目的 通过对类风湿性关节炎（rheumatoid arthritis，RA）患者进行超声扫查，探讨其超声表现及抗环瓜氨酸肽抗体（anti-cyclic citrullinated peptides antibody，ACPA）在评估RA关节病变活动程度及疗效研究中的临床意义。方法 收集RA患者轻度活动期组20例（n＝20），中度活动期组20例（n＝20），重度活动期组20例（n＝20），所收集病例均根据28关节疾病活动度评分法（DSA28）。在治疗前及治疗后三个月分别各组患者的7关节进行超声扫查，7关节包括严重侧的腕关节，第2、3掌指关节，近端指间关节和第2、5跖趾关节，超声扫查包括灰阶超声和能量/彩色多普勒超声检查，并进行ACPA检测，根据检测结果比较3组间差异，分析以上关节超声表现及ACPA与关节病变活动程度及疗效的相关性。结果 重度组关节腔积液、滑膜厚度、滑膜血供高于中度组，中度组关节腔积液、滑膜厚度、滑膜血供高于轻度组，两独立样本检验结果，差异有统计学意义（P＜0.05）。治疗前、后三组患者关节腔积液、滑膜厚度、滑膜血供情况以及血清ACPA结果比较，治疗后显示关节腔积液变少，滑膜厚度显著低于治疗前( P＜0.05)。治疗后关节腔滑膜的血供程度低于治疗前( P＜0.05)，ACPA低于治疗前（P＜0.05）。结论 联合超声与ACPA不仅可以提高类风湿关节炎的早期诊断，了解疾病的病变活动程度，也可以更好的评估预后，为临床诊断治疗提供帮助。

Objective To explore the clinical significance of ultrasonography and anti-cyclic citrullinated peptide antibody (anti-cycliccitrullinatedpeptidesantibody,ACPA) in evaluating the activity and curative effect of rheumatoid arthritis (rheumatoidarthritis,RA) in patients with rheumatoid arthritis (RA). Methods 20 patients with RA were enrolled in this study, including 20 patients with mild active stage, 20 patients with moderate active stage and 20 patients with severe active stage. All the patients were assessed according to the range of motion score (DSA28) of 28 joints. Seven joints of patients in each group were scanned by ultrasound before and three months after treatment, including severe wrist joint, second and third metacarpophalangeal joint, proximal interphalangeal joint and second and fifth metatarsophalangeal joint. Ultrasonic scanning included gray-scale ultrasound and energy / color Doppler ultrasound, and ACPA was detected, and the differences among the three groups were compared according to the results. To analyze the correlation between the ultrasonographic findings and ACPA of the above joints and the degree of activity and curative effect of joint lesions. Results The articular effusion, synovial thickness and synovial blood supply in the severe group were higher than those in the moderate group, and the articular effusion, synovial thickness and synovial blood supply in the moderate group were higher than those in the mild group. There was significant difference between the two independent samples (P < 0.05). The results of synovial effusion, synovial thickness, synovial blood supply and serum ACPA in the three groups before and after treatment showed that the effusion in articular cavity decreased and the synovial thickness was significantly lower than that before treatment (P < 0.05). The blood supply of synovium in articular cavity after treatment was lower than that before treatment (P < 0.05).), ACPA was lower than that before treatment (P < 0.05). Conclusion The combination of ultrasound and ACPA can not only improve the early diagnosis of rheumatoid arthritis, understand the lesion activity of the disease, but also better evaluate the prognosis and provide help for clinical diagnosis and treatment.

1、基于超声及ACPA评估RA关节病变活动程度及疗效的研究 自治区卫生计生研计划项目项目编号：201701068；2、 痛风性关节炎不同时期超声及超声造影表现与尿酸及Dickkopf-1的相关性研究，内蒙古自然科学基金面上项目2015MS0818；3、类风湿性关节炎7关节滑膜血管翳CEUS评估临床缓解与血清学缓解的相关性研究，内蒙古自然科学基金面上项目，项目编号：2019MS08027；4、超声联合SWE对脑卒中单侧下肢运动障碍患者康复训练后跟腱功能的评估价值，内蒙古医科大学附属医院青年创新基金项目，项目编号：YKD2018QNCX101