类风湿性关节炎关节皮肤温度与疾病活动度的关系

Relationship Between Joint Skin Temperature and Disease Activity in Rheumatoid Arthritis

目的探讨关节皮肤温度测量在类风湿性关节炎(RA)病情活动度评估中的应用价值。方法选取2016年4月~2018年2月哈尔滨医科大学附属第二医院收治的RA患者58例设为RA组,另选取同期我院体检的健康者48例设为对照组,测量DAS28范围的关节皮肤温度,记录每个关节皮肤温度,比较两组各关节温度,并分析RA患者关节温度以及CRP与DAS28、CRP的相关性。结果RA组肩关节、近端指间关节、腕关节、膝关节、掌指关节、肘关节皮肤温度最高值、平均值、最高值差、平均值差均高于对照组,差异有统计学意义(P<0.05)。RA组CRP水平、DAS28评分高于对照组,差异有统计学意义(P<0.05)。多因素Logistics回归分析显示,RA各关节皮肤温度与CRP是DAS28>3.2的危险因素(P<0.05),特别是腕、肘关节温度平均值(OR>42)。ROC曲线分析各关节皮肤温度及CRP预测DAS28>3.2的灵敏度、特异度及正确指数结果显示,肩、腕、掌指、近端指间关节的最高值和平均值对DAS28的敏感度和特异度均高于CRP,其中膝关节温度最高值敏感度最高,肘关节温度最高值特异度最高。结论关节皮肤温度可以反映RA疾病活动程度,定期测量受累关节皮肤温度对RA患者病情评估提供一定的帮助。

Objective To explore the application value of joint skin temperature measurement in the evaluation of rheumatoid arthritis(RA)disease activity.Methods 58 patients with RA who were admitted to the Second Affiliated Hospital of Harbin Medical University from April 2016 to February 2018 were selected as the RA group,and 48 healthy patients who were examined in our hospital during the same period were selected as the control group to measure the joint skin in the DAS28 range temperature,record the skin temperature of each joint,compare the joint temperature of the two groups,and analyze the joint temperature of RA patients and the correlation between CRP and DAS28,CRP.Results The RA group's shoulder joint,proximal interphalangeal joint,wrist joint,knee joint,metacarpophalangeal joint,elbow joint skin temperature maximum value,average value,maximum value difference,average value difference are higher than the control group,the difference is statistically significant(P<0.05).The levels of CRP and DAS28 in RA group were higher than those in control group(P<0.05).Multivariate logistic regression analysis showed that RA joint skin temperature and CRP were risk factors for DAS28>3.2(P<0.05),especially the average wrist and elbow joint temperature(OR>42).ROC curve analysis of the skin temperature of each joint and the sensitivity,specificity and correct index of DAS28>3.2 predicted by CRP showed that the highest and average values of the joints of shoulder,wrist,palm,and proximal interphalangeal joints were sensitive and specific to DAS28 both are higher than CRP,among which the highest temperature of knee joint has the highest sensitivity and the highest temperature of elbow joint has the highest specificity.Conclusion The joint skin temperature can reflect the degree of RA disease activity,and regularly measuring the skin temperature of the affected joint can provide some help for the evaluation of RA patients'condition.