彩色超微血管成像技术对活动期类风湿关节炎的评估

Evaluation of rheumatoid arthritis in the active period by color superb microvascular imaging

目的:探讨彩色超微血管成像技术(c SMI)对活动期类风湿关节炎(RA)的评估价值。方法:对62例活动期RA患者行双侧腕关节(Wri)、掌指关节(MCP)及近端指间关节(PIP)超声检查,记录滑膜增厚关节数目及增厚滑膜内cSMI、能量多普勒(PDUS)血流信号半定量评分,分析血流信号评分结果与28个关节疾病活动度评分(DAS28)、血沉(ESR)及C-反应蛋白(CRP)的相关性。结果:(1)440个关节显示滑膜增厚,Wri 112个,MCP+PIP 328个。Wri增厚滑膜中PDUS、cSMI血流显示率分别为62.5%、83.9%;MCP+PIP增厚滑膜中PDUS、cSMI血流显示率分别为63.7%、81.4%。两种成像方式间,Wri及MCP+PIP增厚滑膜血流显示间差异具有统计学意义(P<0.05)。(2)Wri及MCP+PIP增厚滑膜内PDUS与cSMI血流分级间比较,差异具有统计学意义(P<0.05)。较PDUS血流分级,cSMI可上调其分级级别。(3)PDUS及cSMI血流分级指数与CRP、ESR及DAS28均具有一定的正相关性(P<0.05)。较PDUS,cSMI与CRP、ESR及DAS28的相关性均增高(P<0.05)。结论:cSMI能更敏感地探测活动期RA患者增厚滑膜血流,能更好的评估疾病活动度。

Objective: To explore the application of color superb microvascular imaging(cSMI) in evaluating the rheumatoid arthritis(RA) in the active period. Methods: Sixty-two patients with RA in the active period were collected. Ultrasound was used to examine the wrist(Wri) joints and metacarpophalangeal(MCP) joints and proximal interphalangeal(PIP) joints of each patient’s bilateral hands. The numbers of thickened synovial joints were recorded. Blood flow signal of the thickened synovial joints was checked by the c SMI and power doppler ultrasound(PDUS) separately. Color flow signal was graded by the semiquantitative scoring systems. The correlations between the blood flow signal score of PDUS and cSMI and 28 joint disease activity scores(DAS28), blood sedimentation(ESR) and C-reactive protein(CRP) were analyzed. Results:(1)Four hundred and forty joints showed synovial thickening, 82 Wri and 328 MCP+PIP. The proportion of blood flow signal detected by cSMI in thickened synovial membranes of Wri was 83.9%, while that of PDUS was 62.5%. The proportion of blood flow signal detected by cSMI in thickened synovial membranes of MCP+PIP was 81.4%, while that of PDUS was 63.7%. The differences of blood flow signal rate between both Wri and MCP+PIP were statistically significant, so was the comparison of two imaging patterns(P<0.05).(2)The differences of grading of PDUS and c SMI between Wri and MCP+PIP were statistically significant(P<0.05). Compared with PDUS, cSMI could raise the blood flow classification level.(3) PDUS and cSMI blood flow signals grading were positively correlated with CRP, ESR and DAS28(P<0.05). Compared with PDUS, the correlation between cSMI and CRP, ESR and DAS28 increased(P<0.05). Conclusions: cSMI can more prominently detect the thickened synovial blood flow of RA in the active period, and can also assess the disease activity better.