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目的探讨超声评分构建分析手类风湿性关节炎病情程度。方法选择2015年1月至2016年12月解放军第一医院收治的手类风湿性关节炎患者187例,其中男性84例,女性103例,年龄22~65岁。参照Hartung W超声评分标准,分为低分(0~1)组89例和高分(2~3)组98例。低分组男性41例,女性48例;年龄23~63岁,平均年龄43.29岁。高分组男性43例,女性55例;年龄22~65岁,平均年龄43.72岁。行超声手关节检查,观察滑膜厚度、关节腔积液、血流分级情况、骨髓水肿、骨与软骨侵蚀、肌腱炎情况,计算类风湿性关节炎疾病活动度评分、健康相关的生存质量(SF-36)评分;实验室检测C反应蛋白、红细胞沉降率、血管内皮生长因子水平。结果低分组滑膜厚度、关节腔积液比例、血流信号分级为Ⅱ或Ⅲ级比例、骨髓水肿发生率、骨与软骨侵蚀比例、肌腱炎发生率明显低于高分组[(1.28±0.41)mm vs(3.19±0.67)mm,25.84%vs 77.55%,15.73%vs 87.76%,0.00%vs 12.24%,0.00%vs 43.88%,0.00%vs 16.33%];两组比较,差异有显著统计学意义(P=0.000<0.01)。低分组类风湿性关节炎疾病活动度评分显著低于高分组[(3.28±1.48)分vs(4.78±2.06)分],差异有显著统计学意义(P=0.000)。低分组C反应蛋白水平、红细胞沉降率、血管内皮生长因子水平明显低于高分组[(5.29±2.54)mg/L vs(8.95±3.29)mg/L,(21.95±8.95)mm/h vs(35.29±11.72)mm/h,(45.37±9.92)pg/m L vs(77.85±12.77)pg/m L];两组差异有显著统计学意义(P=0.000)。低分组健康相关的生存质量(SF-36)评分显著高于高分组[(83.81±4.99)分vs(78.93±6.49)分];两组差异有显著统计学意义(P=0.000)。结论超声评分可以较好地反映手类风湿性关节炎患者病情严重度,值得进一步推广。
Objective To investigate the severity of hand rheumatoid arthritis by constructing ultrasound scoring system. Methods A total of 187 cases of rheumatoid arthritis patients admitted to the First Hospital of PLA from January 2015 to December 2016 were selected, including 84 males and 103 females, aged 22-65 years. According to the standard of Hartung W ultrasound, 89 cases were divided into low score (0 ~ 1) group and 98 high score (2 ~ 3). 41 cases of low-sub-group of males, 48 females; aged 23 to 63 years, mean age 43.29 years. High-grade group of 43 males and 55 females; aged 22 to 65 years, mean age 43.72 years. The patients underwent ultrasound hand joint examination to observe synovial thickness, joint effusion, blood flow classification, bone marrow edema, bone and cartilage erosion, tendonitis, rheumatoid arthritis disease activity score, health-related quality of life SF-36). The levels of C-reactive protein, erythrocyte sedimentation rate, and vascular endothelial growth factor were detected in the laboratory. Results The synovial thickness, the ratio of effusion in the synovium, the grade Ⅱ or Ⅲ of the blood flow signal, the incidence of bone marrow edema, the ratio of bone to cartilage erosion and the incidence of tendinitis were significantly lower than those in the high group [(1.28 ± 0.41) mm vs (3.19 ± 0.67) mm, 25.84% vs 77.55%, 15.73% vs 87.76%, 0.00% vs 12.24%, 0.00% vs 43.88% vs 0.00% vs 16.33%, respectively]; The difference between the two groups was statistically significant (P = 0.000 <0.01). The disease activity score of low-grade rheumatoid arthritis group was significantly lower than that of high-grade group (3.28 ± 1.48 vs 4.78 ± 2.06), the difference was statistically significant (P = 0.000). The levels of C reactive protein, erythrocyte sedimentation rate and vascular endothelial growth factor in low group were significantly lower than those in high group [(5.29 ± 2.54) mg / L vs (8.95 ± 3.29) mg / L vs (21.95 ± 8.95) mm / 35.29 ± 11.72) mm / h, (45.37 ± 9.92) pg / m L vs (77.85 ± 12.77) pg / m L]. There was significant difference between the two groups (P = 0.000). The health-related quality of life (SF-36) score of the low-grade group was significantly higher than that of the high-grade group [(83.81 ± 4.99) vs 78.93 ± 6.49], with significant difference between the two groups (P = 0.000). Conclusion Ultrasound score can better reflect the severity of hand rheumatoid arthritis patients, it is worth further promotion.