【摘要】 目的:研究超微血管成像技术(SMI)半定量分级与类风湿关节炎(RA)患者骨代谢情况的相关性。方法:选取2017年3月至2018年7月在我院诊断为类风湿性关节炎(RA)的病人131例。根据DAS28结果将病人分为疾病缓解期(20例)、轻度活动期(41例)、中度活动期(46例)及重度活动期(24例) 4组。超声SMI模式评估各组患者关节滑膜内血流信号。全自动生化分析仪检测患者血清中骨形成标志物骨保护素(OPG)、I型前胶原氨基端前肽(PINP)、I型前胶原羧基端前肽(PICP)、I型胶原C端肽(CTX-I)、抗酒石酸酸性磷酸酶5b(TRACP5B)及骨碱性磷酸酶(BALP)的水平。对不同疾病程度RA患者SMI半定量评分和各标志物水平进行单因素方差分析,同时分析SMI半定量评分与DAS28及各标志物的相关性。结果:疾病活动度高组的患者SMI半定量分级评分明显高于活动度低组患者(F=97.516,P <0.01)。疾病活动度高的患者OPG(F=51.292,P <0.01)、PINP(F=102.545,P <0.01)、PICP(F=144.512,P <0.01)、BALP (F=178.535,P <0.01)水平明显高于活动度低组患者(均P <0.05),疾病活动度高组患者CTX-I(F=30.450,P <0.01)和TRACP5B F=118.151,P <0.01)水平明显低于活动度低组患者,且两两之间有显著性差异(均P <0.01))。相关性分析显示,SMI半定量评分与DAS28正相关(R~2=0.486 2,P <0.01),与OPG(R~2=0.372 5,P <0.01)、PINP(R~2=0.484 2,P <0.01)、PICP(R~2=0.485 7,P <0.01)、BALP (R~2=0.475 9,P <0.01)负相关,与CTX-I(R~2=0.237 4,P <0.01)和TRACP5B(R~2=0.437 5,P <0.01)正相关。结论:SMI分级随RA患者疾病活动程度加重而升高,并且与骨代谢状态相关。更多还原

【Abstract】 Objective: To study the relationship between semi-quantitative scoring of superb microvascular imaging and markers of bone metabolism in patients with rheumatoid arthritis.Methods: A total of 131 patients diagnosed with rheumatoid arthritis(RA) in our hospital from March 2017 to July 2018 were enrolled in this study.According to the DAS28 scores,patients were divided into 4 groups: remission group(20 patients),mild-active group(41 patients),moderate-active group(46 patients) and severe-active group(24 patients).The synovial flow signals were provided by the superb microvascular imaging(SMI) pattern of ultrasound.Patients were graded by SMI semi-quantitative scoring.Moreover,the serum levels of osteoprotegerin(OPG),procollagen type I N-terminal propetide(PINP),propeptide of type I procollagen(PICP),carboxy-terminal telopeptide of type I collagen(CTX-I),tartrate-resistant acid phosphatase 5B(TRACP5B) and bone alkaline phosphatase(BALP) were detected.The SMI scores and the level of these six markers of the 4 groups were compared.The relationship of SMI with DAS28 score and levels of the six markers were analyzed by Pearson correlation analysis.Results: The SMI scores in patients with high disease activity were higher than those in patients with low disease activity(F = 97.516,P < 0.01).The levels of OPG(F = 51.292,P < 0.01),PINP(F = 102.545,P < 0.01),PICP(F = 144.512,P < 0.01),BALP(F = 178.535,P < 0.01),CTX-I(F = 30.450,P < 0.01) and TRACP5 B(F = 118.151,P < 0.01) in patients with high disease activity were lower than those in patients with low disease activity.Correlation analysis showed that the SMI score was negatively correlated with the level of OPG(R~2= 0.372 5,P < 0.01),PINP(R~2= 0.484 2,P < 0.01),PICP(R~2= 0.4857,P < 0.01),BALP(R~2= 0.475 9,P < 0.01),and positively correlated with DAS28 scores and the level of CTX-I(R~2= 0.237 4,P < 0.01) and TRACP5 B(R~2= 0.437 5,P < 0.01).Conclusion: The SMI grades of RA patients increase with patients’ disease activity,and are correlated with bone metabolism.更多还原