早期类风湿关节炎患者甲襞微循环积分与腕关节骨侵蚀的关系

Correlation analysis of nailfold videocapillaroscopy score and carpal bone erosion detected by ultrasound in the patient with early rheumatoid arthritis

目的探讨早期类风湿关节炎患者甲襞微循环异常与腕关节骨侵蚀的相关性。方法选取2013年5月—2016年11月就诊于胜利油田中心医院风湿免疫科的早期类风湿关节炎患者,按甲襞微循环积分数值分为轻度异常组、中度及重度异常组。总观察随访期52周,基线时记录患者有关临床及实验室资料,并行甲襞微循环及超声检查,此后按观察随访计划定期复查腕关节超声,发现新发超声下腕关节侵蚀后终止该患者随访并记录时间。结果纳入180例患者骨侵蚀总的危险度为4.11(95%CI:1.299,13.016);以甲襞微循环轻度异常组为对照,计算中、重度组相对危险度分别为3.22[(95%CI:0.934,11.087),P=0.046]和4.98[(95%CI:1.532,11.169),P=0.002];提示甲襞微循环异常程度越高,类风湿关节炎患者出现腕骨侵蚀相对危险度越大。Logistic回归分析结果显示,CRP[O^R=18.85,(95%CI:1.021,34.029)]、微循环积分[O^R=21.08,(95%CI:1.802,24.364)]及关节超声积分[O^R=26.04,(95%CI:2.663,25.838)]是与类风湿关节炎患者腕骨侵蚀发生相关的因素。结论早期类风湿关节炎患者甲襞微循环异常与腕关节骨侵蚀发生密切相关,具有预测价值;甲襞微循环检查作为一种安全无创的技术可有效监测出早期类风湿关节炎患者微循环异常,具有广泛应用前景。

Objective To explore the correlation between nailfold microcirculation and carpal bone erosion in early rheumatoid arthritis.Methods A prospective observational cohort study was conducted.The patients admitted to Shengli Oilfield Central Hospital from May 2013 to November 2016 were divided into mild,moderate and severe abnormal group according to the integral value of nailfold capillaroscopy.The total follow-up period were 52 weeks.The clinical and laboratory data of patients were recorded,and the base values of nailfold capillaroscopy and ultrasound of carpal joint were selected as potential factors predicting outcome.Results Totally 180 patients were enrolled,and 6 patients gave up treatment or referrals were excluded.Finally,174 patients were enrolled in the analysis.The total risk was 4.11[(95%CI:1.299,13.016),P=0.008].In the moderate and severe group,RR was 3.22[(95%CI:0.934,11.087),P=0.046]and 4.98[(95%CI:1.532,11.169),P=0.002]respectively.The result suggested that the degree of abnormal nailfold capillaroscopy in patients with early RA was the higher,the risk of carpal joint erosion was higher.A binary logistic regression analysis showed CRP(OR=18.85,95%CI:1.021,34.029),nailfold capillaroscopy score(OR=21.08,95%CI:1.802,24.364)and ultrasonic score of wrist joint(OR=26.04,95%CI:2.663,25.838)were significantly associated with the occurrence of carpal bone erosion.Conclusions Scores of nailfold capillaroscopy abnormalities were associated with carpal bone erosion.Nailfold capillaroscopy could potentially be used as a diagnostic tool for early rheumatoid arthritis.