类风湿关节炎治疗的超声和临床评估

目的：探讨不同阶段类风湿关节炎（rheumatoidarthritis，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（diseaseactivityscore-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±0.41vs3.93±0.40）、12周（0.51±0.27vs1.47±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）minvs（0.16±0.04）min]、血沉（23.66±3.04）mm/hvs（36.84±2.97）mm/h]、C反应蛋白（6.29±1.79） mg/Lvs（11.37±1.75）mg/L]、健康评估问卷（HAQ）评分（7.43±1.07vs12.73±0.97）和治疗12周后的血沉（15.34±1.91）mm/hvs（23.11±1.87）mm/h]、HAQ评分（2.71±0.98vs7.37±0.89）、DAS28（2.50±0.21vs3.20±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。

Ultrasound and clinical assessment on the treatment of rheumatoid arthritis

Objective： To estimate the value of ultrasound （US） and clinical assessment on the treatment of rheumatoid arthritis （RA） patients in different stages.Method： Fourty-ifve 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 relfect 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 beneift more. Clinical and laboratory remission may not ex-clude joint inlfammation in ultrasound.