高频超声在类风湿关节炎疗效监测中的量化应用
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摘要
目的观察高频超声在类风湿关节炎(rheumatoid arthritis,RA)疗效监测中的量化应用。方法收集RA患者60例,于治疗前、缓解期及缓解后半年进行高频超声检查,观察7个特定关节的滑膜厚度、超声灰阶(gray scale,GS)评分、血流能量多普勒(power Doppler,PD)评分,检测血红细胞沉降率、C反应蛋白、类风湿因子水平,分析关节滑膜改变与炎症指标的相关性。结果 60例RA患者共检查840个关节,治疗后缓解期和缓解后半年7个关节关节滑膜厚度、GS评分、血流PD评分、红细胞沉降率、C反应蛋白、类风湿因子水平均明显小于或低于治疗前,缓解后半年7个关节关节滑膜厚度、GS评分、PD评分、红细胞沉降率、C反应蛋白、类风湿因子水平均明显小于或低于缓解期(P<0.05)。关节滑膜厚度和滑膜血流与红细胞沉降率、C反应蛋白、类风湿因子均呈正相关(P<0.05)。结论高频超声在RA疗效监测中有确定意义,简化的7个关节GS及PD量化评分变化与炎症指标、类风湿因子滴度的变化趋势呈正相关,对制定及调整RA的治疗方案具有重要的指导意义。
Objective To investigate the quantitative application of high frequency ultrasound in monitoring the curative effect of rheumatoid arthritis. Methods Sixty patients with RA were examined by high-frequency ultrasound before treatment, during remission and half a year after remission. Synovial thickness, gray scale(GS) and power Doppler(PD) scores of seven specific joints were observed. Erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor levels were measured. The correlation between synovial changes and inflammatory indexes was analyzed. Results Compared with 840 joint ultrasound images of 60 cases of RA patients, synovial membrane thickness and GS score, blood flow PD score, erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor levels of 7 joints in remission period after treatment and half a year after remission were significantly lower than or lower than those before treatment. Six months after remission, synovial membrane thickness and GS score, PD score, erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor of 7 joints were significantly lower than those before treatment. The levels were significantly lower than or below the remission stage(P<0.05). The synovial membrane thickness and synovial blood flow were positively correlated with erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor(P<0.05). Conclusion High frequency ultrasound shows definite significance in the monitoring of rheumatoid arthritis. Simplified GS and PD quantitative scores of 7 joints are positively correlated with inflammation index and rheumatoid factor titer. It has important guiding significance for formulating and adjusting the therapeutic scheme of rheumatoid therapy.
Objective To investigate the quantitative application of high frequency ultrasound in monitoring the curative effect of rheumatoid arthritis. Methods Sixty patients with RA were examined by high-frequency ultrasound before treatment, during remission and half a year after remission. Synovial thickness, gray scale(GS) and power Doppler(PD) scores of seven specific joints were observed. Erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor levels were measured. The correlation between synovial changes and inflammatory indexes was analyzed. Results Compared with 840 joint ultrasound images of 60 cases of RA patients, synovial membrane thickness and GS score, blood flow PD score, erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor levels of 7 joints in remission period after treatment and half a year after remission were significantly lower than or lower than those before treatment. Six months after remission, synovial membrane thickness and GS score, PD score, erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor of 7 joints were significantly lower than those before treatment. The levels were significantly lower than or below the remission stage(P<0.05). The synovial membrane thickness and synovial blood flow were positively correlated with erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor(P<0.05). Conclusion High frequency ultrasound shows definite significance in the monitoring of rheumatoid arthritis. Simplified GS and PD quantitative scores of 7 joints are positively correlated with inflammation index and rheumatoid factor titer. It has important guiding significance for formulating and adjusting the therapeutic scheme of rheumatoid therapy.
引文
[1] 方思佳,周时高.超声在类风湿关节炎诊疗中的应用进展[J].风湿病与关节炎,2016,5(7):75-80.
[2] 刘敏.高频彩色多普勒超声在类风湿性关节炎跖趾关节病变诊断中的应用价值[J].河北医科大学学报,2015,36(3):362-364.
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[4] 刘玲芳,李拾林,吕国荣,等.简化的关节滑膜超声评分法评估类风湿关节炎活动性的意义[J].中国超声医学杂志,2015,31(6):530-533.
[5] Bruyn GA,Hanova P,Iagnocco A,et al.Ultrasound deinitions of tendon damage in patients with rheumatoid arthritis.Results of a OMERACT consensus-based ultrasound score focussing on the diagnostic reliability[J].Ann Rheum Dis,2014,73(11):1929-1934.
[6] Bruyn GA,Naredo E,Iagnocco A,et al.The OMERACT ultrasound working group 10 years on:update at OMERACT 12[J].J Rheumatol,2015,42(11):2172-2176.
[7] Ohrndorf S,Messerschmidt J,Reiche BE,et al.Evaluation of a new erosion score by musculoskeletal ultrasound in patients with rheumatoid arthritis:is US ready for a new erosion score?[J].Clin Rheumatol,2014,33(9):1255-1262.
[8] Dale J,Purves D,McConnachie A,et al.Tightening Up?Impact of musculoskeletal ultrasound disease activity assessment on early rheumatoid arthritis patients treated using a treat to target strategy[J].Arthritis Care Res(Hoboken),2014,66(1):19-26.
[9] Dhn UM,Terslev L,Szkudlarek M,et al.Detection,scoring and volume assessment of bone erosions by ultrasonography in rheumatoid arthritis:comparison with CT[J].Ann Rheum Dis,2013,72(4):530-534.
[10] Grassi W,Okano T,Di Geso L,et al.Imaging in rheumatoid arthritis:options,uses and optimization[J].Expert Rev Clin Immunol,2015,11(10):1131-1146.
[2] 刘敏.高频彩色多普勒超声在类风湿性关节炎跖趾关节病变诊断中的应用价值[J].河北医科大学学报,2015,36(3):362-364.
[3] Ten Cate DF,Luime JJ,Swen N,et al.Role of ultrasonography in diagnosing early rheumatoid arthritis and remission of rheumatoidarthritis-a systematic review of the literature[J].Arthritis Res Ther,2013,15(1):R4.
[4] 刘玲芳,李拾林,吕国荣,等.简化的关节滑膜超声评分法评估类风湿关节炎活动性的意义[J].中国超声医学杂志,2015,31(6):530-533.
[5] Bruyn GA,Hanova P,Iagnocco A,et al.Ultrasound deinitions of tendon damage in patients with rheumatoid arthritis.Results of a OMERACT consensus-based ultrasound score focussing on the diagnostic reliability[J].Ann Rheum Dis,2014,73(11):1929-1934.
[6] Bruyn GA,Naredo E,Iagnocco A,et al.The OMERACT ultrasound working group 10 years on:update at OMERACT 12[J].J Rheumatol,2015,42(11):2172-2176.
[7] Ohrndorf S,Messerschmidt J,Reiche BE,et al.Evaluation of a new erosion score by musculoskeletal ultrasound in patients with rheumatoid arthritis:is US ready for a new erosion score?[J].Clin Rheumatol,2014,33(9):1255-1262.
[8] Dale J,Purves D,McConnachie A,et al.Tightening Up?Impact of musculoskeletal ultrasound disease activity assessment on early rheumatoid arthritis patients treated using a treat to target strategy[J].Arthritis Care Res(Hoboken),2014,66(1):19-26.
[9] Dhn UM,Terslev L,Szkudlarek M,et al.Detection,scoring and volume assessment of bone erosions by ultrasonography in rheumatoid arthritis:comparison with CT[J].Ann Rheum Dis,2013,72(4):530-534.
[10] Grassi W,Okano T,Di Geso L,et al.Imaging in rheumatoid arthritis:options,uses and optimization[J].Expert Rev Clin Immunol,2015,11(10):1131-1146.