早期和非早期类风湿关节炎患者膝关节高频超声表现与多项血清学指标相关性研究

The Correlation study between high-frequency ultrasonography of knee joint`s lesions in rheumatoid and variety of serum markers inpatients with early and non-early rheumatoid arthritis

目的:观察早期类风湿性关节炎(ERA)与非早期类风湿性关节炎(NERA)患者血清学指标(CRP、ESR、RF、抗CCP)的变化及其与膝关节高频彩色多普勒超声结果的相关性。方法:60例类风湿性关节炎(RA)患者分为早期组(ERA)24例,非早期组(NERA)36例。同时记录患者的一般资料及临床数据,包括年龄、性别、病程、膝关节有无阳性体征,记录DAS28评分,血清学指标包括类风湿因子(RF)、抗环瓜氨酸多肽抗体(抗CCP)、C-反应蛋白(CRP)、血细胞沉降率(ESR)等。结果:①NERA组的CRP及ESR的水平及RF阳性率显著高于ERA组( P =0.002,0.001,0.028)。②NERA组髌上囊积液、滑膜厚度较ERA组增大,且差异有统计学意义( P <0.05),滑膜血流评分两组间无统计学差异( P >0.05);膝关节骨侵蚀多见于股骨外侧髁,ERA 3例,NERA 24例,经卡方检验,NERA组骨侵蚀率明显高于ERA组;而股四头肌腱附着点炎ERA组有6例,NERA组有12例,两组间发生率无统计学差异( P >0.05)。③ERA组中滑膜炎、髌上囊积液及滑膜血流评分与DAS28、血清中CRP及ESR相关性不显著,而NERA组滑膜炎及滑膜血流评分与DAS28、血清中CRP及ESR存在显著的相关性。结论:高频彩色多普勒超声可准确地检测RA膝关节病变情况,对膝关节RA病变具有重要的诊断价值。

Objective:The serum levels of CRP,ESR,RF,anti-CCP and the knee suprapatellar bursa high-frequency color Doppler ultrasonography were detected in patients of ERA and NERA,respectively.The correlation between ultrasonographic(US) knee abnormalities in patients with rheumatoid arthritis(RA) and levels of CRP,ESR were investigated.Methods:60 RA patients were divided into two groups, 24 cases in ERA group and 36 cases in NERA group were enrolled in this study. Demographical and Clinical data were recorded, including aging,sex,duration,positive signs of limited shoulder movement,DAS28,serum markers,such as RF,anti-CCP,CRP and ESR.Results:①The level of CRP and ESR were significantly higher in NERA group than that in ERA group(P=0.002,0.001)Positive rate of RF was significantly higher in NERA group(P=0.028),Positive rate of anti-CCP was not significantly different between NERA and ERA group.②Suprapatellar bursa effusion and synovial thickness of suprapatellar synovitis were also higher in NERA group than ERA group, the difference was statistically significant(P<0.05). There was no significant difference in synovial blood flow score between the two groups. Bone erosion of kneefound most in lateral condyle of femur, 3 cases in ERA,24 cases in NERA. Rate of bone erosion in NERA group were obviously higher than that in ERA group showed by Chi-square test. There were 6 cases of attachment point inflammation of quadriceps femoris tendon long head of biceps tendon in ERA,while 12 cases in NERA. The incidence between the two groups had no difference by Chi-square test.③Synovitis and synovial blood flow score in NERA group were significantly correlated with DAS28,CRP and ESR.None of the ultrasonography in ERA group was significantly correlated with DAS 28,CRP and ESR.Conclusions High-frequency color Doppler ultrasonography detected accurately the abnormalities of knee joint `s lesions in rheumatoid,it was valuable in the diagnosis of knee in RA patients.