沿海居民类风湿性关节炎相关血清学指标与肌骨超声半定量评分的相关性分析

Correlation analysis between serological indexes of rheumatoid arthritis and semi quantitative grading score by musculoskeletal ultrasound in coastal residents

目的探讨沿海居民类风湿性关节炎(RA)相关血清学指标与肌骨超声(MSUS)半定量评分的相关性。方法选取2022年1月至2023年6月秦皇岛市第一医院风湿免疫科收治的沿海居民RA患者100例作为研究对象, 依据28处关节疾病活动度(DAS28)评分法将患者分为4组:高活动期组、中活动期组、低活动期组和缓解期组。采用MSUS半定量分级对各组腕关节, 第2、3掌指关节, 第2、3近端指间关节及第2、5跖趾关节等关节进行评分, 比较各组患者相关血清学指标类风湿因子(RF)、红细胞沉降率(ESR)、C反应蛋白(CRP)水平, 采用Pearson相关性分析MSUS半定量评分与DAS28评分、RF、ESR、CRP的相关性, 使用受试者工作曲线(ROC)分析MSUS半定量评分对RA的诊断价值。结果随着病情加重, RA患者DAS28评分增加, 血清RF、ESR、CRP水平呈现明显上升趋势, 且骨侵蚀评分、滑膜增生评分、关节积液评分、滑膜内血流信号评分及总分比较, 高活动期组评分>中活动期组评分>低活动期组评分>缓解期组评分(P<0.05或P<0.01)。RA患者MSUS半定量项目评分及总评分与DAS28评分及RF、ESR、CRP水平均呈正相关(P<0.05或P<0.01)。ROC曲线结果显示, MSUS半定量评分诊断RA的曲线下面积最高, 其灵敏度和特异度分别为96.89%、79.54%, 均高于血清RF、ESR、CRP的灵敏度和特异度(P<0.05)。结论 RA患者MSUS半定量评分与DAS28评分及RF、ESR、CRP水平呈正相关, MSUS半定量评分对RA诊断具有较高灵敏度和特异度, 对病情进展具有较高的诊断价值。

Objective To explore the correlation between serological indicators related to rheumatoid arthritis(RA)and semi quantitative grading score by musculoskeletal ultrasound(MSUS)in coastal residents.Methods A total of 100 patients with RA who were admitted to the Department of Rheumatology and Immunology of the First Hospital of Qinhuangdao from January 2022 to June 2023 were selected as the research objects.According to the Disease Activity Score of 28 joints(DAS28)scoring method,the patients were divided into four groups:high activity group,moderate activity group,low activity group,and remission group.The semi-quantitative grading score by MSUS was used to evaluate the wrist joints,the 2nd and 3rd metacarpophalangeal joints,the 2nd and 3rd proximal interphalangeal joints,and the 2nd and 5th metatarsophalangeal joints in each group.The levels of rheumatoid factor(RF),erythrocyte sedimentation rate(ESR),and C-reactive protein(CRP)were compared among the RA patients in each group.Pearson correlation analysis was used to analyze the correlation between semi quantitative grading score by MSUS and DAS28 score,RF,ESR,and CRP levels.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the diagnostic value of semi-quantitative grading score by MSUS for RA.Results As the condition aggravating,the DAS28 score of RA patients increased,and the levels of serum RF,ESR,and CRP showed a significant upward trend.Moreover,the scores of bone erosion,synovial hypertrophy,joint effusion,intra-articular synovial flow signal,and the total score were significantly reduced and lower in sequence from the high activity group,the moderate activity group,low activity group,to remission group(P<0.05 or P<0.01).The semi quantitative grading score by MSUS and total score of each group were positively correlated with DAS28 score,RF,ESR,and CRP(P<0.05 or P<0.01).The ROC curve analysis revealed that the semi quantitative grading score by MSUS had the largest AUC in diagnosing RA,with sensitivity and specificity of 96.89%and 79.54%,respectively,which were higher than those of serum RF,ESR,and CRP(P<0.05).Conclusion The semi quantitative grading score by MSUS is positively correlated with DAS28 scores,RF,ESR,and CRP levels in RA patients,which has high sensitivity and specificity in diagnosing RA,thus having high diagnostic value for RA progression.