简化的关节彩色多普勒超声评价类风湿关节炎疾病活动度的有效性研究

Validity study of a simplified colour doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis

目的研究简化的关节彩色多普勒超声(CDU)检查方案与包含28个关节超声检查方案比较,在评价类风湿关节炎(RA)患者疾病活动度时的有效性。方法选取符合纳入及排除标准的RA患者50例,收集ESR、CRP等实验室检查结果并计算其DAS28评分以评价其临床疾病活动度。在临床评估的3h内行超声检查(单盲),彩色多普勒信号均以1～3级进行半定量分级,统计28个关节CDU信号总积分。简化方案的形成以检出彩色多普勒信号的关节受累频数为依据,确定简化方案的组成并统计CDU积分。采用Spearman秩相关分析DAS28与两种CDU积分之间的相关性。结果 1个10关节(包括双腕关节、第3、4近端指间关节、第2掌指关节和双膝关节)的CDU信号积分能够代表全部28关节的CDU积分,简化方案的CDU检查与临床的疾病活动度指标显著相关(r=0.333,P<0.05)。结论简化的关节CDU检查是评估RA患者疾病活动度的有效方案。

Objective To investigate the validity of a simplified colour Doppler ultrasound （CDU） assessment of joint inflammation compared with a comprehensive 28-joint CDU assessment in patients with rheumatoid arthritis （RA）. Methods A total of 50 patients with active RA who met inclusion and exclusion criteria were selected, the ESR, CRP and other laboratory results were collected, and the DAS28 score was calculated in order to evaluate its clinical disease activity. An ultrasound examination （single-blind） was taken in clinical evaluation of 3 hours, the color doppler signals were semi-quantitative grading with level 1-3, 28 total integral joint CDU signal were counted. The formation of the simplified solution was taken on the basis of the joints involved frequency which checked out by color doppler signals, the composition and statistics of simplified CDU integral was determined. The correlation between DAS28 and the two kind of CDU integral was determined by Spearman rank correlation. Results One case of 10 joints （including double joints, the 3, 4 proximal interphalangeal joint and double knee joint） CDU signal points could represented all 28 CDU integral of the joint, the simplify solution of the CDU checking was significantly associated with clinical disease activity index （r = 0.333, P 〈 0.05）. Conclusion The simplified CDU joint inspection is an effective solution to evaluate disease aclivity in patients with RA.