肌骨超声半定量参数与类风湿性关节炎活动度的相关性以及对治疗反应性的预测价值  

The relationship between MSKUS semi-quantitative parameters and RA activity,and the predictive value of that for the treatment response

作　　者：李方旭 赵聪选 洪林巍[1] LI Fang-xu;ZHAO Cong-xuan;HONG Lin-wei(Center of Ultrasonic Electrocardiogram,The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110032,China;不详)

机构地区：[1]辽宁中医药大学附属医院超声心电中心,辽宁沈阳110032

出　　处：《中国医学装备》2023年第6期86-90,共5页China Medical Equipment

基　　金：辽宁省教育厅科学技术项目(L202068)“外周关节超声在类风湿关节炎中医分型及昼夜节律中的应用研究”;沈阳市科技计划(21-173-9-35)“超声评估柴胡龙骨牡蛎汤对改善乳腺癌化疗药件物心肌毒性的应用研究”。

摘　　要：目的:探讨肌骨超声(MSKUS)半定量参数与类风湿性关节炎(RA)活动度的相关性以及对治疗反应性的预测价值。方法:选取医院收治的104例RA患者,依据28个关节疾病活动评分(DAS28)将其分为高活动度组(29例)、中活动度组(41例)及低活动度组(34例)。比较3组MSKUS半定量参数评分,分析MSKUS半定量参数与RA活动度的相关性,采用Logistic回归分析MSKUS半定量参数与治疗反应性的关系,以受试者工作特征(ROC)曲线分析MSKUS半定量参数对治疗反应性的预测价值。结果:随着RA活动度的增加,滑膜增生、滑膜内血流信号、关节积液以及骨侵蚀评分逐渐升高,3组比较差异有统计学意义(F=34.175,F=63.281,F=186.121,F=99.201;P<0.05);滑膜增生、滑膜内血流信号、关节积液以及骨侵蚀评分均与RA活动度呈正相关关系(r=0.821,r=0.812,r=0.796,r=0.799;P<0.001);无应答者滑膜增生、滑膜内血流信号、关节积液以及骨侵蚀评分高于临床应答者,差异有统计学意义(t=5.038,t=5.271,t=5.281,t=5.031;P<0.05);Logistic回归分析显示,滑膜增生、滑膜内血流信号、关节积液以及骨侵蚀评分升高均为无应答危险因素(OR=3.355,OR=4.032,OR=3.905,OR=4.710;P<0.05);ROC曲线显示,滑膜增生、滑膜内血流信号、关节积液以及骨侵蚀评分联合预测治疗反应性的ROC曲线下面积(AUC)值为0.869,灵敏度为92.00%,特异度为72.90%。结论:MSKUS半定量参数与RA活动度存在正相关关系,可有效预测RA治疗反应性,为及时采取有效及个体化治疗提供依据。Objective:To explore the relationship between the semi-quantitative parameters of musculoskeletal ultrasound(MSKUS)and the activity of rheumatoid arthritis(RA),and the predictive value of that for treatment response.Methods:A total of 104 patients with RA admitted to hospital were selected,and they were divided into high activity group(29 cases),moderate activity group(41 cases)and low activity group(34 cases)according to the activity score of 28 joint diseases(DAS28).The MSKUS semi-quantitative parameters of three groups were compared,and the relationship between MSKUS semi-quantitative parameters and RA activity was analyzed.The logistic regression was adopted to analyze the relationship between MSKUS semi-quantitative parameters and treatment response,and the receiver operating characteristics(ROC)curve was used to analyze the predictive value of MSKUS semi-quantitative parameters to treatment response.Results:With the increasing of RA activity,synovial hyperplasia,intra-synovial blood flow signal,joint effusion and bone erosion scores gradually increased,and the differences of them among the three groups were statistically significant(F=34.175,F=63.281,F=186.121,F=99.201,P<0.05),respectively.The synovial hyperplasia,intra-synovial blood flow signal,joint effusion and bone erosion scores were respectively positive correlation with RA activity(r=0.821,r=0.812,r=0.796,r=0.799,P<0.001).The synovial hyperplasia,intra-synovial blood flow signal,joint effusion and bone erosion scores of patients without response were respectively higher than those of patients with clinical response(t=5.038,t=5.271,t=5.281,t=5.031,P<0.05).Logistic regression analysis showed that the synovial hyperplasia,intra-synovial blood flow signal,joint effusion and the increased bone erosion score were all risk factors of non-response(OR=3.355,OR=4.032,OR=3.905,OR=4.710,P<0.05).The ROC curve showed that the area under curve(AUC),sensitivity and specificity of the combination of synovial hyperplasia,intra-synovial blood flow signal,joint effusio

关 键 词：肌骨超声(MSKUS)半定量参数 类风湿性关节炎(RA) 活动度 治疗反应性 

分 类 号：R445.1[医药卫生—影像医学与核医学] R593.22[医药卫生—诊断学]