7关节超声评分评估类风湿关节炎病情进展

Application of 7-joint ultrasound score in evaluation of rheumatoid arthritis progresses

目的探讨7关节超声评分(US7)在评估RA病情进展中的临床意义。方法根据28关节疾病活动度(DAS28),将198例RA患者分为轻度活动期组(n=55)、中度活动期组(n=83)和重度活动期组(n=60),对严重侧腕关节,第2、3掌指关节,近端指间关节和第2、5跖趾关节行灰阶超声(GSUS)和能量多普勒超声(PDUS)检查及US7,比较3组间评分差异,分析其与病情严重程度的相关性,并采用Logistic回归分析寻找RA病情进展的预测因子。结果随病情严重程度增加,DAS28、GSUS滑膜炎、PDUS滑膜炎、GSUS肌腱腱鞘炎、PDUS肌腱腱鞘炎及US7总分均显著增加(P均<0.001),且后5项指标与RA严重程度均呈正相关(P均<0.001)。US7系统中,PDUS滑膜炎是轻-中度活动期的独立预测因子,其与GSUS肌腱腱鞘炎均为中-重度活动期的独立预测因子(P均<0.05)。结论 US7与RA进展存在相关性;PDUS滑膜炎是鉴别RA严重程度的有效指标。

Objective To explore the clinical significance of 7-joint ultrasound score(US7) method in evaluating the progression of RA. Methods Totally 198 RA patients were divided into 3 groups according to disease activity score of 28 joints(DAS28), i.e. light active period group(n=55), medium active period group(n=83) and heavy active period group(n=60). Gray-scale ultrasound(GSUS) and power Doppler ultrasound(PDUS) were performed on the severe lateral wrist joints, the second/third metacarpophalangeal joints, proximal interphalangeal joints and the second/fifth metatarsophalangeal joints. US7 scoring was performed. The differences among 3 groups were compared, and their correlation with the severity of the disease were analyzed. Logistic regression analysis was performed to find the predictive factor of RA. Results With the severity of disease, DAS28, GSUS synovitis, PDUS synovitis, GSUS tendon tenosynovitis, PDUS tendon tenosynovitis, US7 total score showed significant increase(all P<0.001). There were positive correlation of GSUS synovitis, PDUS synovitis, GSUS tendon tenosynovitis, PDUS tendon tendonitis, US7 total score to the severity of RA(all P<0.001). PDUS synovitis in US7 scoring system was an independent predictor of light-medium activity. PDUS synovitis and GSUS tendon tenosynovitis were independent predictors of medium-heavy activity(all P<0.001). Conclusion There is correlation between the progression of US7 and RA. PDUS synovitis is an efficient indicator for identifying the severity of RA.