Abstract: Objective　To evaluate the sensitivity and consistency between ultrasound disease activity score in 28 joints（US-DAS28） and DAS28 score in the assessment of disease activity in patients with rheumatoid arthritis（RA）．Methods　127 RA patients receiving outpatient or inpatient care from Department of TCM Rheumatology，China-Japan Friendship Hospital from January 2013 to July 2017 were recruited.Their 28 joints，including proximal interphalangeal joints，metacarpophalangeal joints，wrist joints，elbow joints，shoulder joints and knee joints，were checked.DAS28 score was calculated based on the number of tender and swollen joints identified by clinical examination，patient self-assessment of general joint status and C-reactive protein（CRP） level.And US-DAS28 score was calculated in accordance with the number of swollen joints identified by gray-scale ultrasound.Results　The average number of swollen joints identified by clinical examination was less than that found by ultrasound〔2.0（0，4.0）vs.5.0（2.0，8.0）〕（Z=-7.783，P<0.001）．Moreover，DAS28 score was lower than US-DAS28 score〔（3.43±1.18） vs.（3.69±1.03）〕（tpaired= -9.668，P<0.001）．Pearson correlation analysis showed that there was a positive correlation between DAS28 score and US-DAS28 score（r=0.968，P<0.001）．The degree of disease activity assessed by US-DAS28 score was more serious than that by DAS28 score（Z=-4.680，P<0.001）．Conclusion　There is a good consistency between US-DAS28 and DAS28 score for assessing RA disease activity，but US-DAS28 score has a higher sensitivity，so it can provide an aid for clinical treatment.

Key words: Rheumatoid arthritis, Ultrasonography, Disease activity score in 28 joints, Joint swelling

摘要： 目的　评价超声下28关节疾病活动评分（US-DAS28）用于类风湿关节炎（RA）患者疾病活动度评估的敏感性及与28关节疾病活动评分（DAS28）的一致性。方法　选取2013年1月—2017年7月于中日友好医院中医风湿病科门诊或住院治疗的RA患者127例为研究对象。临床检查双侧近端指间关节、掌指关节、腕关节、肘关节、肩关节、膝关节28个关节，记录关节压痛数、关节肿胀数以及患者整体评价、C反应蛋白水平，计算DAS28。采用超声下灰阶关节滑膜炎数替代关节肿胀数，计算US-DAS28数值。结果　127例患者临床检查关节肿胀有2.0（0，4.0）个，超声下关节肿胀有5.0（2.0，8.0）个，差异有统计学意义（Z=-7.783，P<0.001）。DAS28为（3.43±1.18），US-DAS28为（3.69±1.03），差异有统计学意义（t配对=-9.668，P<0.001）。Pearson相关分析显示，DAS28与US-DAS28呈正相关（r=0.968，P<0.001）。采用US-DAS28评估的疾病活动度较DAS28严重（Z=-4.680，P<0.001）。结论　US-DAS28与DAS28具有良好的一致性，但US-DAS28可敏感评估RA患者的疾病活动度，宜作为治疗策略的选择依据。

关键词: 类风湿关节炎, 超声检查, 28关节疾病活动评分, 关节肿胀