4项指标7个关节超声诊断类风湿关节炎

Four indicators and seven joints in ultrasound diagnosis for rheumatoid arthritis

目的:探讨超声应用4项指标在判定类风湿关节炎(rheumatoid arthritis,RA)诊断中的价值。方法:对77例临床疑似RA的患者采用双盲法分别用肌骨超声(musculoskeletal ultrasound,MSUS)及临床方法诊断RA。MSUS通过检测患侧腕关节,第2、3掌指关节(metacarpophalangeal joints,MCP),第2、3近端指间关节(proximal interphalangeal joints,PIP),第2、5跖趾关节(metatarsophalangeal joints,MTP)等7个关节,观察滑膜增生、滑膜内血流信号、骨侵蚀及关节积液4项指标,以4步半定量分级系统中滑膜病变为主的病例超声诊断RA。对2种诊断方法进行对比分析。同时对这4项指标进行等级评分,评分总和与同期血清学指标进行相关Pearson分析。结果:MSUS诊断RA 55例,非RA 22例,临床诊断RA 53例,非RA 24例。MSUS和临床2种诊断方法间的差异无统计学意义(P=0.774)。滑膜血流评分总和、积液评分总和与血沉(erythrocyte sedimentation rate,ESR)成正相关(r值分别是0.739、0.564,P值均=0.000)。结论:MSUS同时应用4项指标对RA的诊断同临床诊断基本吻合,且其滑膜血流评分总和及积液评分总和与血清学指标存在正相关性,MSUS可作为RA的筛查方法,为临床早期确诊提供更多影像学依据,值得推广应用。

Objective：To explore the value of four indicators of in ultrasound diagnosis for rheumatoid arthritis（RA）. Methods：Totally 77 suspected RA patients were enrolled and divided into musculoskeletal ultrasound（MSUS） group and clinical group. MSUS and clinical methods were used respectively to diagnose RA using double-blind method. MSUS was used to detect seven joints including ipsilateral wrist, the second and third metacarpophalangeal joints, the second and third proximal interphalangeal joint, and the second and fifth metatarsophalangeal joints. Synovial hyperplasia, the synovial blood signal, bone erosion and joint effusion of ultrasound were used to diagnose synovial lesions of RA. Both MSUS method and clinical method were compared by comparative analysis. At the same time, these four indicators were scored by the serological indicators. Results ： Fifty-five cases of RA and 22 cases of non-RA were di- agnosed by MSUS while 53 cases of RA and 24 cases of non-RA were diagnosed by clinical method. There was no statistical signifi- cance between MSUS method and clinical method in diagnosing RA（P=0.774）. There was a close correlation between sum scores of synovial blood flow, sum score of effusion and erythrocyte sedimentation rate （r=0.739, P=0.000 ; r=0.564, P=0.000）. Conclusion ： Four indicators of MSUS accords with clinical method in the diag- nosis of RA. There is a close correlation between sum scores of synovial blood flow, sum score of effusion and serological indi- cators. MSUS, as a screening method for RA, provides more evi- dences fur the diagnosis for RA,therefore should be widely ap- plied.