ASDAScrp和BASDAI在脊柱关节病患者病情活动评估中的差异及临床意义

Comparison of BASDAI and ASDAScrp in a measure of disease activity in patients with spondyloarthropathy

目的比较Bath强直性脊柱炎病情活动指标(BASDAI)和强直性脊柱炎疾病活动评分-C反应蛋白指标(ASDAScrp)在脊柱关节病(Sp A)疾病活动性评估中的差异及临床意义。方法收集177例Sp A患者,计算BASDAI和ASDAScrp积分,分为BASDAI缓解期、活动期,ASDAS缓解、低中度活动、高度活动、极高度活动期。结果1按照BASDAI标准,177例Sp A中缓解期129例(72.9%),活动期48例(27.1%);按照ASDAScrp标准,121例Sp A中缓解22例(18.2%)、低中度活动23例(19.0%)、高度活动53例(43.8%)、极高度活动23例(19.0%),BASDAI标准和ASDAScrp标准在判断Sp A疾病活动性上有明显差别(χ~2=47.050,P<0.001),一致性为0.454。ASDAScrp缓解组ASDAScrp、BASDAI、BPC、ESR、CRP、PGA和BASFI均显著低于BASDAI缓解组(P<0.05)。2ASDAScrp活动组SPARCC评分>0患者比例明显高于缓解组(χ~2=12.903,P<0.001),且活动组SPARCC评分中位数值明显高于缓解组(z=3.477,P=0.001),而BASDAI标准2组间则无上述差异(P>0.05)。3相关性分析结果显示:BASDAI和ASDAScrp间呈明显正直线相关关系(r=0.795,P<0.001);BASDAI、ASDAScrp和PGA、关节肿胀数、关节压痛数、枕墙距、指地距、BASFI、BPC、ESR、CRP、SPARCC评分均呈正直线相关(P<0.05),两者均和腰椎活动度呈负直线相关(P<0.001)。结论 BASDAI和ASDAScrp间具有较好的相关性,ASDAScrp优于BASDAI,与临床及实验室指标间的总体相关性优于BASDAI,且能反映骶髂关节影像学炎症。

Objective To compare the differences and clinical significance of Bath ankylosing spondylitis disease activity index（BASDAI） and Ankylosing Spondylitis Disease Activity Score-C-reactive protein （ASDAS-crp）in the assessment of disease activity in patients with spondyloarthritis（SPA）. Methods A total of 177 patients with SpA were recruited. The disease activity in SpA were calculated by BASDAI and ASDAScrp and subsequently divided into clinical remission and disease activity according to BASDAI scoring standard, or clinical remission,low-moderate activity, high activity, very high activity according to ASDASerp scoring standard. Results （1）One hundred and twenty-nine patients which accounted for 72.9% in all 177 patients were defined as remission stage according to BASDAI standard, and 48 （27.1% ） patients were categorized as disease activity. Out of 121 patients who had valid ASDAScrp scores,22 （18.2%） patients were classified into remission stage ,23 （ 19.0% ） patients into low-moderate active stage ,53 （43.8%） patients into high active stage and 23 （19.0%） patients into very high activity, whilst according to ASDAScrp standard. There were significant differences between BASDAI and ASDAScrp in assessing disease activity （ χ2 = 47. 050, P 〈 O. 001 ） , the consistency index was 0.454. Variables of ASDAScrp score, BASDAI score, BPC, ESR, CRP, PGA and BASFI in patients with ASDAScrp remis- sion were significantly lower than that in patients with BASDAI remission （ P 〈 0.05 ）. （~）Percentage of SPARCC 〉 0 in ASDAScrp active patients was clearly higher than that in ASDAScrp remission patient （ χ2 = 12. 903, P 〈 0. 001 ）, while median of SPARCC score was also obvious higher than that in the latter group（Z= 3. 477 ,P = 0. 001 ）. No differences were found between patients with BASDAI remission and active patients （ P 〉 0.05 ）. （3）ASDAScrp positively correlated with BASDAI in SpA（ r = 0. 795 ,P 〈 0.001 ）. There were positive linear correlations between BASDAI/ASDAScrp and PGA, swollen joint count, tender joint count, occipital wall distance, finger-floor distance, BASFI, BPC, ESR, CRP and SPARCC scoring（ P 〈 0.05 ）. Both BASDAI and ASDAScrp had negative linear correlations with Schober＇ s test（ P 〈 0. 001 ）. Con- clusion ASDAScrp has good correlation with BASDAI and is superior to BASDAI especially in respects of correlation with clinical and laboratory indexes. ASDAScrp can also reflect the degree of inflammation on MRI in sacroiliac joint.