目的：探讨7关节半定量超声评分在类风湿性关节炎疗效监测中的价值。方法：选取类风湿性关节炎患者62例，使用缓解病情的抗风湿药物治疗，在治疗前、治疗3月、治疗6月分别检测患者的抗环瓜氨酸肽抗体（Anti-CCP）、类风湿因子（RF）、血沉（ESR）、C-反应蛋白（CRP），并行临床DAS28评分。对患者的腕关节（Wri）、第二及第三掌指关节（MCP2、MCP3）、第二及第三近端指间关节（PIP2、PIP3）、第二及第五跖趾关节（MTP2、MTP5）进行高频超声检查，分别用灰阶超声（GSUS）及能量多普勒超声（PDUS）对滑膜炎、腱鞘炎（腱周组织炎）、骨侵蚀程度进行评分。分析各时间点7关节半定量超声评分与DAS28评分、活动性指标之间的相关性。结果：DAS28、Anti-CCP、RF、ESR及CRP治疗6月后均较治疗前明显下降；GSUS/PDUS滑膜炎、GSUS/PDUS腱鞘炎（腱周组织炎）分值均下降，差异均有统计学意义（P＜0.01）；骨侵蚀分值治疗前后改变不明显，差异无统计学意义（P>0.05）。治疗3月及治疗6月后，GSUS/PDUS滑膜炎、GSUS/PDUS腱鞘炎（腱周组织炎）评分与DAS28、ESR、CRP均呈正相关（P＜0.01）；骨侵蚀评分与DAS28、Anti-CCP、RF、ESR、CRP均无明显相关性（P>0.05）。结论：7关节半定量超声评分与临床及血清学指标存在良好的相关性，是类风湿性关节炎疗效监测的重要方法。
Abstract
Objective: To explore the value of the seven joint semi-quantitative ultrasonic score in rheumatoid arthritis(RA) curative effect monitoring. Methods: Sixty-two patients with RA were involved in this study. Anti-CCP, RF, ESR, CRP and DAS28 were examined at the start point, 3 and 6 months after treatment of disease-modifying anti-rheumatic drugs. The patients’s wrist, the second and third metacarpophalangeal joints, the second and third proximal interphalangeal joints, and the second and fifth metatarsophalangeal joints were examined by high frequency ultrasound. Synovitis, tenosynovitis and bone erosion were graded by grey scale ultrasound(GSUS) and power Doppler ultrasound(PSUS). The correlation between the semi-quantitative ultrasound score and the DAS28 score and the activity indicators were analyzed. Results: Six months after treatment, DAS28, Anti-CCP, RF, ESR, and CRP decreased significantly. Values of synovitis GSUS, synovitis PDUS, tenosynovitis GSUS and tenosynovitis PDUS also decreased. There was significant difference(P＜0.01). The change of bone erosion score was not obvious before and after treatment. There was no statistical difference(P>0.05). Three and six months after treatment, there were positive correlations between synovitis GSUS, synovitis PDUS, tenosynovitis GSUS, tenosynovitis PDUS and DAS28, ESR, CRP(P<0.01). There was no correlation between bone erosion score and DAS28, Anti-CCP, RF, ESR and CRP(P>0.05). Conclusion: The seven joint semi-quantitative ultrasonic score has a good correlation with the clinical and serological indicators. It is an important method to monitor the curative effect of RA.
关键词
关节炎 /
类风湿；超声检查
Key words
Arthritis, rheumatoid /
Ultrasonography
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