肌骨超声分级联合血清标志物对类风湿关节炎活动度的预测效能

Performance of musculoskeletal ultrasound grading combined with serum biomarkers in predicting the activity of rheumatoid arthritis

目的探讨肌骨超声半定量分级及基质金属蛋白酶-3(MMP-3)、可溶性程序性死亡受体-1(sPD-1)对类风湿关节炎(RA)活动性的预测价值。方法选取2020年1月-2023年9月在我院诊治的RA病人176例,按照28处关节疾病活动度评分分为高活动组(33例)、中活动组(62例)、低活动组(54例)和缓解期组(27例),选取健康志愿者40例作为对照组。分析肌骨超声半定量总分、MMP-3、sPD-1对RA活动性(低、中、高活动为有活动性,缓解期和对照为非活动性)的预测价值。结果各组肌骨超声半定量(滑膜增生、滑膜血流信号、骨侵蚀、关节积液)评分及总分、MMP-3、sPD-1差异有显著意义(F=119.860~290.329,P<0.05)。肌骨超声半定量总分、MMP-3、sPD-1预测RA活动性的受试者工作特征曲线下面积(AUC)为0.977、0.964、0.888,三者联合预测的AUC为0.986,灵敏度为95.3%,特异度为100.0%。三者联合预测RA活动性的AUC优于sPD-1(Z=-3.395,P=0.001),MMP-3和肌骨超声半定量总分预测的AUC也优于sPD-1(Z=-2.462、-3.026,P=0.002)。结论肌骨超声半定量分级、MMP-3、sPD-1对RA病人疾病活动性有较好的预测价值,三者联合预测价值更高。

Objective To investigate the value of semi-quantitative musculoskeletal ultrasound grading combined with matrix metalloproteinase-3(MMP-3)and soluble programmed death-1(sPD-1)in predicting the activity of rheumatoid arthritis(RA).Methods A total of 176 RA patients who were diagnosed and treated in our hospital from January 2020 to September 2023 were enrolled,and according to the activity scores of 28 joint diseases,they were divided into high activity group with 33 patients,medium activity group with 62 patients,low activity group with 54 patients,and remission group with 27 patients;40 healthy volunteers were enrolled as control group.The total score of semi-quantitative musculoskeletal ultrasound,MMP-3,and sPD-1 were analyzed in terms of their value in predicting the activity of RA(low,medium,and high activity were defined as active and remission and control were defined as inactive).Results There were significant differences between groups in the total score of semi-quantitative musculoskeletal ultrasound,the scores of synovial hyperplasia,synovial blood flow signal,bone erosion,and joint effusion,and the levels of MMP-3 and sPD-1(F=119.860-290.329,P<0.05).The total score of semi-quantitative musculoskeletal ultrasound,MMP-3,and sPD-1 had an area under the ROC curve(AUC)of 0.977,0.964,and 0.888,respectively,in predicting the activity of RA,and the combination of these three indicators had an AUC of 0.986,with a sensitivity of 95.3%and a specificity of 100.0%.The combination of the three indicators had a better AUC than sPD-1 in predicting the activity of RA(Z=-3.395,P=0.001),and MMP-3 and the total score of semi-quantitative musculoskeletal ultrasound also had a better AUC than sPD-1(Z=-2.462,-3.026,P=0.002).Conclusion Semi-quantitative musculoskeletal ultrasound grading,MMP-3,and sPD-1 have a good value in predicting disease activity in RA patients,and the combination of these three indicators has a higher predictive value.