建立类风湿关节炎患者手腕关节滑膜炎的简化超声半定量评价系统

Simplified semi-quantitative ultrasound score to evaluate the synovitis of bilateral wrists and hands in patients with rheumatoid arthritis

目的制定一个简化的关节超声半定量评价系统，以评估RA患者腕和手指关节滑膜炎的活动性。方法对705例RA患者的全部近端指间（PIP）、掌指（MCP）关节和双腕关节进行超声检查，并对滑膜炎的灰阶（GS）和能量多普勒（PD）进行半定量（0～3）分级。符合正态分布的计量资料以互蜘表示；计数资料以率表示。采用t检验及Wilcoxon符号秩和检验的统计学方法。通过Spearnlan相关系数分析超声变量间的相关性，应用多元线性逐步回归分析方法建立一个简化的关节超声评分系统反映上述22个关节的滑膜炎症。结果经多元线性逐步回归分析，腕、MCP5、MCP2及MCP3关节在GS超声下标准系数高于其他关节部位，这4个预测因子构成的模型的调整Re〉0．9。与其他组合相比，这8个关节组合对RA双腕和手指关节滑膜炎探查的敏感性、阴性预测值最高，GS和PD超声下分别为97．35％与92．67％；97．20％与97．21％（P〈0．01）；与22个关节评分总和的相关系数最高，GS和PD超声下r值分别为0．989和0．972（P〈0．01）。结论双腕、MCP2、MCP3及MCP5关节构成的简化的8个关节超声半定量评价系统可用于代表其双腕和双手共22个关节滑膜炎的程度，是临床中监测RA患者双手和腕关节滑膜炎活动度简单且有效的评分系统。

Objective To develop the optimal simplified combination of joints for uhrasonographic assessment of joint inflammation of wrists and hands in patients with rheumatoid arthritis （RA）. Methods US examination was performed using grey-scale （GSUS） and power Doppler （PDUS） seml-quantitative scoring systems with scores 0-3 in 22 joints of 705 RA patients, including all proximal interphalangeal （PIP）, metacarpophalangeal （MCP）, and bilateral wrist joints. Continuous variables were presented as mean and standard deviation if normally distributed, and dichotomous variables were presented as frequencies. T test and Wileoxon signed test were applied for statistical analysis. All correlations among US variables were assessed using Spearman＇s rank correlation test. Candidate joint set was selected by multiple stepwise linear regression analysis. Results Through multiple linear stepwise regression analysis, the standard coefficient of wrist, MCP5, MCP2 and MCP3 joints under GSUS was higher than other joints. And the adjusted R2 of the model composed of wrist, MCP5, MCP2 and MCP3 joints was greater than 0.9. Among the sum GS and PD scores of various selected joint combinations, total score-8 （GS vs PD）, including bilateral wrist, MCP2, MCP3, MCP5 joints, not only showed highest sensitivity and negative predictive value （97.35% vs 97.20%; 92.67% vs 97.21%, respectively）, but also had the highest correlation with the total score-22 （GS, PD） （r=0.989, 0.972, P〈0.01）. Conclusion Total score-8, including bilateral wrist, MCP2, MCP3, MCP5 joints, is simple and efficient enough for monitoring active synovitis of wrists and hands in patients with RA in daily practice.