肌骨超声在类风湿关节炎评估中的应用分析

Application analysis of musculoskeletal ultrasound in the evaluation of rheumatoid arthritis

目的探讨肌骨超声在类风湿关节炎评估中的应用价值。方法选取我院2017年1月～2018年9月91例类风湿关节炎患者,随机分为四组:A组(高活动期)、B组(中活动期)、C组(低活动期)、D组(缓解期),实施肌骨超声检查,对其7个手足关节分别从4个方面(骨侵蚀、滑膜增生、关节积液、血流信号)予以半定量评分,对四组半定量评分予以评价。对四组骨形成、骨吸收血清标志物予以检测,对其与肌骨超声半定量评分相关性进行分析。结果 A、B、C组肌骨超声半定量总评分、骨侵蚀、滑膜增生、关节积液、血流信号评分均显著高于D组(P<0.05);A、B组肌骨超声半定量总评分、骨侵蚀、滑膜增生、关节积液、血流信号评分均显著高于C组(P<0.05);A组肌骨超声半定量总评分、骨侵蚀、滑膜增生、关节积液、血流信号评分均显著高于B组(P<0.05);A、B、C组骨形成各项血清标志物水平均显著低于D组,骨吸收各项血清标志物水平均高于D组(P<0.05);A、B组骨形成各项血清标志物水平均显著低于C组,骨吸收各项血清标志物水平均高于C组(P<0.05);A组骨形成各项血清标志物水平均显著低于B组,骨吸收各项血清标志物水平均高于B组(P<0.05);肌骨超声半定量评分与血清PⅠNP、PⅠCP、BALP、OPG水平表现为负性相关(P<0.05),与血清CTX-Ⅰ、TRACP5b表现为正性相关(P<0.05)。结论肌骨超声能够有效判断类风湿关节炎患者的疾病活动度,其半定量分级能够对患者骨代谢状态予以良好反映。

Objective To investigate the application value of musculoskeletal ultrasound in the evaluation of rheumatoid arthritis.Methods 91 patients with rheumatoid arthritis from January 2017 to September 2018 were randomly divided into 4 groups:group A(high activity period),group B(middle activity period),group C(low activity period),group D(remission period),and were treated with musculoskeletal ultrasonography.And the seven hand-foot joints were semi-quantitatively scored from four aspects(bone erosion,synovial hyperplasia,joint effusion,blood flow signal),and the semi-quantitative scores of the four groups were evaluated.The bone formation and bone resorption serum markers of the four groups were detected,and the correlation between them and semi-quantitative scores of musculoskeletal ultrasound was analyzed.Results The semi-quantitative total scores of musculoskeletal ultrasound,bone erosion,synovial hyperplasia,joint effusion and blood flow signal scores in group A,B and C were significantly higher than those in group D(P<0.05).Semi-quantitative total score,bone erosion,synovial hyperplasia,joint effusion,and blood flow signal scores were significantly higher than those in group C(P<0.05).The semi-quantitative total score,bone erosion,synovial hyperplasia,joint volume and blood flow signals of the musculoskeletal ultrasound in the group A were significantly higher than those of group B(P<0.05).The serum levels of bone formation in group A,B and C were significantly lower than those in group D,and the serum levels of bone resorption in group A,B and C were higher than those in group D(P<0.05).The serum markers of bone formation in group A and group B were significantly lower than those of group C,and the serum levels of bone resorption in group A and group B were higher than those in group C(P<0.05).The serum markers levels of bone formation in group A were significantly lower than those of group B.The serum markers evels of bone resorption were higher than those of group B(P<0.05).The semi-quantitative scores of musculoskeletal ultrasound were negatively correlated with serum PINP,PICP,BALP and OPG levels(P<0.05)and were positively correlated with serum CTX-Ⅰand TRACP5b(P<0.05).Conclusion Musculoskeletal ultrasound can effectively judge the disease activity of patients with rheumatoid arthritis,and its semi-quantitative grading can reflect the bone metabolism status of patients well.