肌骨超声联合CRP、ESR检测对RA疾病活动度的评估价值

Evaluation value of musculoskeletal ultrasound combined with CRP and ESR in RA disease activity

目的:探讨肌骨超声联合血清C反应蛋白(CRP)、血沉(ESR)在类风湿关节炎(RA)疾病活动度评估中的价值。方法:选取95例RA患者为研究对象,根据28个关节疾病活动度评分(DAS28评分)分为轻中度组(2.6分5.1分,n=30);根据肌骨超声血流信号分为0~1级组(n=50)和2~3级组(n=45);根据滑膜增生分为0~1级组(n=52)和2~3级组(n=43)。比较不同临床特征患者组间临床资料、肌骨超声参数、CRP及ESR水平,分析肌骨超声联合CRP、ESR对RA疾病活动度的评估价值。结果:重度组患者血清CRP、ESR水平高于轻中度组(P<0.05);肌骨超声血流信号分级3级、滑膜增生分级2~3级比例高于轻中度组(P<0.05)。血流信号2~3级组患者CRP及ESR水平均高于0~1级组(P<0.05)。滑膜增生2~3级组患者CRP和ESR水平高于0~1级组(P<0.05)。肌骨超声联合CRP、ESR预测RA疾病活动度的ROC曲线下面积为0.852,高于肌骨超声、CRP、ESR单独预测(P<0.05)。结论:RA患者疾病活动度越严重,肌骨超声血流信号和滑膜增生分级、CRP及ESR水平越高,在预测重度活动度方面有一定应用价值。

Objective:To explore the value of musculoskeletal ultrasound combined with C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)in evaluating the disease activity of rheumatoid arthritis(RA).Methods:95 RA patients were selected as the research subjects.According to the 28 joint disease activity scores(DAS28 score),they were divided into mild to moderate groups(2.6<DAS28 score≤5.1,n=65)and severe groups(DAS28 score>5.1,n=30).Divided into 0~1 grade groups(n=50)and 2~3 grade groups(n=45)based on the ultrasound blood flow signals of muscles and bones,and divided into 0~1 grade group(n=52)and 2~3 grade group(n=43)based on synovial hyperplasia.The clinical data,musculoskeletal ultrasound parameters,CRP and ESR levels were compared between groups of patients with different clinical characteristics,and the evaluation value of musculoskeletal ultrasound combined with CRP and ESR for RA disease activity were analyzed.Results:CRP and ESR in severe patients were higher than those in mild and moderate patients(P<0.05).The proportion of gradeⅢof musculoskeletal ultrasonic blood flow signal and the grade 2~3 of synovial hyperplasia in severe patients were higher than those in mild and moderate patients(P<0.05).Compared with in patients with blood flow signal grade 0~1,CRP and ESR in patients with blood flow signal grade 2~3 were higher(P<0.05).Compared with in patients with synovial hyperplasia grade 0~1,CRP and ESR in patients with synovial hyperplasia grade 2~3 were higher(P<0.05).The area under the ROC curve of RA disease activity predicted by musculoskeletal ultrasound combined with CRP and ESR was 0.852,which was higher than that predicted by musculoskeletal ultrasound,CRP and ESR alone(P<0.05).Conclusion:The more severe the disease activity of RA patients,the higher the musculoskeletal ultrasound blood flow signal,synovial hyperplasia grade,CRP and ESR levels,which has certain application value in predicting severe activity.