CHEN Dan,LI Yongji,WANG Xiaobing, et al. Ultrasound and clinical assessment on the treatment of rheumatoid arthritis[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2014, 44(6): 431-434.
摘要目的：探讨不同阶段类风湿关节炎（rheumatoid arthritis，RA）治疗的超声和临床评估。方法：分别选用早期RA患者（A组）和非早期RA患者（B组）共45例，予改善病情的抗风湿药物加用依那西普治疗3个月。主要评价标准是治疗前、治疗后检测病变关节的灰阶超声及能量多普勒超声等各项指标变化，次要标准是临床、实验室、疾病活动性评分（disease activity score-28，DAS28）等各项指标变化。结果：与B组比较，A组能量多普勒超声评分在治疗6周（2.07±0.41 vs 3.93±0.40）、12周（0.51±0.27 vs 1.47±0.26）后均降低（p＜0.01或p＜0.05）；A组与B组比较，治疗6周后的晨僵时间[（0.00±0.04）min vs（0.16±0.04）min]、血沉[（23.66±3.04）mm/h vs（36.84±2.97）mm/h]、C反应蛋白[（6.29±1.79）mg/L vs（11.37±1.75）mg/L]、健康评估问卷（HAQ）评分（7.43±1.07 vs 12.73±0.97）和治疗12周后的血沉[（15.34±1.91）mm/h vs（23.11±1.87）mm/h]、HAQ评分（2.71±0.98 vs 7.37±0.89）、DAS28（2.50±0.21 vs 3.20±0.20）均降低（p＜0.05或p＜0.01）。多数患者的超声缓解晚于临床和实验室的缓解。结论：依那西普联合抗风湿药物治疗对早期和非早期RA均有疗效，但对早期RA疗效更佳，超声检查能正确反映RA的关节病变，在RA随访治疗中应同时结合超声检查。
Abstract：Objective: To estimate the value of ultrasound (US) and clinical assessment on the treatment of rheumatoid arthritis (RA) patients in different stages. Method: Fourty-five RA patients, including early RA patients (group A) and non-early RA patients (group B) took traditional disease modifying anti-rheumatic drugs and etanercept for three months. Main evaluation indicators included the gray-scale US (GSUS) and the power Doppler US （PDUS） of the joints before treatment, during and after treatment, secondary evaluation indicators were clinical features, laboratory results, DAS28. Results: Compared to group B, the improvement of PDUS was greater in group A than group B after treatment for 6 weeks (2.07±0.41 vs 3.93±0.40, p<0.01) and 12 weeks (0.51±0.27 vs 1.47±0.26, p<0.05). The group A showed lower morning stiffness (0.00±0.04 vs 0.16±0.04, p<0.05), erythrocyte sedimentation rate (23.66±3.04 vs 36.84±2.97, p<0.01), c-reactive protein (6.29±1.79 vs 11.37±1.75, p<0.05), health assessment questionnaire (7.43±1.07 vs 12.73±0.97, p<0.01) than group B after treatment of 6 weeks, as well as the erythrocyte sedimentation rate (15.34±1.91 vs 23.11±1.87, p<0.01), health assessment questionnaire (2.71±0.98 vs 7.37±0.89, p<0.01) and disease activity score-28 (2.50±0.21 vs 3.20±0.20, p<0.05) after treatment of 12 weeks. And ultrasound alleviation was not showed in all clinical and laboratory remission. Conclusion: Ultrasound can accurately reflect the condition of RA involved joints, so it should be recommended in the follow-up of RA patients. Joint therapy with traditional DMARDs and etanercept helps for early and non-early RA patients, and the former is benefit more. Clinical and laboratory remission may not exclude joint inflammation in ultrasound.
