摘要
目的:分析超声声触诊组织成像量化技术(VTIQ)与临床诊断类风湿性关节炎(RA)患者手关节滑膜病变DAS-28评分的相关性，探讨VTIQ技术对评估RA疾病活动性程度的应用价值。方法:选取汕大附一院风湿科临床诊断为RA的32例患者，选取符合RA诊断标准的患者，排除同时患有其他风湿免疫系统疾病、其他关节疾病、关节发生过创伤史和有严重疾病无法配合检查的患者。检测RA组患者的生化指标细胞沉降率(ESR)，结合临床病史计算DAS-28评分。根据临床DAS-28评分的范围把RA患者分成两组：DAS-28评分≤2.6分的10例患者分为缓解组，DAS-28评分>2.6分的22例患者分为活动组。利用VTIQ技术测量不同DAS-28评分的RA患者双手第1～5掌指关节(MCP)与腕关节关节增厚滑膜的剪切波速度(SWV)值，获得滑膜弹性定量的信息。分析SWV结果与DAS-28评分的关系。计量资料符合正态分布运用参数检验，数据呈非正态分布，运用非参数检验Mann-Whitney U检验，相关性研究运用Spearman秩相关分析。结果:缓解组与活动组两组患者年龄以及性别组成之间，差异不具有统计学意义(均为P>0.05)，均有可比性。124个关节(124/384)滑膜扫查到满意的弹性成像图，其中活动组有87个关节，缓解组有37个关节。活动组MCP、腕关节的SWV值均比缓解组的SWV值高，差异有统计学意义(Z＝4.47、4.43，均为P<0.05)。MCP、腕关节的滑膜SWV值与年龄、病程均无相关性(均为P>0.05)，与DAS-28评分呈正相关(r＝0.74、0.72，均为P<0.05)。结论:RA患者手关节滑膜SWV值与DAS-28评分呈正相关，提示VTQI技术可作为评估RA疾病活动性的参考。
Abstract
Objective:To analyze the correlation between ultrasound virtual touch tissue imaging and quantification technique (VTIQ) and DAS-28 scores in the clinical diagnosis of hand synovial lesions in patients with rheumatoid arthritis (RA), and to explore the application value of VTIQ technology in evaluating the degree of RA disease activity.Methods:Thirty-two patients clinically diagnosed as RA were selected from the rheumatology Department of the First Affiliated Hospital of Shantou University. Patients meeting the diagnostic criteria for RA were selected, and patients with other rheumatic immune system diseases, other joint diseases, history of joint trauma, and serious diseases that could not cooperate with the examination were excluded. The biochemical index of erythrocyte sedimentation rate (ESR) in RA group was detected, and DAS-28 score was calculated based on clinical history. According to the range of clinical DAS-28 score, RA patients were in two groups: 10 patients with DAS-28 score ≤2.6 were in remission group, and 22 patients with DAS-28 score>2.6 were in active group. The shear wave velocity (SWV) values of the first to fifth metacarpophalangeal joints (MCP) and the thickened synovium of the wrist joints in RA patients with different DAS-28 scores were measured by VTIQ technique to obtain quantitative information of synovium elasticity. The relationship between SWV results and DAS-28 scores was analyzed. The measurement data were consistent with normal distribution using parameter test, while the data were non-normal distribution using non-parametric test Mann-Whitney U test, and Spearman rank correlation analysis was used for correlation study.Results:There was no statistically significant difference in age and gender between the remission group and the active group (all P>0.05), and all groups were comparable. Synovial scans of 124 joints (124/384) showed satisfactory elastograms, including 87 joints in the active group and 37 joints in the remission group. The SWV values of MCP and wrist joint in the active group were significantly higher than those in the remission group (Z=4.47, 4.43, both P<0.05). The SWV values of MCP and wrist joint were not correlated with age or course of disease (all P>0.05), but was positively correlated with DAS-28 scores(r=0.74, 0.72, both P<0.05).Conclusion:Synovial SWV values of hand joints in RA patients were positively correlated with DAS-28 scores, suggesting that the VTQI technique can be used as a reference to assess RA disease activity.
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