全膝关节磁共振成像积分对膝骨关节炎诊断价值的探讨

摘要

目的:探讨全膝关节磁共振成像积分(WORMS)对膝骨关节炎(KOA)患者的诊断价值.方法:回顾性分析2009年11月至2011年1月门诊及住院KOA伴膝关节积液患者70例,男12例,女58例；年龄46～75岁,平均(59.66±9.93)岁.用WOMAC量表进行临床症状评估,用K-L分级及全膝关节磁共振成像积分(WORMS)进行放射学评估,同时应用ELISA法检测患者关节液中COMP及CTX-Ⅱ的浓度.并对上述指标进行相关性分析及多重线性回归分析.结果:WOMAC评分及WORMS分别为(57.50±8.20)和(64.54±16.45)分,CTX-Ⅱ及COMP含量分别为2.42ng/ml和4.56 ng/ml.选择WORMS四分位数中轻和严重2组,比较2组COMP差异有统计学意义(Z=2.04,P=0.039),而CTX-Ⅱ差异则无统计学意义(Z=0.79,P=0.427).相关性分析发现WORMS与WOMAC评分、K-L分级呈正相关(r=0.777,P＜0.01；r=0.716,P＜0.01),K-L分级与WOMAC评分也呈正相关(r=0.692,P＜0.01).WORMS中关节软骨积分、骨赘积分、滑膜炎积分分别与WOMAC评分、K-L分级及COMP亦呈正相关(r=0.771,P＜0.01；r=0.509,P＜0.01；r=0.917,P＜0.01).以WOMAC评分为应变量,年龄、性别、K-L分级、WORMS、COMP和CTX-Ⅱ为自变量进行逐步回归(F=20.327,P＜0.01),KOA病情主要受WORMS、K-L分级影响(P=0.015,P=0.025).结论:WORMS对膝骨关节炎的诊断有较高的参考价值.WORMS高时,关节液中COMP含量升高.膝骨关节炎的临床症状主要受WORMS、K-L分级影响.%Objective:To explore the diagnostic value of whole-organ magnetic resonance imaging score (WORMS) in knee osteoarthritis (KOA). Methods: From November 2009 to January 2011,70 patients with KOA combined with knee effusion among outpatient and inpalient were analyzed retrospectively. Among the patients, 12 patients were male, 58 patients were female,ranging in age from 46 to 75 years,with a mean age of (59.66?.93) years. The clinical symptoms were evaluated by WOMAC ,lhe imaging of KOA was assessed by K-L score and WORMS,and COMP and CTX- D were measured respectively by EUSA. The correlation analyses and multiple linear regression analysis were studied to determine associations among biomarkers,clinical variables and radiographic findings of knee joints. Results:The average scores of WOMAC and WORMS were (57.50?.20) and (64.54?6.45) respectively. The median of CTX- Q nd COMP were 2.42 ng/ml and 4.56 ng/ml respectively. Grouped by less than the lowest quartile and more than the highest quartile of WORMS,COMP was significantly different (fc2.04,P=0.039) Tbut there was no significant difference in CTX- II (Z=0.79.P=0.427). WORMS were positively correlated with WOMAC and K-L score (r=0.777,P<0.01 ;r=0.716,P<0.01;respectively); WOMAC was also positively correlated with K-L score (r=0.692 ,P<0.0). WORMS's cartilage,osteophytes and synovitis were positively correlated with WOMAC,K-L score and COMP respectively (r=0.771 ,P<0.01; r=0.509,P<0.01 :r=0.9l7.P<0.01). It was determined by stepwise regression that the KOA was mainly affected by WORMS,K-L score (P=0.015.P=0.025 respectively)when WOMAC as a dependent variable, age, gender, K-L score .WORMS,COMP and CTX - II as independent variables (F=20.327, P