彩色多普勒超声和抗环瓜氨酸肽抗体在类风湿关节炎病情评估中的应用价值  

Value of ultrasonography and anti-cyclic citrullinated peptide antibody for evaluating activity of rheumatoid arthritis

作　　者：陈琳[1] 李慧颖[1] 姜国平[1] 吕英春[1] 张晓宏[2] 韩梅[1] 

机构地区：[1]吉林省人民医院血液风湿科,长春130021 [2]吉林省人民医院超声科,长春130021

出　　处：《中国医药》2015年第9期1333-1335,共3页China Medicine

基　　金：吉林省自然科学基金

摘　　要：目的 探讨彩色多普勒超声和抗环瓜氨酸肽（CCP）抗体在类风湿关节炎（RA）病情评估中的价值.方法 选择2010年3月至2013年12月于吉林省人民医院就诊的RA患者105例,所有患者均行腕关节、掌指关节、近端指间关节、肘关节、膝关节、踝关节彩色多普勒超声检查,记录受累关节个数、部位以及有无关节腔积液、滑膜血管翳生成、骨侵蚀,同时检测滑膜厚度、血清抗CCP抗体、红细胞沉降率（ESR）、C反应蛋白（CRP）、类风湿因子（RF）,计算病情活动度（DAS28评分）.根据抗CCP抗体检测结果将RA患者分为抗CCP抗体阳性组和抗CCP抗体阴性组;根据DAS28评分将患者分为疾病轻度活动组和疾病中重度活动组,分别比较2组患者关节超声的改变情况.结果 抗CCP抗体阳性组55例,抗CCP抗体阴性组50例,抗CCP抗体阴性组关节受累个数（239个）明显多于抗CCP抗体阳性组（196个）.抗CCP抗体阳性组患者抗CCP抗体、RF水平明显高于抗CCP抗体阴性组[（155 ±91） RU/ml比（13±4） RU/ml,（228±60） IU/L比（95 ±45） IU/L],差异均有统计学意义（均P＜0.05）;2组关节滑膜厚度、ESR、CRP、DAS28评分比较,差异均无统计学意义（均P＞0.05）.疾病轻度活动组40例,疾病中重度活动组65例;疾病中重度活动组患者关节滑膜厚度明显高于疾病轻度活动组[（2.8±1.0）mm比（2.2 ±0.8）mm],差异有统计学意义（P＜0.05）.结论 彩色多普勒超声能确定RA受累关节,动态观察疾病活动程度,可广泛应用于RA患者的疾病活动监测.Objective To investigate the value of ultrasonography and anti-cyclic citrullinated peptide （CCP） antibody for evaluating the activity of rheumatoid arthritis （RA）.Methods Totally 105 consecutive patients with RA from March 2010 to December 2013 were enrolled and underwent ultrasound of bilateral wrist,metacarpophalangeal,proximal intephalangeal,elbow,knee and ankle joints to determine the number and location of involved joint,joint effusion,synovial pannus,bone erosion,synovial thickness.The anti-CCP antibody,rheumatoid factor（RF）,erythrocyte sedimentation（ESR） and C-reactive protein（CRP） were measured.According to the level of anti-CCP antibody,the patients were divided into positive anti-CCP group and negative anti-CCP group.The disease activity score 28 joints （DAS-28） were calculated and the patients were divided into mild activity group and moderate-severe activity group according to the DAS-28 score.The ultrasound parameters were compared between different groups.Result There were 55 cases in positive anti-CCP group and 50 cases in negative anti-CCP group.The numbers of involved joints,the levels of anti-CCP and RF in negative anti-CCP group were higher than those in positive anti-CCP group [239 vs 196,（155 ± 91） RU/ml vs （13 ± 4） RU/ml,（228 ±60） IU/L vs （95 ±45） IU/L] （P 〈0.05） ; there were no differences in synovial thickness,ESR,CRP and DAS28 between the two groups （P 〉 0.05）.There were 40 cases in mild activity group and 65 cases in moderate-severe activity group.The synovial thickness in moderate-severe activity group was significantly greater than that in mild activity group [（2.8-± 1.0） mm vs （2.2 ±0.8） mm] （P 〈0.05）.Conclusion Ultrasonography can determine the involved joints and observe the disease activity in patients with RA.

关 键 词：关节炎 类风湿 环瓜氨酸肽 超声检查 多普勒 彩色 

分 类 号：R684.3[医药卫生—骨科学]