超声评估类风湿关节炎患者手和前足滑膜炎的相关性  

Evaluating the Correlation Between Hand and Forefoot Synovitis in Patients with Rheumatoid Arthritis by Ultrasound

作　　者：苗青 温德惠[2] 高辰玮[2] 胡敏霞 任占芬[2] 张文静[2] 徐大奎[2] MIAO Qing;WEN De-hui;GAO Chen-wei;HU Min-xia;REN Zhan-fen;ZHANG Wen-jing;XU Da-kui

机构地区：[1]唐山市工人医院,河北唐山063000 [2]河北北方学院附属第一医院,河北张家口075000

出　　处：《风湿病与关节炎》2024年第3期13-17,共5页Rheumatism and Arthritis

基　　金：河北省医学科学研究计划(20210405)。

摘　　要：目的:通过对类风湿关节炎患者手部及足部关节进行超声检查,结合临床指标,预测类风湿关节炎患者前足滑膜炎存在的相关因素,便于临床医师关注病情变化,及时调整治疗方案。方法:收集类风湿关节炎患者69例,对其均行二维和能量多普勒(PDUS)检查,并收集其临床指标。根据二维超声跖趾关节滑膜是否增厚将患者分为前足受累组19例和前足未受累组50例,对比2组之间临床指标和超声结果的差异,评估临床指标及手部关节超声结果与足部关节超声结果之间的相关性。结果:①前足受累组关节肿胀数(SJC)、患者的总体评估(PGA)、医师的总体评估(EGA)、DAS28评分、临床疾病活动度评分(CDAI)、手PDUS总分、手PDUS阳性关节数均明显高于前足未受累组,差异有统计学意义(P<0.05)。②前足PDUS阳性关节数与SJC、DAS28评分、CDAI间存在低度相关,与手PDUS总分之间存在显著相关(P<0.05)。③单因素变量回归分析显示,SJC、PGA、EGA、DAS28评分、手PDUS总分、手PDUS阳性关节数均是前足滑膜炎的危险因素(P<0.05)。多因素变量回归分析显示,只有手PDUS总分是前足滑膜炎的独立危险因素(P<0.05)。④类风湿关节炎患者手PDUS评分的受试者工作特征曲线(ROC)提示,当手总PDUS评分>5分时与跖趾关节滑膜炎有关,敏感性为90%,特异性为78%,提示手部PDUS评分与跖趾关节滑膜炎存在相关性。结论:手PDUS总分对于提示类风湿关节炎患者跖趾关节滑膜炎的存在具有很好的价值。Objective:To predict the relevant factors of forefoot synovitis in patients with rheumatoid arthritis by conducting ultrasound examinations of the hand and foot joints and combining clinical indicators,in order to facilitate clinical physicians'attention to changes in the condition and adjust treatment plans in a timely manner.Methods:Sixty-nine patients with rheumatoid arthritis were collected.All patients underwent twodimensional and power PDUS examinations,and their clinical indicators were collected.According to whether the synovial membrane of the metatarsophalangeal joint is thickened by two-dimensional ultrasound,patients were divided into a front-foot-affected(FFA)group of 19 cases and a front-foot-unaffected(FFU)group of 50 cases.The differences in clinical indicators and ultrasound results between the two groups were compared,and the correlation between clinical indicators and ultrasound results of hand joint and foot joint was evaluated.Results:①SJC,PGA,EGA,DAS28 score,CDAI,the total score of hand PDUS,and number of PDUS positive joints in the affected group were significantly higher than those in the unaffected group,with statistical significance(P<0.05).②There was a low correlation between the number of front foot PDUS positive joints and SJC,DAS28 score,and CDAI,but a significant correlation(P<0.05)with the total hand PDUS score.③Univariate regression analysis showed that SJC,PGA,EGA,DAS28 score,total hand PDUS score,and positive hand PDUS joint count were all risk factors for anterior foot synovitis(P<0.05).Through multivariate regression analysis,it was found that only the total score of hand PDUS was an independent risk factor for anterior foot synovitis(P<0.05)④The ROC of the receiver of hand PDUS score suggested that when the total hand PDUS score was greater than 5 points,it was associated with metatarsophalangeal synovitis,with a sensitivity of 90%and a specificity of 78%,suggesting a correlation between hand PDUS score and metatarsophalangeal synovitis.Conclusion:The total PDUS score

关 键 词：类风湿关节炎 超声检查 跖趾关节 滑膜炎 

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]