多关节超声评分对早期类风湿关节炎的评估作用
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摘要
背景:早发现、早诊断、早治疗为早期类风湿关节炎临床防治的重点,超声评分系统能够为疾病的诊疗提供量化信息。目的:分析多关节超声评分在早期类风湿关节炎诊疗中的应用价值。方法:以50例早期类风湿关节炎患者为观察组,以70例健康志愿者为对照组。2组对象均予以高频超声检查,检查关节包括腕关节、第二指近端指间关节、第三指近端指间关节、第二指掌指关节、第三指掌指关节、第二跖指关节、第五跖指关节共7个关节,统计并比较2组对象的7关节超声评分。同时根据患者临床病历资料,对比分析不同疾病活动分期、功能活动分级、体征分级早期类风湿性关节炎患者的7关节超声评分;另外检测观察组患者血清超敏C-反应蛋白和白细胞介素6水平,对比分析血清超敏C-反应蛋白和白细胞介素6阳性组和阴性组患者的7关节超声评分。结果与结论:①观察组患者7个关节的平均超声评分均高于对照组(P <0.05),且平均7关节超声评分高于对照组(P <0.05);②在平均7关节超声评分上,疾病活动分期中重度活动期组>稳定期、轻度活动期组(P <0.05),功能活动分级Ⅲ-Ⅳ级组>Ⅰ-Ⅱ级组(P <0.05),体征分级Ⅱ-Ⅲ级组>0-Ⅰ级组(P <0.05),且血清超敏C-反应蛋白、白细胞介素6阳性组患者均高于阴性组(P <0.05);③提示7关节超声评分能全面描述早期类风湿关节炎患者的基础临床特征,并可用以评估患者病情活动性、功能活动程度、炎性病变程度及关节损伤程度,为早期类风湿关节炎的诊疗提供参考依据。
BACKGROUND: Early discovery, diagnosis and treatment are critical for the prevention and treatment of early rheumatoid arthritis.Ultrasound scoring system can provide quantified data for the disease diagnosis and treatment.OBJECTIVE: To study the application value of seven joint ultrasound score in the diagnosis and treatment of early rheumatoid arthritis.METHODS: Fifty patients with early rheumatoid arthritis were as observation group, and 70 healthy subjects were as control group. All subjects were examined by high-frequency ultrasound. The joints included wrist joints, proximal interphalangeal joint of the second finger,proximal interphalangeal joint of the third finger, metacarpophalangeal joint of the second finger, metacarpophalangeal joint of the third finger,second metatarsophalangeal joint and fifth metatarsophalangeal joint. The seven joint ultrasound scores were compared between two groups.According to the clinical data, the seven joint ultrasound scores of patients with early rheumatoid arthritis at different stages of disease activity,function classification and grading signs were compared. The serum levels of high-sensitivity C-reactive protein and interleukin-6 were detected in the observation group. The seven joint ultrasound scores were compared between high-sensitivity C-reactive protein and interleukin-6 positive and negative groups.RESULTS AND CONCLUSION:(1) The average score of seven joints in the observation group was higher than that in the control group(P <0.05), and the average seven joint ultrasound score was higher than that in the control group(P < 0.05).(2) For the average seven joint ultrasound score, staging of disease activity in moderate severe group > stable and mild activity group(P < 0.05), grade III-IV group > grade I-II group(P < 0.05), sign grade II-III group > sign grade 0-I group(P < 0.05), and high-sensitivity C-reactive protein and interleukin-6 positive group > negative group(P < 0.05).(3) To conclude, the seven joint ultrasound score can fully describe the basic clinical characteristics of early rheumatoid arthritis, and can evaluate the disease activity, functional activity, the inflammatory degree and the degree of joint injury, so as to provide a reference for the diagnosis and treatment of early rheumatoid arthritis.
BACKGROUND: Early discovery, diagnosis and treatment are critical for the prevention and treatment of early rheumatoid arthritis.Ultrasound scoring system can provide quantified data for the disease diagnosis and treatment.OBJECTIVE: To study the application value of seven joint ultrasound score in the diagnosis and treatment of early rheumatoid arthritis.METHODS: Fifty patients with early rheumatoid arthritis were as observation group, and 70 healthy subjects were as control group. All subjects were examined by high-frequency ultrasound. The joints included wrist joints, proximal interphalangeal joint of the second finger,proximal interphalangeal joint of the third finger, metacarpophalangeal joint of the second finger, metacarpophalangeal joint of the third finger,second metatarsophalangeal joint and fifth metatarsophalangeal joint. The seven joint ultrasound scores were compared between two groups.According to the clinical data, the seven joint ultrasound scores of patients with early rheumatoid arthritis at different stages of disease activity,function classification and grading signs were compared. The serum levels of high-sensitivity C-reactive protein and interleukin-6 were detected in the observation group. The seven joint ultrasound scores were compared between high-sensitivity C-reactive protein and interleukin-6 positive and negative groups.RESULTS AND CONCLUSION:(1) The average score of seven joints in the observation group was higher than that in the control group(P <0.05), and the average seven joint ultrasound score was higher than that in the control group(P < 0.05).(2) For the average seven joint ultrasound score, staging of disease activity in moderate severe group > stable and mild activity group(P < 0.05), grade III-IV group > grade I-II group(P < 0.05), sign grade II-III group > sign grade 0-I group(P < 0.05), and high-sensitivity C-reactive protein and interleukin-6 positive group > negative group(P < 0.05).(3) To conclude, the seven joint ultrasound score can fully describe the basic clinical characteristics of early rheumatoid arthritis, and can evaluate the disease activity, functional activity, the inflammatory degree and the degree of joint injury, so as to provide a reference for the diagnosis and treatment of early rheumatoid arthritis.
引文
[1]温朝美,张萍.肌骨超声评分系统在类风湿关节炎中的应用[J].中国医学影像技术,2016,32(5):807-810.
[2]张玮婧,金志斌,张捷,等.超声在早期类风湿关节炎目标治疗中的监测作用[J].中国超声医学杂志,2017,33(4):338-341.
[3]郑洁,张文静,邱少东,等.改良的7关节半定量超声对类风湿关节炎治疗前后的评价[J].中国超声医学杂志,2016,32(2):170-172.
[4]吴娇娇,朱向明,李国杰.28关节超声评分法在类风湿关节炎病情评估中的应用价值[J].皖南医学院学报,2017,36(3):277-279.
[5]章春来,张菁菁,雷建明.超声评分在膝关节类风湿关节炎中的临床意义[J].重庆医学,2017,46(21):2923-2926.
[6]高培森,任水明,刘磊,等.高频超声在类风湿关节炎患者神经卡压诊断中的应用价值[J].中国医学科学院学报,2016,38(3):327-330.
[7]华兴,邹庆华,方勇飞,等.小关节超声整体评分系统在类风湿关节炎疗效评价中的应用[J].临床超声医学杂志,2016,18(8):512-516.
[8]王海隆,姜泉,刘维,等.《类风湿关节炎中医诊疗指南》临床应用评价研究[J].中华中医药杂志,2016,31(10):4103-4106.
[9]吴景玲,薛卫军,成慧霞.超声评分构建在手类风湿性关节炎患者中的应用价值[J].生物医学工程与临床,2017,21(5):502-506.
[10]陈美西,刘秉彦,林坚平,等.类风湿关节炎患者肌骨超声半定量分级与疾病活动度及骨代谢平衡的关系[J].山东医药,2017,57(32):62-64.
[11]Hirata A,Ogura T,Hayashi N,et al.Concordance of patient‐reported joint symptoms,physician‐examined arthritic signs,and ultrasound‐detected synovitis in rheumatoid arthritis.Arthritis Care Res.2017;69(6):801-806.
[12]Finzel S,Ohrndorf S,Englbrecht M,et al.A detailed comparative study of high-resolution ultrasound and micro-computed tomography for detection of arthritic bone erosions.Arthritis Rheum.2011;63(5):1231-1236.
[13]Zhang LY,Qiu L,Wang L,et al.[Destruction of synovial pannus of antigen-induced arthritis by ultrasonic cavitation in rabbits].Sichuan Daxue Xuebao(Yixue Ban).2012;42(6):850-855.
[14]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.
[15]游岚岚,郑元义,王志刚,等.4项指标7个关节超声诊断类风湿关节炎[J].重庆医科大学学报,2014,39(10):1478-1483.
[16]宋佳,杜引会,张巧娟,等.类风湿性关节炎肩关节高频超声评分与多项血清学指标的相关性分析[J].中华实用诊断与治疗杂志,2017,31(10):1011-1013.
[17]陈红菊,程大伟,张新颖.高频超声在类风湿性关节炎腕关节早期病变中的诊断价值[J].中国实用医药,2017,12(8):64-65.
[18]周凌.基质金属蛋白酶-3和超声US7评分在类风湿关节炎中的评价[D].上海:第二军医大学,2016.
[19]吴娇娇,朱向明,胡怡芳,等.7关节超声评分在中西医治疗类风湿关节炎疗效评估中的应用[J].中国介入影像与治疗学,2017,14(9):556-560.
[20]宋佳,杜引会,张巧娟,等.类风湿性关节炎肩关节高频超声评分与多项血清学指标的相关性分析[J].中华实用诊断与治疗杂志,2017,31(10):1011-1013.
[21]纪宗萍.类风湿性关节炎膝关节高频彩色多普勒超声临床应用评价[J].中国实用医药,2016,11(17):72-73.
[22]张镔.超声早期检查类风湿性关节炎中的应用价值分析[J].中国伤残医学,2014,22(5):162-163.
[23]张英娟,刘健,刘晓玲,等.类风湿性关节炎:膝关节高频超声及超声造影表现与实验室检查的相关性[J].中国医学影像技术,2012,28(5):986-989.
[24]毛剑莹,赵小虎,张兰,等.超声对类风湿性肩关节炎的早期诊断价值[J].中国医学影像技术,2012,28(10):1894-1897.
[25]杜引会,赵丽娟,宋佳,等.高频超声与MRI在类风湿关节炎腕关节病变诊断中的价值[J].中华实用诊断与治疗杂志,2018,32(9):855-857.
[2]张玮婧,金志斌,张捷,等.超声在早期类风湿关节炎目标治疗中的监测作用[J].中国超声医学杂志,2017,33(4):338-341.
[3]郑洁,张文静,邱少东,等.改良的7关节半定量超声对类风湿关节炎治疗前后的评价[J].中国超声医学杂志,2016,32(2):170-172.
[4]吴娇娇,朱向明,李国杰.28关节超声评分法在类风湿关节炎病情评估中的应用价值[J].皖南医学院学报,2017,36(3):277-279.
[5]章春来,张菁菁,雷建明.超声评分在膝关节类风湿关节炎中的临床意义[J].重庆医学,2017,46(21):2923-2926.
[6]高培森,任水明,刘磊,等.高频超声在类风湿关节炎患者神经卡压诊断中的应用价值[J].中国医学科学院学报,2016,38(3):327-330.
[7]华兴,邹庆华,方勇飞,等.小关节超声整体评分系统在类风湿关节炎疗效评价中的应用[J].临床超声医学杂志,2016,18(8):512-516.
[8]王海隆,姜泉,刘维,等.《类风湿关节炎中医诊疗指南》临床应用评价研究[J].中华中医药杂志,2016,31(10):4103-4106.
[9]吴景玲,薛卫军,成慧霞.超声评分构建在手类风湿性关节炎患者中的应用价值[J].生物医学工程与临床,2017,21(5):502-506.
[10]陈美西,刘秉彦,林坚平,等.类风湿关节炎患者肌骨超声半定量分级与疾病活动度及骨代谢平衡的关系[J].山东医药,2017,57(32):62-64.
[11]Hirata A,Ogura T,Hayashi N,et al.Concordance of patient‐reported joint symptoms,physician‐examined arthritic signs,and ultrasound‐detected synovitis in rheumatoid arthritis.Arthritis Care Res.2017;69(6):801-806.
[12]Finzel S,Ohrndorf S,Englbrecht M,et al.A detailed comparative study of high-resolution ultrasound and micro-computed tomography for detection of arthritic bone erosions.Arthritis Rheum.2011;63(5):1231-1236.
[13]Zhang LY,Qiu L,Wang L,et al.[Destruction of synovial pannus of antigen-induced arthritis by ultrasonic cavitation in rabbits].Sichuan Daxue Xuebao(Yixue Ban).2012;42(6):850-855.
[14]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.
[15]游岚岚,郑元义,王志刚,等.4项指标7个关节超声诊断类风湿关节炎[J].重庆医科大学学报,2014,39(10):1478-1483.
[16]宋佳,杜引会,张巧娟,等.类风湿性关节炎肩关节高频超声评分与多项血清学指标的相关性分析[J].中华实用诊断与治疗杂志,2017,31(10):1011-1013.
[17]陈红菊,程大伟,张新颖.高频超声在类风湿性关节炎腕关节早期病变中的诊断价值[J].中国实用医药,2017,12(8):64-65.
[18]周凌.基质金属蛋白酶-3和超声US7评分在类风湿关节炎中的评价[D].上海:第二军医大学,2016.
[19]吴娇娇,朱向明,胡怡芳,等.7关节超声评分在中西医治疗类风湿关节炎疗效评估中的应用[J].中国介入影像与治疗学,2017,14(9):556-560.
[20]宋佳,杜引会,张巧娟,等.类风湿性关节炎肩关节高频超声评分与多项血清学指标的相关性分析[J].中华实用诊断与治疗杂志,2017,31(10):1011-1013.
[21]纪宗萍.类风湿性关节炎膝关节高频彩色多普勒超声临床应用评价[J].中国实用医药,2016,11(17):72-73.
[22]张镔.超声早期检查类风湿性关节炎中的应用价值分析[J].中国伤残医学,2014,22(5):162-163.
[23]张英娟,刘健,刘晓玲,等.类风湿性关节炎:膝关节高频超声及超声造影表现与实验室检查的相关性[J].中国医学影像技术,2012,28(5):986-989.
[24]毛剑莹,赵小虎,张兰,等.超声对类风湿性肩关节炎的早期诊断价值[J].中国医学影像技术,2012,28(10):1894-1897.
[25]杜引会,赵丽娟,宋佳,等.高频超声与MRI在类风湿关节炎腕关节病变诊断中的价值[J].中华实用诊断与治疗杂志,2018,32(9):855-857.
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