来源：风湿病与关节炎,2018,7（4）:24-27.

类风湿关节炎临床缓解与超声影像学缓解的对比研究

（临床研究）

孟飞龙，石亚妹，罗采南，武丽君

　　【摘　要】目的：比较不同临床缓解标准与超声影像学缓解标准的一致性及差异，探讨超声影像学缓解在达标治疗中的价值。方法：选取达到DAS28缓解的类风湿关节炎患者51例，分析达到DAS28缓解的类风湿关节炎在不同缓解标准下的缓解率；并比较不同缓解标准与超声缓解的一致性，比较超声评分与临床各项指标的一致性。采用t检验、χ²检验、Kappa一致性分析、Pearson或Spearman相关分析。结果：51例患者中达到ACR缓解50例（98.04%），ACR、EULAR缓解37例（72.55%），CDAI缓解43例（84.31%），SDAI缓解35例（68.63%），超声缓解29例（56.86%）。超声缓解与DAS28-ESR深度缓解、DAS28-CRP缓解、SDAI缓解、ACR缓解、ACR/EULAR缓解、GS缓解、PD缓解的一致性检验Kappa系数分别为：0.13，0.05，0.09，0.05，0.25，1.00，0.05。结论：达到临床缓解的类风湿关节炎患者有近一半仍存在亚临床滑膜炎，即使严格的临床标准与超声缓解之间一致性仍较差。

　　【关键词】　关节炎，类风湿；超声检查；临床缓解；影像学缓解；对比研究

Comparative Study of Clinical Remission and Sonographic Remission of Rheumatoid Arthritis

MENG Fei-long,SHI Ya-mei,LUO Cai-nan,WU Li-jun

　　【ABSTRACT】Objective:To compare the similarity and difference between criteria of clinical remission and sonographic remission,and to explore the value of sonographic remission in standard treatment.Methods:Fifty-one cases with rheumatoid arthritis reaching DAS28 were selected.Analyze the remission rate of rheumatoid arthritis with DAS28 relief under different remission criteria.The consistency of different remission criteria and sonographic remission,and the consistency of sonographic scores and clinical indicators were all compared.t test,χ² test,Kappa consistency analysis,and Pearson or Spearman correlation analysis were used.Results:Among 51 cases,50 cases（98.04%）reached ACR,37 cases（72.55%）reached ACR and EULAR,43 cases（84.31%）reached CDAI,35 cases（68.63%）reached SDAI,and 29 cases（56.86%）were relieved by ultrasound.The consistency of sonographic remission with DAS28-ESR deep remission,DAS28-CRP remission,SDAI remission,ACR remission,ACR/EULAR remission,GS remission and PD remission were respectively 0.13,0.05,0.09,0.05,0.25,1.00 and 0.05.Conclusion:Nearly half of patients with rheumatoid arthritis reaching clinical remission have subclinical synovitis,causing a worse consistency of strict clinical criteria and sonographic remission.

　　【Keywords】 arthritis,rheumatoid;ultrasound examination;clinical remission;imaging remission;comparative study