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  

Value of therapeutic effect evaluation on rheumatoid arthritis for small joints by ultrasonic global scoring system

作　　者：华兴[1] 邹庆华[2] 方勇飞[2] 郭燕丽[1] 何芸[1] 冯玉洁[1] 

机构地区：[1]第三军医大学西南医院超声科,重庆市400038 [2]第三军医大学西南医院中西医结合风湿病科,重庆市400038

出　　处：《临床超声医学杂志》2016年第8期512-516,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的建立成人小关节超声整体评分系统(GLOSS),探讨其在类风湿关节炎(RA)疗效评价中的应用价值。方法选取RA患者38例,于抗风湿药物(DMARDs)治疗的起点、3个月、6个月、9个月及12个月分别行疾病活动性评分(DAS28)、C反应蛋白(CRP)、红细胞沉降率(ESR)及GLOSS检查。灰阶超声(GSUS)和能量多普勒超声(PDUS)检查分别对滑膜炎、滑膜/腱鞘炎血流及骨侵蚀进行半定量分级;并将26个关节区域的相应评分总和形成GLOSS整体评分,比较各时间点的差异;评价各GLOSS与DAS28、CRP及ESR值之间的相关性。结果患者经过1年治疗后DAS28、CRP、ESR值,以及滑膜炎GSUS、滑膜炎PDUS和肌腱/腱鞘炎PDUS值较治疗起点明显下降,差异均有统计学意义(均P<0.01);肌腱/腱鞘炎GSUS与骨侵蚀值无明显变化。DAS28与滑膜炎GSUS、滑膜炎PDUS及肌腱/腱鞘炎PDUS均呈正相关(r=0.426、0.502、0.354,均P<0.01);ESR与滑膜炎PDUS呈正相关(r=0.297,P<0.01)。结论 GLOSS可有效反映RA治疗后变化,并与临床及实验室指标有良好的相关性,可作为RA评价疗效的指标。Objective To construct the ultrasonic global scoring system（GLOSS）of human small joints and assess its value in the therapeutic effect evaluation on rheumatoid arthritis（RA）. Methods Thirty-eight patients with RA were involved in this study. DAS28,CRP,ESR and GLOSS were examined at the start point and 3,6,9 and 12 months after treatment of diseasemodifying anti-rheumatic drugs（DMARDs）,respectively. Synovitis,teno / synovitis and bone erosion were semi- quantitatively graded by grey-scale（GSUS）ultrasonography and power Doppler（PDUS）,and corresponding scores were recorded. The sum of the scores of 26 joints was considered as the GLOSS value. The differences of GLOSS,DAS28,CRP and ESR at different time and the correlations between GLOSS and DAS28,CRP and ESR were analyzed. Results Twelve months aftertreatment,values of synovitis GSUS,synovitis PDUS and teno/synovitis PDUS in GLOSS,DAS28,CRP and ESR decreased significantly（all P〈0.01）.However, teno/synovitis GSUS and bone erosion in GLOSS changed not significantly. There were positive correlations between DAS28 and synovitis GSUS,PDUS and teon/synovitis PDUS（r=0.426,0.502,0.354,all P〈0.01）,and between ESR and synovitis PDUS（r = 0. 297,P〈0.01）. Conclusion GLOSS can effectively reflect the changes of RA after treatment and have a good correlation with the clinical and laboratory parameters,therefore, it could be used as an evaluation index for the treatment of RA in future.

关 键 词：超声检查 整体评分系统 类风湿关节炎 疗效评价 

分 类 号：R593.22[医药卫生—内科学] R445.1[医药卫生—临床医学]