CAJ | 학술논문

目的：探讨数字化断层融合技术（DTS）在类风湿关节炎（RA）诊断中的价值，探讨DTS用于评估RA疾病严重程度、疾病活动性及预后方面的可行性，为RA临床诊断、分级、随访、疗效评估提供可靠依据。方法2013年12月至2014年12月就诊于山西医科大学第一医院30例RA患者作为试验研究组，收集和记录试验对象组的实验室检查信息及临床检查信息，包括：红细胞沉降率（ESR）、类风湿因子（RF）、抗环瓜氨酸肽抗体（Anti-CCP）浓度、肿胀关节数、压痛关节数。对试验研究组行手腕部DR、DTS检查，由三位有经验的放射科医师观察、分析和记录两种检查手段的影像学表现。结果 DTS和DR检查RA手腕部病变的特异度、敏感度分别为90.0%、76.7%和96.7%、53.3%，DTS灵敏度显著高于DR，特异度略低于DR。其ROC曲线下面积分别为0.833、0.683，Z检验P＜0.05，DTS诊断效率高于DR。将手腕部分为4个关节组，各关节组关节间隙变窄、骨侵蚀检出率DTS明显高于DR，掌指关节组的检出率差异无统计学意义（P＞0.05），指间关节组、桡腕关节组、腕骨间关节组均有统计学差异（均P＜0.05）。RA患者DTS骨侵蚀评分与活动性评分、Anti-CCP及RF均有正相关性（r值分别为0.565、0.799、0.432），相关系数检验均有统计学差异（均P＜0.05）。结论对于RA手腕部骨质改变，DTS可以察觉DR没能检查的骨改变，DTS发现骨质改变的灵敏度显著高于DR。在手腕各关节组部位DTS对于骨质改变的检出能力均高于DR，诊断效率的曲线下面积高于DR。DTS上骨侵蚀评分与反映RA疾病活动性各指标均有显著相关性。DTS检查技术可以作为RA的临床诊断手段，为RA疾病程度的评估、诊断、鉴别诊断、疗效观察提供可靠依据。
목적：탐토수자화단층융합기술（DTS）재류풍습관절염（RA）진단중적개치，탐토DTS용우평고RA질병엄중정도、질병활동성급예후방면적가행성，위RA림상진단、분급、수방、료효평고제공가고의거。방법2013년12월지2014년12월취진우산서의과대학제일의원30례RA환자작위시험연구조，수집화기록시험대상조적실험실검사신식급림상검사신식，포괄：홍세포침강솔（ESR）、류풍습인자（RF）、항배과안산태항체（Anti-CCP）농도、종창관절수、압통관절수。대시험연구조행수완부DR、DTS검사，유삼위유경험적방사과의사관찰、분석화기록량충검사수단적영상학표현。결과 DTS화DR검사RA수완부병변적특이도、민감도분별위90.0%、76.7%화96.7%、53.3%，DTS령민도현저고우DR，특이도략저우DR。기ROC곡선하면적분별위0.833、0.683，Z검험P＜0.05，DTS진단효솔고우DR。장수완부분위4개관절조，각관절조관절간극변착、골침식검출솔DTS명현고우DR，장지관절조적검출솔차이무통계학의의（P＞0.05），지간관절조、뇨완관절조、완골간관절조균유통계학차이（균P＜0.05）。RA환자DTS골침식평분여활동성평분、Anti-CCP급RF균유정상관성（r치분별위0.565、0.799、0.432），상관계수검험균유통계학차이（균P＜0.05）。결론대우RA수완부골질개변，DTS가이찰각DR몰능검사적골개변，DTS발현골질개변적령민도현저고우DR。재수완각관절조부위DTS대우골질개변적검출능력균고우DR，진단효솔적곡선하면적고우DR。DTS상골침식평분여반영RA질병활동성각지표균유현저상관성。DTS검사기술가이작위RA적림상진단수단，위RA질병정도적평고、진단、감별진단、료효관찰제공가고의거。
ObjectiveTo study the diagnosis value of DTS in the RA patients and evaluate the RA disease severity, disease activity and feasibility of prognosis with DTS, to provide a reliable basis for early RA clinical diagnosis, classification, follow-up and evaluation of curative effect.Methods 30 cases of RA patients as study group, and 15 cases of non-RA patients as the control group, from December 2013 to December 2014 in the hospital of Shanxi Medical University, were studied. The result of laboratory information and clinical examination of the study group, including: serum concentration of ESR, RF, Anti-CCP; the number of swelling of the joints, tender joints, were recorded. 45 subjects (30 cases of RA patients and 15 cases of non-RA patients) respectively examined hand-wrist DR and DTS, and then three experienced radiologists observed, analyzed and recorded the imaging manifestations.Results The sensitivity and specificity hand-wrist lesions of the RA patients with DTS and DR respectively was 90.0%, 76.7% and 96.7%, 96.7% detecting, the sensitivity of DTS was significantly higher than the DR.Z-test was P<0.05, the area under the curve of two kinds of examination respectively were 0.683, 0.833. The hand-wrist were divided into four joint group, including radiocarpal joint, wrist joint, metacarpophalangeal joint and proximal interphalangeal joint. DR and DTS for radiocarpal joint, wrist joint group, group of the proximal interphalangeal (PIP) detection rate of joint space narrowing, bone erosion had obvious difference (P<0.05), detection rate for metacarpophalangeal joint groups had not difference between the DR and DTS (P>0.05). Score of bone erosion with DAS28-3 scores, Anti-PCC and RF were positively correlated in 30 RA patients (P<0.05),r=0.565, 0.799, 0.432.Conclusions DTS can detect bone lesion that DR failed to check the change for RA hand-wrist bone lesion, the sensitivity of DTS detecting bone lesion is significantly higher than the DR, and the area under the curve of the diagnosis efficiency is higher than the DR. DTS has a significant correlation in regard to RA disease activity index. DTS examination can be used as a means of clinical diagnosis of RA, with RA disease degree of assessment, diagnosis, differential diagnosis, curative effect observation to provide reliable basis.