类风湿关节炎疾病活动度四种评价方法的比较研究

Comparison of Four Assessment Criteria for Disease Activity of Rheumatoid Arthritis

目的比较类风湿关节炎(RA)疾病活动度的四种评价方法。方法收集我院类风湿关节炎患者的临床资料,分别用血沉(ESR)、C反应蛋白(CRP)计算28关节疾病活动指数(DAS28),即DAS28-ESR、DAS28-CRP,以及简化疾病活动指数(SDAI)和临床疾病活动指数(CDAI)四种方法进行疾病活动度评价,比较各组间的相关性及一致性。结果 172例类风湿关节炎患者用四种方法评估组间均存在显著正相关(P<0.01)。SDAI与CDAI之间及DAS28-ESR与DAS28-CRP之间的一致性极好,Kappa值分别为0.949和0.862。进一步比较四种评价方法评估出的缓解期、低、中及高疾病活动度患者比例,结果显示四种方法对于缓解期及高疾病活动度的评估差异无统计学意义,而在低疾病活动度及中疾病活动度的评估中DAS28-ESR及DAS28-CRP两种方法与CDAI及SDAI两种方法组间差异有统计学意义(P<0.05)。结论四种评价方法有很好相关性。在临床工作中使用CDAI评估RA是否活动是最优选择,对于活动期RA的进一步评估则DSA28-ESR和DAS28-CRP优于CDAI和SDAI。

Objective To compare of the efficacy of four assessment criteria for evaluating disease activity in rheumatoid arthritis.Methods Clinical data were collected from 172 patients ofrheumatoid arthritis.Disease activity was evaluatedby four assessment criteria,which are disease activity score 28-C-reactive protein（DAS28-CRP）,disease activity score 28-erythrocyte sedimentation rate（DAS28-ESR）,simplified disease activity index（SDAI）and clinical disease activity index（CDAI）.The patients were divided into four groups which were remission,low,middle and high disease activity.The correlations and consistencies among four methods were compared.Results Disease activities evaluated by four methods in 172 RA patients were significantly positive correlated（P0.01）.It was significantly consistent between SDAI and CDAI,also between DAS28-ESR and DAS28-CRP,the Kappavalues were 0.949 and 0.862 respectively.The differences of the four methods in remission and high disease activity groups were no statistical significance.The proportion of the patients in low disease activity and middle disease activity groups evaluated by DAS28-ESR and DAS28-CRP were statistical different from that evaluated by CDAI and SDAI（P〈0.05）.Conclusion Strong correlation was observed between the four methods.CDAI could be used to evaluate whether RA is remission or activity.For disease activity assessment,DSA28-ESR and DAS28-CRP seems superior to CDAI and SDAI.