肌骨超声与超声造影检查及关节液血管生成素样蛋白4评估类风湿关节炎疾病活动度的价值  

Value of musculoskeletal ultrasonography,contrast-enhanced ultrasonography and articular fluid angiopoietin-like protein-4 in assessing disease activity in rheumatoid arthritis

作　　者：刘一博 刘昕[1] 齐丹 郑冬 刘梦 马伟松[2] LIU Yi-bo;LIU Xin;QI Dan(Department of Ultrasound,Baoding First Central Hospital,Baoding Hebei 071000,China)

机构地区：[1]保定市第一中心医院超声科,河北保定071000 [2]保定市第一中心医院骨科,河北保定071000

出　　处：《临床和实验医学杂志》2025年第5期534-538,共5页Journal of Clinical and Experimental Medicine

基　　金：河北省医学科学研究课题计划(编号:20220292)。

摘　　要：目的探讨肌骨超声、超声造影及关节液中血管生成素样蛋白4(ANGPTL4)水平与类风湿性关节炎(RA)疾病活动度的关系。方法采用回顾性病例对照试验设计方案,选取2022年5月至2024年5月在保定市第一中心医院确诊的87例RA患者作为研究对象,根据28个关节的疾病活动度评分(DAS28)将RA患者按照病情严重程度分为缓解期组19例、低活动期组22例、中活动期组26例、高活动期组20例。比较各组患者的肌骨超声结果(滑膜增生程度、关节软骨骨侵蚀程度、骨关节中血流信号丰富程度、关节中积液程度、肌骨超声总分)、超声造影结果[峰值强度(PI)、达峰时间(TTP)、斜率、平均通过时间(MTT)]及关节液中ANGPTL4水平差异,并采用线性相关分析法分析各项指标与DAS28评分的相关性。结果高活动期组、中活动期组、低活动期组、缓解期组RA患者经超声检查评估得到的滑膜增生程度、关节软骨骨侵蚀程度、骨关节中血流信号丰富程度、关节中积液程度、肌骨超声总分均表现为组间逐渐降低的趋势,上述各项超声特征评分在任意两组患者之间比较,差异均有统计学意义(P<0.05)。高活动期组、中活动期组、低活动期组、缓解期组RA患者的PI、斜率测定值组间逐渐增高的趋势,PI、斜率测定值在任意两组患者之间比较,差异均有统计学意义(P<0.05)。高活动期组、中活动期组、低活动期组、缓解期组RA患者的TTP、MTT测定值组间呈逐渐降低的趋势,除低活动期组与缓解期组MTT测定值比较差异无统计学意义外(P>0.05),TTP、MTT测定值在任意两组患者之间比较,差异均有统计学意义(P<0.05)。高活动期组、中活动期组、低活动期组、缓解期组RA患者的红细胞沉降率(ESR)、DAS28评分、ANGPTL4测定值组间呈逐渐增高的趋势,ESR、DAS28评分、ANGPTL4测定值在任意两组患者之间比较,差异均有统计学意义(P<0.05)。RA患者的�Objective To investigate the relationship between the level of angiopoietin-like protein 4(ANGPTL4)in musculoskeletal ultrasound,contrast-enhanced ultrasound and joint fluid and the disease activity of rheumatoid arthritis(RA).Methods A retrospective case-control study design was adopted,87 patients with RA diagnosed in Baoding First Central Hospital were selected as the research subjects.According to the disease activity score of 28 joints(DAS28),the RA patients were divided into four groups based on the severity of their condition:19 cases in the remission group,22 cases in the low-activity group,26 cases in the moderate-activity group,and 20 cases in the high-activity group.The results of musculoskeletal ultrasound(degree of synovial hyperplasia,degree of articular cartilage and bone erosion,richness of blood flow signal,degree of effusion in joints,total score of musculoskeletal ultrasound),contrast-enhanced ultrasound results[peak intensity(PI),time to peak(TTP),slope and mean transit time(MTT)]and ANGPTL4 level in synovial fluid were compared among the groups,linear correlation analysis was performed to assess the correlation between each index and the DAS28 score.Results The degree of synovial hyperplasia,the degree of articular cartilage bone erosion,the richness of blood flow signal in bone and joint,the degree of joint effusion,and the total score of musculoskeletal ultrasound in RA patients in the high activity group,the middle activity group,the low activity group,and the remission group were evaluated by ultrasound.The degree of synovial hyperplasia,the degree of articular cartilage bone erosion,the richness of blood flow signal in bone and joint,the degree of joint effusion,and the total score of musculoskeletal ultrasound in ultrasound examination showed a decreasing trend between the groups.The above-mentioned ultrasound feature scores were compared between the every two groups of patients,and the differences were statistically significant(P<0.05).The PI and slope measurement values of RA patients

关 键 词：类风湿性关节炎 肌骨超声 超声造影 关节液 血管生成素样蛋白4 疾病活动度 

分 类 号：R593.22[医药卫生—内科学]