高频超声对重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白治疗银屑病关节炎的评价

High frequency ultrasound evaluating severe psoriatic arthritis treated with recombinant human tumor necrosis factor-or receptor 1I ： IgG Fc fusion protein

目的探讨高频超声评价重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白治疗重度银屑病关节炎效果的价值。方法对重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白治疗73例重症银屑病关节炎患者于药物治疗前、治疗2周后、治疗12周后采用Siemens Sequoia 512彩色超声诊断仪观察关节肌腱及韧带附着点、滑膜厚度、关节面及关节腔有无积液、滑膜血流情况。按银屑病皮损面积和严重程度（PASI）评分标准计算总有效率。结果治疗前血流信号丰富70例，关节周围软组织回声减少66例，关节处皮下真皮组织增厚54例；治疗2周后血流信号稀疏68例（97.1%，68/70），关节周围软组织回声减低63例（95.4%,63/66），关节处皮下真皮组织增厚较治疗前好转50例（92.6%，50/54）；治疗12周后73例患者关节处皮下真皮组织无明显增厚；关节周围软组织回声减低，彩色多普勒检查无明显血流信号。治疗2周后皮损开始减轻（治愈3例＋显效4例＋有效40例），总有效率64.4%（47/73）；12周所有患者皮损基本消退（治愈15例＋显效34例＋有效24例），总有效率100.0%（73/73）。治疗期间没有不良反应发生。结论高频超声可更好更准确地评价重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白对银屑病关节炎的疗效，丰富了该病疗效评价手段。

ObjectiveTo study the effect of high frequency ultrasonography （HFUS）on severe psoriatic arthritis（PsA）treated with recombinant human tumor necrosis factorα receptorⅡ：IgG Fc fusion protein.MethodsTendons and ligaments attachment points, synovial membrane thickness, facet, cavity effusion of joints were analyzed with high resolution uhrasonography in 73 patients with PsA. They were administered recombinant human tumor necrosis factorα receptorⅡ： IgG Fc fusion protein. The severity was evaluated with the psoriasis area and severity index（PASI） Score. Then the results of treatment were classified into four grades with the declination of PASA score between pre and posttreatment： grade 1（cure）, declination≥95%; grade 2 （excellent） , declination between 60% and 94%;grade 3 （effective）, PASI Score declination between 20% and 59%; grade 4 （no effect）： declination 〈20%. Total effective rate was the percentage of the patients of graed 13.ResultsBefore treatment, rich blood flow signals were detected with high frequency ultrasound in 70 patients; synovial membrane thickening was in 54 patients; soft tissue echo decreased in 66 patients. Two weeks after treatment, rich blood flow signals were detected in 68 patients（97.1%, 68/70）; synovial membrane thickening was in 50 patients（92.6%, 50/54）; soft tissue echo decreased in 63 patients（95.4%, 63/66）; 12 weeks after treatment, no synovial membrane thickening, soft tissue echo decrease, rich blood flow signal were detected in all patients.Two weeks after treatment, skin lesions were improved （grade 1, 3 cases, grade 2, 4 cases, grade 3, 40 cases, total effective rate 64.4%（47/73）. Twelve weeks after treatment, skin lesions were improved （grade 1, 15 cases, grade 2, 34 cases, grade 3, 24 cases, total effective rate 100.0%（73/73）. No adverse reaction occurred during treatment. ConclusionsHigh frequency ultrasonography is an effective evaluation method for the treatment of severe PsA treated with recombinant human tumor necrosis factorα receptorⅡ： IgG Fc fusion protein.