血液透析患者下肢附着点亚临床病变的超声研究

Sonographic Features of Subclinical Enthesopathy of the Lower Extremity in Patients on Hemodialysis

目的长期接受血液透析治疗会继发肌肉骨骼病变,严重影响患者生活质量。本文探讨血液透析患者下肢附着点亚临床病变的超声表现和危险因素,为血液透析患者发展为症状型附着点病变提供早期诊断依据。资料与方法观察性研究36例血液透析患者和36例健康对照者（对照组）下肢附着点的超声图像特点,分析超声检查结果与临床和实验室指标间的相关性。结果血液透析组的平均体重指数（BMI）明显小于对照组（t=2.8,P〈0.01）。血液透析组较对照组下肢亚临床附着点病变发生率明显增加（χ2=101.8,P〈0.001）,肌腱韧带明显增厚,韧带骨赘和能量多普勒信号增多（χ2=41.5、28.2、4.2,P〈0.05）,平均GUESS评分明显升高（t=-5.3,P〈0.001）。附着点病变与年龄、BMI呈正相关（F=12.3,P〈0.05）,与血钙、血磷、肌酐、三酰甘油、甲状旁腺素、β_2微球蛋白浓度以及C反应蛋白水平等实验室指标均无明显相关性（P〉0.05）。结论超声可有效发现血液透析患者的下肢附着点亚临床病变,超声检查结果联合高龄、高BMI可为血液透析患者发展为症状型附着点病变提供重要参考依据。

Purpose Musculoskeletal disease can be a secondary lesion occurred in patients on long-term hemodialysis, which seriously affects the quality of life. This paper investigates the ultrasonographic manifestations and risk factors of subclinical enthesopathy in the lower extremities of hemodialysis patients to provide important reference information for early diagnosis of symptomatic enthesopathy. Materials and Methods Ultrasonographic imaging features of entheses in lower extremity of 36 hemodialysis patients（hemodialysis group） and 36 healthy controls（control group） were reviewed, and the relationship between ultrasound findings and the clinical as well as laboratory data were analyzed. Results The average body mass index（BMI） of hemodialysis group was significantly less than the control group（t=2.8, P〈0.01）. The incidence of subclinical entheses lesions, thicker ligament, osteophyte and power Doppler signal of entheses were significantly higher in hemodialysis group than in control group（χ~2=101.8, 41.5, 28.2 and 4.2, P〈0.05）. The GUESS score was significantly higher in patients with hemodialysis（t=- 5.3, P〈0.001）. There was a significant correlation between enthesopathy and age as well as BMI（F=12.3, P〈0.05）, while no significant correlation between enthesopathy and calcium, phosphorus, creatinine, triglycerides, parathormone, beta-2-microglobulin, C-reactive protein were noted（P〈0.05）. Conclusion Ultrasound can be effectively used in finding subclinical enthesopathy of lower extremity in hemodialysis patients. Combined with ultrasound results, older age and higher BMI will provide important reference information for the development of symptomatic dialysis-related enthesopathy.