摘要
目的探讨类风湿性膝关节患者的肌骨超声(Musculoskeletal ultrasound,MSUS)特征与炎性病变的关联及在临床疗效评价中的作用,为类风湿性膝关节炎的早期诊断、精准治疗及预后评估提供客观影像学依据。方法选取2022年4月至2024年3月北京中医药大学附属护国寺中医医院收治的类风湿性关节炎累及膝关节患者116例,均为活动期。入院后,根据28关节活动性评分(Disease activity score in 28 joints,DAS 28)将患者分为轻度活动组、中度活动组、重度活动组,检测炎症因子[红细胞沉降率(Erythrocyte sedimentation rate,ESR)、超敏C-反应蛋白(Hypersensitive C-reactive protein,hs-CRP)、类风湿因子(Rheumatoid factor,RF)]水平并行MSUS检查,分析3组MSUS特征与炎症病变的相关性。治疗3个月后根据疗效分为疗效良好组和疗效差组,采用受试者工作特征(Receiveroperator characteristiccurve,ROC)曲线分析MSUS对类风湿性膝关节炎患者临床疗效的预测价值。结果随着病情严重程度的增加,患者的滑膜厚度、骨侵蚀程度、关节积液深度及滑膜内血流信号评分、ESR、hs-CRP及RF水平均呈递增趋势(P<0.05)。相关性分析结果表明,滑膜厚度、骨侵蚀程度、关节积液深度、滑膜内血流信号均与ESR、hs-CRP及RF的水平呈正相关(P均<0.05)。治疗后,疗效良好患者的滑膜变薄、骨侵蚀程度、关节积液减少、滑膜内血流信号评分较疗效差患者改善更显著(P<0.05)。ROC分析揭示,在评估类风湿性膝关节炎患者的临床疗效时,MSUS参数中的滑膜厚度、骨侵蚀程度、关节积液深度、滑膜内血流信号,其单独及联合评估的曲线下面积(Area under curve,AUC)分别为0.835、0.818、0.834、0.783、0.884,联合评估效能最高(P<0.05)。结论类风湿性膝关节炎患者MSUS下可见骨侵蚀、髌上囊积液、滑膜内血流信号增强等特征,MSUS参数与炎症因子成正相关,MSUS参数可为早期关节功能评估提供客观影像学依据,进而为临床治疗方案的优化提供参考。
Objective To explore the association between musculoskeletal ultrasound(MSUS)features and inflammatory lesions in rheumatoid knee joint patients and the application of clinical efficacy evaluation,with the aim of providing objective and quantitative imaging biomarkers for the early diagnosis,precise treatment and prognosis evaluation of rheumatoid knee arthritis.Methods From April 2022 to March 2024,a total of 116 active patients with rheumatoid arthritis(RA)affecting the knee joint were enrolled in the study upon hospital admission.According to the 28 joint activity score(DAS 28),the patients were categorized into 3 distinct groups:those with mild activity,moderate activity,and severe activity.After admission,the levels of inflammatory factors[erythrocyte sedimentation rate(ESR),hypersensitive C-re-active protein(hs-CRP)and rheumatoid factor(RF)]were detected,and MSUS was examined to analyze the correlation between the characteristics of MSUS and inflammatory lesions.After 3 months of the treatment,the efficacy was divided into good and poor group.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of MSUS in the clinical efficacy of patients with rheumatoid knee arthritis.Results With the increase of the severity of the disease,the thickness of the synovial mem-brane,the degree of bone erosion,the depth of joint effusion,the blood flow signal score within the syno-vial membrane,ESR,hs-CRP and RF levels of the patients all showed an increasing trend(P<0.05).The results of the correlation analysis indicated that the thickness of the synovial membrane,the degree of bone erosion,the depth of joint effusion,and the blood flow signal within the synovial membrane were all positively correlated with the levels of ESR,hs-CRP,and RF(all P<0.05).After treatment,patients with good therapeutic outcomes showed more significant improvements in synovial thinning,bone erosion,joint effusion reduction,and scores for blood flow signals within the synovium compared to patients with poor therapeutic outcomes(P<0.05).ROC analysis revealed that in evaluating the clinical efficacy of pa-tients with RA,the AUC for the MSUS parameters-synovial thickness,bone erosion degree,joint effusion depth,and scores for blood flow signals within the synovium-were 0.835,0.818,0.834,0.783,and 0.884,respectively.The combined evaluation had the highest efficiency(P<0.05).Conclusion Bone erosion,suprapatellar sac effusion and enhanced intrasynovial blood flow signal were observed under MSUS in patients with rheumatoid knee arthritis.MSUS parameters were positively correlated with in-flammatory factors.Clinically,MSUS can be used to assess the joint function status of thepatients at an early stage,preliminarily predict the treatment outcome,and formulate appropriate interventions to im-prove the prognosis of the patients.
作者
单玉辉
李阳
乔学能
朱家安
SHAN Yuhui;LI Yang;QIAO Xueneng;ZHU Jiaan(Department of Ultrasound,Huguo Temple Hospital of Traditional Chinese Medicine Affiliated to Beijing University of Chinese Medicine,Beijing 100044,China;Department of Ultrasound Medicine,Peking University People's Hospital,Beijing 100034,China)
出处
《新疆医科大学学报》
2025年第7期957-962,967,共7页
Journal of Xinjiang Medical University
基金
北京市科技计划项目(Z201200002010220)。
关键词
类风湿性关节炎
超声检查
红细胞沉降率
超敏C反应蛋白
疗效
评估
rheumatoid arthritis(RA)
ultrasound examination
erythrocyte sedimentation rate
hypersen-sitive C-reactive protein(hs-CRP)
therapeutic effect
evaluation
作者简介
单玉辉(1973-),女,副主任医师,研究方向:浅表器官及肌骨神经超声等;通信作者:朱家安,男,硕士,主任医师,研究方向:肌骨神经超声。
