高频彩超在类风湿性关节炎腕关节病变诊断和治疗中的应用

Application value of high frequency color Doppler ultrasound for rheumatoid arthritis on wrist lesions

目的探讨高频彩超在类风湿性关节炎（RA）腕关节病变诊断和治疗中的价值。方法对广东省东莞市第三人民医院风湿免疫科2011年1月-2014年1月收治的RA患者86例（RA组）、同期健康体检者40例（对照组）进行腕关节高频彩超检查,比较两组声像图表现及腕关节滑膜厚度,分析RA患者滑膜血流分级与动脉血流阻力指数（RI）,对RA组进行DR摄片检查,比较超声和DR摄片对骨侵蚀的检出率。对RA组进行3个月的中西医结合治疗,比较治疗前后滑膜厚度、血流分级及RI值变化情况。结果对照组关节腔未见积液,滑膜内未见血流信号;RA组161个（93.6%）腕关节滑膜增生,137个（79.7%）腕关节显示关节腔积液;彩色多普勒成像显示141个（82.0%）关节滑膜内可见血流信号。RA组滑膜厚度高于对照组,差异有高度统计学意义[（3.21±1.42）mm比（1.59±0.62）mm,t=9.772,P=0.000];滑膜血流RI值与分级呈负相关（r=-0.81,P〈0.05）;病程〈2年的RA患者超声检查对骨侵蚀检出率高于DR摄片,差异有统计学意义（35.1%比13.5%,χ^2=4.698,P=0.030）,病程≥2年的RA患者超声检查与DR摄片对骨侵蚀的检出率差异无统计学意义（P〉0.05）。治疗3个月后,RA组患者滑膜厚度降低[（3.21±1.42）mm比（2.35±0.86）mm,t=6.794,P=0.000],RI值增加[（0.52±0.11）比（0.60±0.12）,t=6.445,P=0.000],血流分级0、Ⅰ级患者增加,Ⅱ、Ⅲ级患者减少,与治疗前比较差异有高度统计学意义（Z=8.619,P=0.006）。结论高频彩超可较好显示RA腕关节病变,并对疗效的评价提供依据,在RA的诊断和治疗中有较高的临床价值。

Objective To explore the clinical diagnosis and treatment value of high frequency color Doppler ultrasound for heumatoid arthritis（RA） on wrist lesions. Methods 86 patients with RA admitted to rheumatism immunity branch in the Third People＇s Hospital of Dongguan City from January 2011 to January 2014（RA group）, and 40 healthy subjects（control group） were examinated by high frequency color Doppler ultrasound of the wrist, sonographic appearance and carpal synovial membrane thickness of two groups were compared, synovial flow resistance level and arterial blood flow index（resistive index, RI） of patients with RA were analyzed, and DR radiography of RA group were examinated, detection rate of ultrasound and DR radiography for bone erosion were compared. Three months of combining treatment of traditional Chinese medicine and Western medicine were given the RA group, synovial thickness, blood flow grade and RI value history before and after the treatment were compared. Results There was no joint cavity exudation and no blood flow signals in the synovium of the control group; 161 joints（93.6%） had synovium proliferation synovial of wrist joint of the RA group, arthroedema was showed in wrist joints of 137 joints（79.7%）; under color Doppler imaging, there were 141 cases（82.0%） of visible blood flow signal in joint synovial tissues. Synovial membrane thickness of the RA group was higher than that of the control group with statistically significant difference [（3.21±1.42） mm vs（1.59±0.62） mm, t=9.772, P=0.000]; RI value of synovial blood was negatively correlated with the grade（r=-0.81, P 0.05）; the course of desease of the patients with RA was less than 2 years,the detection rate of ultrasound examination for bone erosion was higher than that of DR radiography with statistically significant difference（35.1% vs 13.5%, χ^2=4.698, P=0.030）, the course of desease of the patients with RA ≥2years, there were not statistically significant differences in detection rates of ultrasound inspection and the DR radiography for bone erosion（P 〈0.05）. After 3 months of treatment, synovial thickness of the patients in RA group decreased[（3.21±1.42） mm vs（2.35±0.86） mm, t=6.794, P=0.000], RI value increased [（0.52±0.11） vs（0.60±0.12）, t =6.445, P =0.000], the patients with blood flow in grade 0 and grade Ⅰ increased, patients at grade Ⅱ and grade Ⅲ reduced,compared with before treatment, the difference was statistically significant（Z=8.619, P=0.006）. Conclusion High frequency color Doppler ultrasound can display RA wrist lesions better, and provide the basis for the evaluation of curative effect, it has high clinical value in the diagnosis and treatment of RA.