CAJ | 학술논문

目的探讨影响类风湿关节炎X线平片进展的几个临床因素,及评价其治疗价值.方法 178例活动期类风湿性关节炎患者,内科治疗前后均接受X线平片检查,按照初诊时X线平片关节损害表现分为轻度(1组)、中度(2组)和重度(3组).随访两年,评价放射学进展、临床缓解率和美国健康评定调查表(HAQ)等指标,并分析其相关性.结果以X线平片结果为指标,1组和2组之间进展率差异无统计学意义(P＞0.05);3组(30.0%,9/30)分别和1组(15.4%,12/78)及2组(11.9%,7/59)之间进展率差异有统计学意义(P＜0.05),提示初诊时轻、中度关节损害患者应用药物遏制病变放射学发展概率均等,而重度关节损害患者放射学恶化更显著.所有患者治疗2年后临床缓解率为85.0%(142/167),3组之间差异无统计学意义(P＞0.05),提示关节损伤程度对临床缓解无显著影响,初诊时关节损伤严重者亦能达到较理想的临床缓解效果.结论女性、血类风湿因子阳性、HAQ评分较高、有关节外表现是类风湿关节炎放射学进展的高危因素.早期(＜6月)使用抗风湿药物有助于改善放射学进展.X线平片能确诊、复查和确定关节破坏程度,临床症状改善缓解者关节破坏不一定停止,须定时复查关节X线片,确定关节损伤进展程度来调整用药方案.
목적 탐토영향류풍습관절염X선평편진전적궤개림상인소,급평개기치료개치.방법 178례활동기류풍습성관절염환자,내과치료전후균접수X선평편검사,안조초진시X선평편관절손해표현분위경도(1조)、중도(2조)화중도(3조).수방량년,평개방사학진전、림상완해솔화미국건강평정조사표(HAQ)등지표,병분석기상관성.결과 이X선평편결과위지표,1조화2조지간진전솔차이무통계학의의(P＞0.05);3조(30.0%,9/30)분별화1조(15.4%,12/78)급2조(11.9%,7/59)지간진전솔차이유통계학의의(P＜0.05),제시초진시경、중도관절손해환자응용약물알제병변방사학발전개솔균등,이중도관절손해환자방사학악화경현저.소유환자치료2년후림상완해솔위85.0%(142/167),3조지간차이무통계학의의(P＞0.05),제시관절손상정도대림상완해무현저영향,초진시관절손상엄중자역능체도교이상적림상완해효과.결론 녀성、혈류풍습인자양성、HAQ평분교고、유관절외표현시류풍습관절염방사학진전적고위인소.조기(＜6월)사용항풍습약물유조우개선방사학진전.X선평편능학진、복사화학정관절파배정도,림상증상개선완해자관절파배불일정정지,수정시복사관절X선편,학정관절손상진전정도래조정용약방안.
Objective To investigate the clinical factors related to radiological progression in rheumatoid arthritis(RA) and the role of radiology in the assessment of RA outcomes. Methods A total of 178 cases of active rheumatic arthritis were enrolled in a 2-year trial given radiological assessment at baseline and during follow up. These cases were classified into three groups, namely groups 1, 2 and 3 for mild,moderate and severe based on baseline X-ray images of joint damage. Radiological progression, clinical remission and Health Assessment Questionnaire (HAQ) were used in the two-year follow-up and analyzed for the correlation between each other. Results At the end point, groups 1 and 2 did not differ in radiological progression (P＞0.05). Significant difference was found between group 1 (15.4%, 12/78)and group 2 (30.0%,9/30) (P＜0.05) , as well as between group 3 (11.9% , 7/59) and group 3 (P＜0.05) , suggesting that radiological damages may deteriorate more in patients with higher level of bone erosion at baseline. After 2years of medications, the rate of clinical remission in all the cases was 85.0% (142/167) and was not different among the three groups (P＞0.05), which indicated that clinical remission had no relevance with radiological progression. Conclusion Female gender, positive rheumatoid factor, high HAQ scores and peri- articular lesions are risk factors for radiological progression in RA. Early use of disease-modifying antirheumatic drugs (within less than 6 months) is beneficial for patients with radiological progression. X-ray is sufficiently effective to confirm, re-evaluate and determine the articular erosion. Clinical remission may not necessarily indicate suspension of radiological progression and routine X-ray is required in the whole follow up process of RA in order to modify medications based on progression of articular lesions.