肌骨超声评分联合RF对类风湿关节炎患者病情活动度的评估价值  

Assessment value of musculoskeletal ultrasound scoring combined with RF level detection in the activity level of rheumatoid arthritis patients

作　　者：邓椀月 谢莉 李茂伦 龚裕洁 王磊 程蔚然 温乔 Deng Wanyue;Xie Li;Li Maolun;Gong Yujie;Wang Lei;Cheng Weiran;Wen Qiao(Department of Ultrasound,Ziyang Central Hospital,Ziyang Sichuan 641399,China;Department of Rheumatology,Anyue County People's Hospital,Ziyang Sichuan 642350,China;Department of Orthopedics,Anyue Hospital of Traditional Chinese Medicine,Ziyang Sichuan 642350,China;Department of Ultrasound,The Affiliated Hospital of University of Electronic Science and Technology of China&Sichuan Provincial People's Hospital,Chengdu 610000,China)

机构地区：[1]四川省资阳市中心医院超声科,四川资阳641399 [2]四川省安岳县人民医院风湿内科,四川资阳642350 [3]四川省安岳县中医医院骨伤科,四川资阳642350 [4]电子科技大学附属医院·四川省人民医院超声科,成都610000

出　　处：《保健医学研究与实践》2024年第8期45-50,110,共7页Health Medicine Research and Practice

基　　金：四川省自然科学基金项目(2022NSFSC0832);四川省资阳市科技局2023年度第二批市级科技计划项目(zykjjsc20-yyjc-2023-32)。

摘　　要：目的 探讨肌骨超声(MSUS)评分联合类风湿因子(RF)水平对类风湿关节炎(RA)患者病情活动度的评估价值。方法选取2022年1月—2023年12月资阳市中心医院收治的160例RA患者为研究对象。根据28关节疾病活动度(DAS28)评分将患者分别纳入轻度活动组(n=76,DAS28评分≤3.2分)和中重度活动组(n=84,DAS28评分>3.2分)。收集所有患者临床资料,包括MSUS评分、RF水平。采用受试者工作特性(ROC)曲线评估MSUS评分联合RF水平对RA患者病情活动度的评估价值,采用多因素logistic回归分析探讨RA患者病情活动度的影响因素。结果 中重度活动组患者滑膜增生、关节积液、骨侵蚀、滑膜内血流信号评分以及总分均高于轻度活动组,差异均有统计学意义(P<0.05)。中重度活动组患者RF水平[(235.84±30.68)IU/m L]高于轻度活动组[(91.36±17.38)IU/m L],差异有统计学意义(P<0.05)。MSUS评分、RF水平及二者联合评估RA患者病情活动度的AUC(95%CI)分别为0.838(0.793~0.887)、0.779(0.729~0.824)及0.921(0.871~0.970)。中重度活动组患者中职业性质为体力劳动者所占比例、月收入<2000元者所占比例高于轻度活动组,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,职业性质为体力劳动(OR=2.843,95%CI:1.429~5.657),MSUS评分≥8.36分(OR=4.216,95%CI:1.895~9.381),血清RF≥170.25 IU/m L(OR=3.586,95%CI:1.631~7.885)是RA患者病情活动度的影响因素(P<0.05)。结论 MSUS评分和RF水平在RA中重度活动患者中显著升高,与其疾病活动度存在密切关联,可作为联合评估RA患者病情活动度的有效检查方法。Objective To explore the assessment value of musculoskeletal ultrasound(MSUS)scoring combined with rheumatoid factor(RF)level detection in the activity level of rheumatoid arthritis(RA)patients.Methods A total of 160 RA patients admitted to Ziyang Central Hospital from January 2022 to December 2023 were selected as the research participants.Patients were allocated to mild activity(n=76,DAS28 score≤3.2 points)and moderate to severe activity groups(n=84,DAS28 score>3.2 points)based on the Disease Activity Score in 28 Joints(DAS28).Clinical data of all patients were collected,including MSUS scores and RF levels.The receiver operating characteristic(ROC)curve was used to assess the value of MSUS scores combined with RF levels in evaluating the activity level of RA patients,and multiple logistic regression analysis was employed to explore the influencing factors of RA patient activity.Results The subscale(synovial hyperplasia,joint effusion,bone erosion,and intra-articular blood flow signal)and total scores were all significantly higher in the moderate to severe activity group than in the mild activity group(P<0.05).The RF level in the moderate to severe activity group[(235.84±30.68)IU/mL]was significantly higher than in the mild activity group[(91.36±17.38)IU/mL;P<0.05].The AUC(95%CI)for evaluating the activity level of RA patients using MSUS scores,RF levels,and their combined assessment were 0.838(0.793-0.887),0.779(0.729-0.824),and 0.921(0.871-0.970),respectively.The proportion of patients in the moderate to severe activity group with physically demanding occupations and a monthly income of less than 2000 yuan was significantly higher than in the mild activity group(P<0.05).Multiple logistic regression analysis results showed physically demanding occupations(OR=2.843,95%CI:1.429-5.657),MSUS score≥8.36 points(OR=4.216,95%CI:1.895-9.381),and serum RF level≥170.25 IU/mL(OR=3.586,95%CI:1.631-7.885)are influencing factors of the activity level of patients with RA(P<0.05).Conclusion MSUS scores and RF levels are

关 键 词：类风湿关节炎 肌骨超声 类风湿因子 病情活动度 

分 类 号：R445.1[医药卫生—影像医学与核医学]