老年类风湿性关节炎的肌骨超声病理特征及其与ESR、CRP等炎性指标的相关性研究  

Study on the pathological characteristics of musculoskeletal ultrasound in senile rheumatoid arthritis and its correlation with inflammatory indexes such as ESR and CRP

作　　者：褚静洁[1] 赵航一 王平 CHU Jing-jie;ZHAO Hang-yi;WANG Ping(Department of Ultrasound,Anshan Central Hospital,Anshan Liaoning 221000,China;Department of Orthopedics,The Second Hospital of Tangshan,Tangshan Hebei 063000,China)

机构地区：[1]鞍山市中心医院超声科,辽宁鞍山221000 [2]唐山市第二医院骨科,河北唐山063000

出　　处：《临床和实验医学杂志》2025年第1期84-88,共5页Journal of Clinical and Experimental Medicine

基　　金：河北省医学科学研究课题(编号:20191511)。

摘　　要：目的 研究老年类风湿性关节炎的肌骨超声病理特征及其与红细胞沉降率(ESR)、C反应蛋白(CRP)等炎性指标的相关性。方法 回顾性选取2020年8月至2021年10月鞍山市中心医院收治的67例老年RA患者(共176个关节)作为研究对象。均行肌骨超声、MRI、X线检查及炎性指标[ESR、CRP、肿瘤坏死因子-α(TNF-α)、类风湿因子(RF)、白细胞介素-6(IL-6)和抗环瓜氨酸多肽抗体(anti-CCP)]检测。采用Spearman相关性分析法分析肌骨超声病理特征与ESR、CRP、TNF-α、RF、IL-6及anti-CCP的相关性。结果 肌骨超声对滑膜增生和关节积液的检出率分别为75.57%、60.80%,明显高于X线(0、0),对关节积液的检出率明显高于MRI,差异均有统计学意义(P<0.05);MRI对滑膜增生和关节积液的检出率分别为71.59%、42.05%,明显高于X线(0、0),差异均有统计学意义(P<0.05);但3种方法对骨侵蚀的检出率比较,差异无统计学意义(P>0.05)。不同滑膜厚度分级之间血清ESR、CRP、TNF-α、RF、IL-6及anti-CCP水平比较,差异无统计学意义(P>0.05)。不同滑膜血流信号分级之间血清ESR、CRP、TNF-α、RF、IL-6及anti-CCP水平比较,差异均有统计学意义(P<0.05)。活动期RA患者滑膜内动脉RI为0.65±0.14,显著低于非活动期RA患者(0.84±0.16),差异有统计学意义(P<0.05)。Spearman分析结果显示,滑膜厚度与ESR、CRP、TNF-α、RF、IL-6及anti-CCP水平无相关性(P>0.05),滑膜血流信号与ESR、CRP、TNF-α、RF、IL-6及anti-CCP水平均呈正相关(P<0.05)。结论 肌骨超声对骨膜增生、关节积液的诊断效率显著高于MRI和X线,且能在滑膜血流信号与炎性指标之间建立相关性,结合滑膜内动脉RI进行信息交叉验证,更能有效地动态评估病情进展,对临床制定及调整治疗方案有重要意义。Objective To study the pathological characteristics of musculoskeletal ultrasound in senile rheumatoid arthritis and its correlation with inflammatory indicators such as erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP).Methods A total of 67 elderly patients with RA(176 joints)admitted to Anshan Central Hospital from August 2020 to October 2021 were retrospectively selected as the study subjects.All patients underwent musculoskeletal ultrasound,MRI,X-ray examination and inflammatory indexes[ESR,CRP,tumor necrosis factor-α(TNF-α),rheumatoid factor(RF),interleukin-6(IL-6)and anti-cyclic citrullinated polypeptide antibody(anti-CCP)]detection.The correlation between the pathological characteristics of musculoskeletal ultrasound and ESR,CRP,TNF-α,RF,IL-6 and anti-CCP was analyzed using Spearman correlation analysis method.Results The detection rates of synovial hyperplasia and joint effusion by musculoskeletal ultrasound were 75.57%and 60.80%,respectively,which were significantly higher than those by X-ray(0,0).The detection rate of joint effusion by musculoskeletal ultrasound was significantly higher than that by MRI,and the differences were statistically significant(P<0.05).The detection rates of synovial hyperplasia and joint effusion by MRI were 71.59%and 42.05%,respectively,which were significantly higher than those by X-ray(0,0),and the differences were statistically significant(P<0.05).However,there was no statistically significant difference in the detection rate of bone erosion among the three methods(P>0.05).The RI of intrasynovial artery in active RA patients was 0.65±0.14,which was significantly lower than that in inactive RA patients(0.84±0.16),and the difference was statistically significant(P<0.05).There were no statistically significant differences in serum ESR,CRP,TNF-α,RF,IL-6 and anti-CCP levels between different synovial thickness grades(P>0.05).There were statistically significant differences in serum ESR,CRP,TNF-α,RF,IL-6 and anti-CCP levels between different synovial blood fl

关 键 词：老年类风湿性关节炎 肌骨超声 病理特征 红细胞沉降率 C反应蛋白 

分 类 号：R59[医药卫生—内科学]