手关节能量多普勒超声评分预测生物制剂治疗类风湿关节炎疗效的价值

Value of power Doppler ultrasound score of hand joints in predicting the therapeutic effects of tropizumab in the treatment of moderate to severe rheumatoid arthritis

目的分析手关节能量多普勒超声评分(PD评分)预测托珠单抗(TCZ)治疗中重度类风湿关节炎(RA)疗效的价值。方法选取2017年4月—2018年4月的80例中重度RA患者,给予TCZ治疗,给药剂量为8 mg/kg,4周1次,治疗时间为24周,同时酌情给予非甾类抗炎药(NSAIDs)和/或激素治疗。对所有患者在入组时、TCZ治疗12周时、TCZ治疗24周时的红细胞沉降率(ESR)、C反应蛋白(CRP)、白细胞计数(WBC)、类风湿因子(RF)、血小板计数(PLT)、28个关节疾病活动度积分(DAS28-ESR、DAS28-CRP)及手关节滑膜厚度、PD评分进行分析。对患者在TCZ治疗12周时、TCZ治疗24周时达到美国风湿病学会(ACR20)标准的比例进行评价和分析。结果随着TCZ治疗的进行,患者各时点的ESR、CRP、WBC、RF、PLT水平及DAS28-CRP、DAS28-ESR、滑膜厚度、手关节PD评分逐渐降低,不同时点的差异均有统计学意义(P<0.05)。在TCZ治疗12周时、TCZ治疗24周时,分别有43例(42.00%)和54例(68.00%)达到ACR20标准。患者在TCZ治疗12周时的手关节PD评分预测TCZ治疗24周时达到ACR20标准的受试者工作特征曲线下面积(AUC)为0.704(P<0.05),在Cut-off值下,灵敏度为0.875,特异度为0.529。结论TCZ治疗能够显著缓解中重度RA患者的炎症反应程度、降低疾病活动度和关节滑膜损害程度,患者在治疗12周时的手关节PD评分可用于预测治疗24周时的治疗效果。

Objective To analyze the value of power Doppler ultrasound score of hand joints(PD scores)in predicting the therapeutic effects of tropizumab(TCZ)in the treatment of moderate to severe rheumatoid arthritis(RA).Methods Totally 80 patients with moderate to severe RA from April 2017 to April 2018 were selected and treated with TCZ at a dose of 8 mg/kg once per week for 24 weeks.At the same time,they were treated with DMARDs and hormones as appropriate.The levels of erythrocyte sedimentation rate(ESR),C reactive protein(CRP),white blood cell count(WBC),rheumatoid factor(RF),platelet count(PLT),28 joint disease activity integral(DAS28)-ESR,DAS28-CRP and the synovial membrane thickness,the PD score of the hand joints at the time points of hospital admission,12 weeks and 24 weeks of TCZ treatment were observed and analyzed in all the patients.The proportions of the patients met the standard of American College of Rheumatology(ACR)20 at 12 weeks and 24 weeks of TCZ treatment were evaluated and analyzed.Results With the implementation of TCZ treatment,the ESR,CRP,WBC,RF,PLT levels and DAS28-CRP,DAS28-ESR,synovial membrane thickness and PD score of hand joints of the patients at different time points gradually decreased,and there were significant differences between each time point(P<0.05).At 12 weeks and 24 weeks of TCZ treatment,43 cases(42.00%)and 54 cases(68.00%)met the ACR20 standard respectively.The area under receiver operating characteristic criteria at 24 weeks of TCZ treatment ( P <0.05), and the sensitivity and specificity were 0.875 and 0.529 under the Cut-off value. Conclusion TCZ treatment can significantly alleviate the inflammatory response, reduce the disease activity and the joint synovial damages in patients with moderate to severe RA. The PD score of hand joints at 12 weeks of treatment can be used to predict the therapeutic effects at 24 weeks of treatment.