超微血管成像技术半定量分级与类风湿关节炎患者骨代谢平衡的相关性分析

Relationship between semi-quantitative scoring of superb microvascular imaging and markers of bone metabolism in patients with rheumatoid arthritis

目的:研究超微血管成像技术(SMI)半定量分级与类风湿关节炎(RA)患者骨代谢情况的相关性。方法:选取2017年3月至2018年7月在我院诊断为类风湿性关节炎(RA)的病人131例。根据DAS28结果将病人分为疾病缓解期(20例)、轻度活动期(41例)、中度活动期(46例)及重度活动期(24例)4组。超声SMI模式评估各组患者关节滑膜内血流信号。全自动生化分析仪检测患者血清中骨形成标志物骨保护素(OPG)、I型前胶原氨基端前肽(PINP)、I型前胶原羧基端前肽(PICP)、I型胶原C端肽(CTX-I)、抗酒石酸酸性磷酸酶5b(TRACP5B)及骨碱性磷酸酶(BALP)的水平。对不同疾病程度RA患者SMI半定量评分和各标志物水平进行单因素方差分析,同时分析SMI半定量评分与DAS28及各标志物的相关性。结果:疾病活动度高组的患者SMI半定量分级评分明显高于活动度低组患者(F=97.516,P<0.01)。疾病活动度高的患者OPG(F=51.292,P<0.01)、PINP(F=102.545,P<0.01)、PICP(F=144.512,P<0.01)、BALP(F=178.535,P<0.01)水平明显高于活动度低组患者(均P<0.05),疾病活动度高组患者CTX-I(F=30.450,P<0.01)和TRACP5B(F=118.151,P<0.01)水平明显低于活动度低组患者,且两两之间有显著性差异(均P<0.01)。相关性分析显示,SMI半定量评分与DAS28正相关(R^2=0.4862,P<0.01),与OPG(R^2=0.3725,P<0.01)、PINP(R^2=0.4842,P<0.01)、PICP(R^2=0.4857,P<0.01)、BALP(R^2=0.4759,P<0.01)负相关,与CTX-I(R^2=0.2374,P<0.01)和TRACP5B(R^2=0.4375,P<0.01)正相关。结论:SMI分级随RA患者疾病活动程度加重而升高,并且与骨代谢状态相关。

Objective:To study the relationship between semi-quantitative scoring of superb microvascular imaging and markers of bone metabolism in patients with rheumatoid arthritis.Methods:A total of 131 patients diagnosed with rheumatoid arthritis(RA)in our hospital from March 2017 to July 2018 were enrolled in this study.According to the DAS28 scores,patients were divided into 4 groups:remission group(20 patients),mild-active group(41 patients),moderate-active group(46 patients)and severe-active group(24 patients).The synovial flow signals were provided by the superb microvascular imaging(SMI)pattern of ultrasound.Patients were graded by SMI semi-quantitative scoring.Moreover,the serum levels of osteoprotegerin(OPG),procollagen type I N-terminal propetide(PINP),propeptide of type I procollagen(PICP),carboxy-terminal telopeptide of type I collagen(CTX-I),tartrate-resistant acid phosphatase 5B(TRACP5B)and bone alkaline phosphatase(BALP)were detected.The SMI scores and the level of these six markers of the 4 groups were compared.The relationship of SMI with DAS28 score and levels of the six markers were analyzed by Pearson correlation analysis.Results:The SMI scores in patients with high disease activity were higher than those in patients with low disease activity(F=97.516,P<0.01).The levels of OPG(F=51.292,P<0.01),PINP(F=102.545,P<0.01),PICP(F=144.512,P<0.01),BALP(F=178.535,P<0.01),CTX-I(F=30.450,P<0.01)and TRACP5 B(F=118.151,P<0.01)in patients with high disease activity were lower than those in patients with low disease activity.Correlation analysis showed that the SMI score was negatively correlated with the level of OPG(R^2=0.3725,P<0.01),PINP(R^2=0.4842,P<0.01),PICP(R^2=0.4857,P<0.01),BALP(R^2=0.4759,P<0.01),and positively correlated with DAS28 scores and the level of CTX-I(R^2=0.2374,P<0.01)and TRACP5 B(R^2=0.4375,P<0.01).Conclusion:The SMI grades of RA patients increase with patients’disease activity,and are correlated with bone metabolism.