肌肉骨骼超声与类风湿关节炎患者血清学指标的相关性及其诊断价值

Study on the correlation between musculoskeletal ultrasound and serological markers and its diagnostic value in patients with rheumatoid arthritis

摘要

目的 探讨类风湿关节炎（RA）患者肌肉骨骼超声（MSUS）与血清学指标的相关性,并评估MSUS对RA疾病活动度的诊断价值。方法 回顾性分析85例RA患者的临床资料。血清学指标包括红细胞沉降率（ESR）、C反应蛋白（CRP）及类风湿因子（RF）。采用MSUS评估双侧腕关节、掌指关节、近端指间关节及跖趾关节的关节积液、滑膜增生、能量多普勒（PD）血流信号及骨侵蚀情况,并进行0～3分半定量评分。采用Spearman相关性分析评估MSUS半定量评分与血清学指标的相关性,以28个关节疾病活动度评分（DAS28）＞3.2定义为中／高疾病活动度,通过受试者工作特征（ROC）曲线分析MSUS评分对其诊断效能。结果 MSUS总评分与ESR、CRP、RF均呈正相关（r值分别为0.740、0.470、0.606,P＜0.01）。ROC曲线分析显示,MSUS总评分及滑膜增生评分鉴别中／高疾病活动度（DAS28）＞3.2的曲线下面积（AUC）分别为0.850、0.764,MSUS总评分的诊断效能最高,其最佳截断值为7分时,敏感度为85.3％,特异度为66.7％。结论 RA患者MSUS表现与血清学指标具有显著相关性,能够反映疾病的局部与全身炎症状态。MSUS总评分在鉴别RA中／高疾病活动度具有重要诊断价值。基于滑膜增生联合骨侵蚀的简化方案与总评分在诊断效能上差异无统计学意义,在临床资源有限时可作为快速筛查工具。

Abstract

Objective To investigate the correlation between musculoskeletal ultrasound (MSUS) findings and serological markers in patients with rheumatoid arthritis (RA), and to evaluate the diagnostic value of MSUS for assessing disease activity in RA. Methods Clinical data from 85 RA patients were retrospectively analyzed, including serological markers: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and rheumatoid factor (RF). Musculoskeletal ultrasound (MSUS) was performed to assess joint effusion, synovial hyperplasia, power Doppler (PD) signals, and bone erosion in bilateral wrist, metacarpophalangeal, proximal interphalangeal, and metatarsophalangeal joints, with each finding semi-quantitatively scored (0-3). Spearman correlation analysis was used to evaluate the relationship between MSUS semiquantitative scores and serological markers. A 28 joint Disease Activity Score (DAS28) ＞3.2 was defined as moderate to high disease activity. Receiver operating characteristic (ROC) curve analysis was conducted to assess the diagnostic performance of MSUS scores in identifying moderate to high disease activity. Results The total MSUS score showed positive correlations with ESR, CRP, and RF (r=0.740, 0.470, and 0.606, respectively; P＜0.01). ROC curve analysis revealed that the areas under the curve (AUC) of the total MSUS score and synovial hyperplasia score for distinguishing moderate-to-high disease activity (DAS28＞3.2) were 0.850 and 0.764, respectively. The total MSUS score had the highest diagnostic efficacy, with an optimal cut-off value of 7, yielding a sensitivity of 85.3% and a specificity of 66.7%. Conclusion MSUS findings in patients with RA demonstrate a significant correlation with serological markers, reflecting both local and systemic inflammatory states of the disease. The total MSUS score demonstrates valuable diagnostic performance for discriminating moderate-to-high disease activity in RA. The simplified protocol incorporating synovial hyperplasia and bone erosion yields diagnostic efficacy comparable to the total MSUS score (P＞0.05), and can be applied as a rapid screening strategy under conditions of limited clinical resources.

关键词

类风湿关节炎 / 肌肉骨骼超声 / 疾病活动度 / 敏感性与特异性 / 血清学指标

Key words

rheumatoid arthritis / musculoskeletal ultrasound / disease activity / sensitivity and specificity / serological markers

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基金资助

贵州省卫健委科学技术基金资助项目(gzwkj2022-443)