常用类风湿关节炎缓解标准的比较及临床诊疗中实用性的探讨  

Comparison of Clinical Remission Criteria of Rheumatoid Arthritis and Discussion about the Practicability in Clinical Practice

作　　者：路晓燕[1] 李春[2] 王庆文[1] 

机构地区：[1]北京大学深圳医院风湿免疫科,广东深圳518036 [2]北京大学人民医院风湿免疫科,北京100044

出　　处：《深圳中西医结合杂志》2013年第2期83-88,共6页Shenzhen Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的:了解国内类风湿关节炎(RA)的临床缓解情况,评价各RA缓解标准的优劣和临床实用性。方法:选取门诊或住院的RA患者进行现场问卷调查,使用9种RA缓解标准进行评价,了解各缓解标准达到的缓解率,对相关标准进行比较,评价各标准的相关性、差异性。结果:共完成调查问卷310份。其中240份为有效问卷。ACR标准最严格,缓解率为15.4%,缓解率最高的为DAS28-CRP标准,为47.2%。其余分别:mACR(22.1%)、Clin42(22.6%)、CDAI(23.8%)、Clin28(26%)、SDAI(26.4%)、DAS28(32.1%)、RAPID3(32.4%)。9种缓解标准之间差异有统计学意义(P=0.00)。结论:ACR标准最严格,可以认为达到真正的缓解,DAS28标准相对宽松,部分有残余病情活动。RAPID3标准操作简便,将其作为日常临床诊疗中评价病情缓解的标准值得探讨。Objective To get the message of clinical remission rate of rheumatoid arthritis（RA） patients in China, and to evaluate the advantage and practicability of remission criteria. Methods The questionnaires of patients with RA, who were receiving usual care at the two hospitals, were used for the study. We got clinical symptom and sign, laboratory data by the questionnaire. The database was analyzed according to nine criteria of remission. The remission rate of RA patients and the association, difference of the nine criteria for clinical pratice were evaluate and compared. Results Among 310 cases, 240 effective questionnaires were gotten. The remission rate ranged from 15.4 % to 47.2 %, the lowest was ACR criterion （15.4 %） and the highest was DAS28- CRP criterion （47.2%）, mACR was 22.1%, Clin42 was 22.6%, CDAI was 23.8%, Clin28 was 26%, SDAI was 26.4 %, DAS28 was 32.1%, RAPID3 was 32.4 %. The differences among the nine criterias were significant （P = 0.00）. Conclusion ACR criteria is the most strict, which can be considered as real remission. DAS28 criteria is the liberal criterion, which partly still has residual disease activity. RAPID3 criteria is feasible and maybe a useful remission criterion for busy clinical practice.

关 键 词：类风湿关节炎 缓解标准 临床诊疗 RAPID3 

分 类 号：R593.22[医药卫生—内科学]