关节超声评分在类风湿性关节炎评价中的应用价值研究

Value of ultrasonographic scores in the clinical evaluation of rheumatoid arthritis

目的 通过比较类风湿关节炎（rheumatoid arthritis,RA）患者不同活动期关节超声评分（ultrasound score,US）,探索超声检查在RA临床评价中的应用价值.方法 彩色多普勒超声测定133例处于不同活动期的RA患者US7评分,分析其与血沉、抗CCP抗体、HAQ、DAS28等指标的相关性,并且分析US7评分中不同关节区域的评分比重.结果 （1）重度活动期的RA患者US7评分（7.0分）较稳定期、轻度活动性、中度活动性RA患者评分（0、2.0、3.0分）差异有统计学意义（P＜0.05）.超声US7评分与DAS28、HAQ呈正相关;（2） US7评分中滑膜炎灰阶等级评分（CS）为63.1％,滑膜炎血流多普勒评分（PD）为18.3％,腱鞘滑膜炎GS为7.2％,腱鞘滑膜炎PD为4.3％,骨质破坏为6.9％.滑膜炎中最易累及的是背侧腕关节滑膜炎为82.7％,其次是掌侧MCPⅡ滑膜炎（53.3％）.腱鞘滑膜炎中最常累及的是背侧腕关节（15.8％）,其次是背侧掌指关节（mete carpophalangeal,MCPⅡ）（15.7％）,骨质破坏中最易累及关节为尺侧MTP Ⅴ（33.8％）,其次为桡侧MCPⅡ （24.1％）.结论 超声US7评分能有效反映RA患者的疾病活动性,尤其对重度活动性RA患者有较好的评估价值.在US7评分中,滑膜炎的比例高于腱鞘滑膜炎和骨质破坏,最易累及的关节是背侧腕关节和掌侧的MCPⅡ,在临床上需更加注意这2个关节区域的改变.

Objective To explore the value of ultrasonographic US7 scores in clinical evaluation of rheumatoid arthritis （RA） patients,by comparing US7 scores in RA patients with different disease activities.Methods US7 scores of 133 patients in different active stages of RA were measured and evaluated by using color Doppler ultrasonography.Then,its relationship with erythrocyte sedimentation rate （ESR）,anti-CCP antibody,HAQ,DAS28 and other indicators was analyzed statistically.Results （1） Significant differences could be seen in the US7 scores of the patients with severe active RA,as compared with those of the patients with stable,mild and moderate active RA（7.0 VS 0,7.0 VS 1.0,7.0 VS 2.0,7.0 VS 3.0） （P ＜0.05）.Ultrasonographic US7 scores were positively correlated with DAS28 and HAQ.（2） US7 revealed that synovitis gray scale （GS） scores accounted for the highest （63.1％）,while synovitis blood flow signal （PD） scores,tenosynovitis GS scores,tenosynovitis PD scores and bone destruction scores accounted for （18.3％）,（7.2％）,（4.3％） and （6.9％） respectively.The most easily affected site in synovitis was dorsal wrist synovium （82.7％）,followed by volar MCP Ⅱ synovium （53.3％）.The most easily affected site in tenosynovitis was the dorsal wrist joint （15.8％）,followed by the dorsal MCPⅡ （15.7％）.In bone destruction,the most easily affected site was ulnar MTPV （33.8％）,with radialis MCPⅡ （24.1％） being the second.Conclusions Ultrasonographic US7 scores could effectively reflect the disease activity in RA patients,and it was of good value to those with severe active RA.In US7 scores,the rate of synovitis was significantly higher than those of tenosynovitis and bone destruction,and the most easily affected site was dorsal wrist joint and palmar MCPⅡ.Clinically,more attention should be paid to the changes in these two joints.