多普勒超声预测抗TNFα治疗类风湿关节炎患者的有效性:一项前瞻性队列研究

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Rheumatology (Oxford). 2011 Mar;50(3):506-12. Epub 2010 Nov 11. Ultrasound Doppler measurements predict success of treatment with anti-TNF-α drug in patients with rheumatoid arthritis: a prospective cohort study. Ellegaard K, Christensen R, Torp-Pedersen S, Terslev L, Holm CC, Kønig MJ, Jensen PS, Danneskiold-Samsøe B, Bliddal H. The Parker Institute, Copenhagen University Hospital, Frederiksberg, Nordre Fasanvej 57, DK-2000, Frederiksberg, Denmark. parker@frh.regionh.dk. Abstract Objective. To investigate the predictive ability of core outcomes applied in RA trials, including ultrasound (US) Doppler (USD) measurements differentiating patients who remain on anti-TNF-α therapy following 1 year. Methods. Patients with RA in anti-TNF-α therapy were followed 1 year after therapy initiation. All patients had wrist involvement. At baseline, 2 weeks, 26 weeks and 1 year a USD examination, clinical examination including tender and swollen joint count, visual analogue scale (VAS) global and HAQ, biochemical measures and 28-joint DAS (DAS28) were collected for all patients. The amount of USD signal in the synovium was quantified by measuring the percentage of colour pixels-the colour fraction (CF). Predictive validity for patients who remain on anti-TNF-α therapy after 1 year was assessed for both USD measurements and other disease measures. Baseline values of disease measures of patients who remained on treatment after 1 year was compared with those who stopped therapy. Results. The study cohort consisted of 109 patients. In this study, the baseline CF was the only measure predicting which patients would stay on the initial anti-TNF-α therapy for 1 year, evaluated using the square-root of CF (P = 0.024). The other disease markers could not significantly differentiate between the two groups of patients, with P-values of 0.86 and 0.98 for tender and swollen joint count, respectively, 0.86 for CRP, 0.24 for VAS, 0.10 for HAQ and 0.38 for DAS28. Conclusion. There is now evidence to support that baseline USD, in contrast to clinical measures, can predict which patients will remain on anti-TNF-α 1 year after initiating therapy.

多普勒超声预测抗TNFα治疗类风湿关节炎患者的有效性:一项前瞻性队列研究 Ellegaard K, Christensen R, et al,Rheumatology (Oxford). 2011 Mar;50(3):506-12. Epub 2010 Nov 11. 目的：探索RA临床研究中的核心结果包括多普勒超声(USD)检测，对鉴别1年后仍坚持抗TNF-α治疗的患者的预测能力。方法：对抗TNF-α治疗的RA患者在治疗开始后进行1年的随访。所有患者都有腕关节受累。在基线、2周、26周和1年时都进行USD检测，同时收集临床检查指标，包括关节压痛和肿胀数、总体视觉模拟评分(VAS)和HAQ、血生化检测和28个关节的DAS（DAS28）。通过彩色像素的百分比-彩色分数 (CF)，对滑膜USD信号进行量化。检验BSD和其他疾病指数对预测患者1年后仍坚持应用抗TNF-α的效率。比较1年后坚持用药患者和停用药物患者在基线水平的疾病参数。结果：研究对象包括109例患者。本研究中, 基线水平的CF是唯一可以预测哪些病人会在1年后维持初始抗TNF-α治疗的指标,采用CF的平方根进行评价(P = 0.024)。其他的疾病标记在两组患者无明显差异,如压痛关节数和肿胀关节数的P值分别为0.86和0.98，CRP为0.86，VAS为0.24，HAQ为0.10，DAS28为0.38。结论：现有证据支持基线水平的USD相比临床指标更能预测起始治疗1年后那些患者会维持应用抗TNF-α。