肌骨超声图像和类风湿性关节炎治疗后患者报告结果的相关性分析  

Correlation analysis between muscle bone ultrasound images and patient reported outcomes after treatment of rheumatoid arthritis

作　　者：陈佩瑾 王华[2] 庞树旺 CHEN Pei-jin;WANG Hua;PANG Shu-wang(Department of Ultrasound Diagnosis,Zhengzhou Yihe Hospital,Zhengzhou 450047,China;Department of Ultrasound,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)

机构地区：[1]郑州颐和医院超声诊断科,郑州450047 [2]郑州大学第二附属医院超声科,郑州450014

出　　处：《医药论坛杂志》2024年第20期2237-2240,F0003,共5页Journal of Medical Forum

摘　　要：目的通过深入分析肌骨超声图像(Musculoskeletal ultrasound,MSUS)与类风湿性关节炎治疗后患者报告结果之间的关系,为临床实践提供新的评估思路,推动该病治疗策略的进步。方法选取郑州颐和医院2021年1月至2023年12月接受治疗的类风湿关节炎患者90例,以基于C反应蛋白水平的28个关节疾病活动度评分(disease activity score-28 for rheumatoid arthritis with CRP,DAS28-CRP)≤2.6为临界点,分为临床缓解(remission,REM)/低疾病活动(LDA)组32例,高疾病活动(HDA)/中疾病活动(MDA)组58例。比较患者临床资料,MSUS包括多平面灰度(gray scale,GS)和能量多普勒(power Doppler,PD)检查,患者报告结果(patient reported outcomes,PRO)包括晨僵时间,疼痛和疲劳视觉模拟评分(visual analogue scale,VAS),健康评估问卷残疾指数(health assessment questionnaire disability index,HAQ-DI)和生活质量(EQ-5D-5L)得分。结果LDA/REM患者压痛和肿胀关节计数,CRP、ESR、类风湿因子、抗环瓜氨酸肽抗体、MMP-3水平,泼尼松龙剂量,HAQ-DI、晨僵时间、疼痛和疲劳VAS均低于HDA/MDA患者,EQ-5D-5L高于HDA/MDA患者。LDA/REM患者GS和PD评分总分较低,≥1分比率较高,≥2分和≥3分比率较低。压痛关节计数、疼痛VAS和GS评分≥2是患者DMARD治疗后LDA/REM的相关因素。GS和PD评分与DAS28-CRP、晨僵时间、HAQ-DI以及疼痛和疲劳VAS呈中度正相关,与EQ-5D-5L呈中度负相关。结论类风湿关节炎患者关节病理状况对PRO有显著影响,MSUS扫描是评估这些区域炎症和变性表现的重要工具,有助于对此类患者进行更好的治疗管理。Objective Through in-depth analysis of the relationship between MSUS images and patient reported results after treatment of rheumatoid arthritis,new evaluation ideas are provided for clinical practice to promote the advancement of treatment strategies for this disease.Methods Totally 90 patients with rheumatoid arthritis who were treated in Zhengzhou Yihe Hospital from January 2021 to December 2023 were selected and divided into clinical remission(REM)/low disease activity(LDA)group(32 cases)and high disease activity(HDA)/moderate disease activity(MDA)group(58 cases)with disease activity score-28 for rheumatoid arthritis with CRP(DAS28-CRP)≤2.6 as the critical point.The clinical data of the patients were compared.MSUs included multiplanar gray scale(GS)and power doppler(PD)examinations.Patient reported outcomes(PRO)included morning stiffness time,visual analogue scale(VAS)of pain and fatigue,health assessment questionnaire disability index(HAQ-DI)and quality of life(eq-5d-5l)scores.Results The tenderness and swelling joint count,CRP,ESR,rheumatoid factor,anti cyclic citrullinated peptide antibody,MMP-3 levels,prednisolone dose,HAQ-DI,morning stiffness time,pain and fatigue vas of patients with LDA/REM were lower than those of patients with HDA/MDA,and eq-5d-5l was higher than that of patients with HDA/MDA.The total score of GS and PD in LDA/REM patients was lower,the ratio of≥1 point was higher,and the ratio of≥2 points and≥3 points was lower.Tenderness joint count,pain vas and GS score≥2 were the influencing factors of LDA/REM after DMARD treatment.GS and PD scores were moderately positively correlated with DAS28-CRP,morning stiffness time,HAQ-DI,and pain and fatigue VAS,and moderately negatively correlated with EQ-5D-5L.Conclusion The pathological condition of joints in patients with rheumatoid arthritis has a significant impact on PRO.MSUs scanning is an important tool to evaluate the inflammatory and degenerative lesions in these areas,which is helpful for better treatment and management of such pat

关 键 词：肌肉骨骼超声检查 患者报告结果 残留症状 类风湿性关节炎 抗风湿治疗 

分 类 号：R445.1[医药卫生—影像医学与核医学]