应用超声造影（CEUS）对类风湿关节炎（RA）亚临床滑膜炎进行血流定量评估，探讨CEUS相关参数评估RA亚临床滑膜炎疾病进展的价值。

收集2019年10月至2023年12月就诊于内蒙古医科大学附属医院的RA亚临床滑膜炎患者87例。纳入患者进行腕关节CEUS检查，获取造影定量参数：开始显影时间（AT）、达峰时间（TTP）、峰值强度（PI）、Gard梯度及时间-强度（TIC）曲线下面积，并对滑膜血流情况进行分级；治疗3、6、12个月后对患者进行随访。将CEUS定量指标与28关节活动度评分（DAS 28）进行相关性分析，以DAS 28评分作为判断RA亚临床滑膜炎是否加重的标准，将患者分为加重组33例与非加重组54例，应用单因素及多因素Logistic回归分析筛选RA亚临床滑膜炎加重的独立危险因素，并绘制ROC曲线分析相关参数的预测效能。

87例患者中，滑膜血流分级1级36例、2级29例、3级22例。治疗后3个月滑膜血流分级、TIC曲线下面积、PI与DAS 28评分存在显著正相关（r为0.659、0.711、0.777，P<0.05）。治疗后6个月滑膜血流分级、TIC曲线下面积、PI与DAS 28评分存在显著正相关（r为0.651、0.707、0.757，P<0.05）。治疗后12个月滑膜血流分级、TIC曲线下面积、PI与DAS 28评分存在显著正相关（r为0.640、0.688、0.721，P<0.05）。多因素Logistic回归分析结果表明，TIC曲线下面积（OR=1.023，95% CI：1.003~1.047）、PI（OR=1.564，95% CI：1.031~2.267）是RA亚临床滑膜炎疾病加重的独立危险因素。二者预测疾病是否加重的ROC曲线下面积分别为0.909、0.692，差异有统计学意义（P<0.05）。

CEUS定量指标与DAS 28评分具有较好的相关性，TIC曲线下面积、PI对于预测RA亚临床滑膜炎疾病进展具有良好的应用价值，可以为临床治疗方案的制定、疗效评估及病情监测提供客观依据。

To evaluate the synovial blood flow in rheumatoid arthritis (RA) patients with subclinical synovitis by contrast-enhanced ultrasound (CEUS), and to evaluate the value of CEUS-related parameters in evaluating the progression of subclinical synovitis in these patients.

A total of 87 patients with RA and subclinical synovitis admitted to the Affiliated Hospital of Inner Mongolia Medical University from October 2019 to December 2023 were collected. The patients were included for wrist CEUS examination, and quantitative parameters of CEUS were obtained: arrival time (AT), time to peak (TTP), peak intensity (PI), Gard gradient, and area under the time-intensity curve (TIC). The synovial blood flow was graded. Patients were followed up at 3, 6, and 12 months after treatment. Correlation analysis was conducted between the quantitative indexes of CEUS and the Disease Activity Score (DAS) 28, and the DAS28 was used as the criterion to judge whether the disease was aggravated. The patients were divided into 33 cases with disease exacerbation and 54 without. Univariate and multivariate Logistic regression analyses were performed to identify the independent risk factors for predicting the exacerbation of subclinical synovitis in RA, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive efficacy of related parameters for the exacerbation of subclinical synovitis.

Among the 87 patients included, 36 had grade 1 synovial blood flow, 29 had grade 2, and 22 had grade 3. Synovial blood flow grade, area under the TIC, and PI had a significant correlation with DAS28 at 3 months (r = 0.659, 0.711, 0.777, P<0.05), 6 months (r = 0.651, 0.707, and 0.757, respectively, P<0.05) and 12 months (r = 0.640, 0.688, and 0.721, respectively, P<0.05) after treatment. Multivariate Logistic regression analysis showed that the area under the TIC (odds ratio [OR]=1.023, 95% confidence interval [CI]: 1.003~1.047) and PI (OR = 1.564, 95%CI: 1.031~2.267) were independent risk factors for predicting the exacerbation of subclinical synovitis in patients with RA. The area under the ROC curve values of the area under the TIC and PI for predicting disease exacerbation were 0.909 and 0.692, respectively, and their difference was statistically significant (P<0.05).

There is a good correlation between CEUS quantitative indexes and DAS28, and the area under the TIC and PI have good application value in predicting the progression of subclinical synovitis in RA patients, which can provide an objective basis for the formulation of clinical treatment plan, efficacy evaluation, and disease monitoring.