摘要
目的探讨高频超声检查在亚临床RA评估中的价值。方法选择达到DAS28缓解的RA患者共44例，对所有患者68个关节包括双侧颞下颌关节、胸锁关节、肩锁关节、肩关节、肘关节、腕关节、第1～5掌指关节、拇指指间关节、第2～5近端指间关节、第2～5远端指间关节、髋关节、膝天节、踝关节、跗关节、第1～5跖趾关节、第1～5趾间关节进行超声评估。分析超声滑膜内血流能鼠多普勒（PD）硬灰度等级（GS）评分与患者性别、年龄、病程以及各项临床疾病活动指标：疼痛视觉模拟评分法（VAS）、晨僵时间、肿胀关节数（SJC）和压痛关节数（TJC）、健康评估问卷（HAQ）评分、受试者和医生分别对目前疾病状况的评估、ESR、CRP、RF、CCP抗体、简化疾病活动指数（SDAI）、DAS28－CRP、DAS28－ESR的相关性。超声滑膜炎关节指数评分与临床观察指标作Pearson或Spearman相关分析，2组均数比较采用两独立样本t检验。结果纳入研究的44例RA患者中，达到ACR/EULAR2011缓解26例，达到ACR缓解标准19例，而达到超声缓解的仅3例。超声GS评分与病程,肿张关节数之间存在相关性（r=0．602、0．470，P〈0．01）；超声PD评分则与患者疼痛评分、患者总体评分、ACR／EULAR2011、DAS28-ESR、DAS28-CRP呈正相关（r=0．323、0．337、0．329、0．360、0．343，P〈0，05），同时与CRP、ESR、晨僵时间亦呈正相关关系（r=0．474、0．490、0．415，P〈0．01）。结论大部分临床缓解RA患者中仍存在高频超声检查可检测到的亚临床滑膜炎，PD超声在反映RA疾病活动度方面较GS超声更有优势。
Objectiive To discuss the value of high frequency ultrasound for the evaluation of subclinical rheumatoid arthritis. Methods Forty-fnur rheumatoid arthritis patientswho reached disease activity score （DAS28） clinical remis-sion were included. Ultrasound assess were carried out in all 68 joints, including bilateral temporomandibular joints, sternoelavicular joint, acromioclavieular joint, shoulder joint, elbow joint, wrist joint, 1-5 metacarpophalangeal joints and the interphalangeal joint of the thumb, the 2-5 proximal interphalangeal joints, the 2-5 distal interphalangeal joints, hip, knee joint, ankle joinl, tarsus joint, the 1-5 metatarsophalangeal joint, 1-5 toeinterphalangeal joints. Analysis for the correlation between PD, GS score and gender, age, course of disease and clinical disease activity index were conducted. The pain visual analogue scale （VAS）, time of morning stiffness, swollen joint counl （SJC） and tender joint count （TJC）, health assessment questionnaire （HAQ） score, erythrocyle sedimentation rate （ESR）, and C-reactive protein （CRP） and rheumatoid factor （RF）, anti cyclic citrnllinated peptide （anti CCP） antibody, simplified disease activity index （SDAI）, DAS28-CRP, DAS28-ESR were compared, Using Pearson and Spearman to analyze ultrasonic joint synovitis index score and clinical indexes, Student＇s t-test was employed to assess the significance of difference between two independent sample. Results Twenty-six palients read.bed/European League against Rheumatism （ACR/EULAR） 2011 remission, 19 patients achieved ACR remission, and 3 patients achieved ultrasound remission. There was correlation between GS score and the course of disease and the number of swollen joints （r=0.602, 0.470, P〈0.01）. There was a positive correlation between ultrasound PD score and the patient＇s pain score, the total score of patients, ACR/EULAR2011, DAS28-ESR, DAS28-CRP （r=0.323, 0.337, 0.329, 0.360, 0.343, P〈0.05）. The ultrasound PD score also had a positive corr
出处
《中华风湿病学杂志》
CAS
CSCD
北大核心
2016年第9期592-596,共5页
Chinese Journal of Rheumatology
基金
浙江省卫计委科研项目（2015KYB386）
浙江省中西医结合重点学科建设基金（2012-XKA31）
关键词
类风湿
关节炎
超声检查
Arthritis, rheumatoid
Ultrasonography
