的价值[J]. 中国药物与临床，2006，6（6）：429-432．
[10]Stewart NR, McQueen FM, Crabbe JP． Magnetic resonance imaging of the wrist in early rheumatoid arthritis: a pictorial essay[J]. Australas Radiol, 2001, 45(3): 268-273．
[11]郭玲，安娜，唐先平，等． 类风湿性关节炎膝关节病变的超声改变与中医辨证分型的相关性研究[J]. 中国中医药信息杂志，2010，17（11）：17-19．
[12]马俊福，侯秀娟． 肌肉骨骼超声表现与活动期类风湿关节炎湿热痹阻及寒湿痹阻证型的相关性研究[J]. 中华中医药杂志，2016，31（1）：244-247．
[13]王志中，方勇飞，罗彦，等． 322例湿热痹阻型及寒湿痹阻型类风湿关节炎中医证型的客观化研究[J]. 中国中西医结合杂志，2011，31（4）：466-470．
[14]孙红梅，潘颂华，岳涛，等． 磁共振成像在类风湿性腕关节炎早期诊断中的价值[J]. 上海医学影像，2011，20（1）：32-35．
[15]王艳艳，冯阳，梅焕平，等． 磁共振在早期类风湿关节炎诊断中的价值[J]. 中国现代医学杂志，2009，19（23）：3610．
[16]张建新，李俊峰，王峻，等． MRI对早期类风湿性关节炎手、腕部关节的诊断价值[J]. 中国医学影像技术，2007，23（5）：731-736．
[17]刘秀华，余永强，钱银锋，等． 90例腕关节类风湿关节炎的MRI诊断分析[J]. 重庆医学，2014，43（15）：1929-1931．
[18]Troum OM, Pimienta O, Olech E． Magnetic resonance imaging applications in early rheumatoid arthritis diagnosis and management[J]． Rheum Dis Clin North Am, 2012, 38(2): 277-297．
基金
中国中医科学院自主选题研究项目（Z20908012）。
