多普勒对脊柱关节病患者肌腱韧带附着点血流的分析(英文)

Analysis of entheseal blood flow in patients with spondyloarthropathies by color Doppler

背景:脊柱关节病(spondyloarthropathies,SpA)是一组累及脊柱、外周关节、关节周围结构及关节外组织的疾病,多侵犯青壮年男性,发病率及致残率均较高。目前多数人认为肌腱韧带附着点是SpA病变的首发部位,因而附着点炎是SpA最重要的病理基础和特征性的临床表现,但其临床表现缺乏特异性。目的:对比健康志愿者和SpA患者肌腱韧带附着点血流的差异,探讨彩色多普勒(ColorDoppler,CD)在协助评估附着点病变中的价值。设计:以患者为研究对象的非随机正常对照的基础研究。单位:一所大学医院的风湿科、超声科及解放军总医院风湿科。对象:病例组纳入2001-08/2002-04在中山大学附属第三医院就诊并愿意接受CD检查的30例SpA患者,所有入选患者均符合1991年欧洲SpA研究组关于SpA的分类标准,其中男24例,女6例;对照组纳入30例在中山大学附属第三医院工作或学习的年轻健康工人和医学生,所有对照者均无关节病和慢性腰背痛病史,自愿参加,其中男22例,女8例。干预:以CD测定每例入选的健康志愿者和SpA患者下肢18个附着点的血流,并以半定量法进行分级。主要观察指标:附着点血流情况。结果:30例健康志愿者,有5例(占16.7%)至少在1个附着点检测到血流,全部540个被检附着点中,共有9个检测到血流信号,均为1级血流,附着点血流阳性率为1.7%

BACKGROUND:Seronegative spondyloarthropathies(SpA) are a group of diseases involving the spine,peripheral joints and structures around the joints that mostly occur in adult males with high morbidity and disability rate.Presently,it is widely believed that enthesis is the initiated site of SpA so that enthesitis is an important pathologic base and one of the characteristic clinical manifestations of SpA,however, there is no specific clinical manifestation enthesitis. OBJECTIVE:To compare the difference on entheseal blood flow between health volunteers and patients with SpA and explore the value of color Doppler(CD) in assessing the pathological change of enthesis. DESIGN:Non randomized case controlled study to patients SETTING:Department of Rheumatology,Department of Ultrasound of a university,Department of Rheumatology of General Hospital of Chinese PLA. PARTICIPANTS:Totally 30 patients with SpA admitted into Third Affilated Hospital of Sun Yat sen University during August 2001 to April 2002 and willing to take CD examination were selected as case group.All of them met the classification criteria of SpA set up by the European SpA Study Group in 1991 with 24 males and 6 females. Thirty healthy workers and students working or studying in the same Hospital were enrolled as volunteers for the control group,none of them had any histories of arthropathy or chronic lower back pain, and there were 22 males and 8 females among them. INTERVENTIONS:Color Doppler was used to examine the blood flow of 18 entheses in lower limbs of every healthy volunteers and SpA patients and semi quantitative method was used to classify the blood flow. MAIN OUTCOME MEASURES:Blood flow of entheses RESULTS:Among 30 healthy volunteers,5 cases(16.7% ) had been detected blood flow from at least one enthesis.From the 540 entheses being examined,9 entheses were detected blood flow signals of grade I,the positive rate was 1.7% .While among 30 SpA patients, 24(80.0% ) had at least one enthesis being detected for positive blood flow.Eighty four of totally 540 examined entheses were found for positive blood flow signals with a positive rate of 15.6% ,and the number of entheses with grade Ⅰ ,Ⅱ and Ⅲ of blood flow were 19, 33 and 32 respectively among the 84 positive entheses.There was significantly different in the positive rate of blood flow and classification of entheses between SpA patients and healthy volunteers by χ 2 test (P< 0.05). CONCLUSION:Colour Doppler examination is an effective way to detect the blood flow of enthesis.There were blood flow abnormity in the entheses of lower limbs in patients with SpA.