彩色多普勒对炎症和非炎症性膝关节疾病的鉴别诊断价值

Differential of inflammatory and non- inflammatory arthritis of knee in color Doppler

目的比较非炎症性和炎症性膝关节疾病患者彩色多普勒血流信号,探讨彩超检查对两类疾病的诊断价值。方法选择2014年1月至2015年1月就诊的膝关节炎患者,根据滑膜液白细胞（WBC）计数分为炎症性和非炎症性疾病组,在髌骨上、内外侧髁三个方位分别进行彩色多普勒检查,按血流信号分为0、Ⅰ、Ⅱ、Ⅲ级,比较单切面和合计评分。结果共入选53例膝关节炎患者,其中非炎症组31例和炎症组22例,彩色多普勒血流信号评分表明非炎症组患者总分低于炎症组（P〈0.05）,不同方位评分中外侧髁位最高,组间比较差异有统计学意义（P〈0.05）,而髌骨上、内侧髁两个方位组间比较差异无统计学意义（P〉0.05）;ROC曲线下面积（AUC）=0.743（95%CI为0.605-0.853,P=0.0003）,所对应的评分为3,诊断敏感度为61.29%,特异度为77.27%。结论彩色多普勒有助于区分膝关节炎症和非炎症性疾病,但难以确定明确的诊断折点,应结合临床资料综合判断。

Objective To evaluate the color doppler signal between non- inflammatory and inflammatory knee arthritis,probe the diagnosis value of ultrasonography for those disease. Methods From Jan 2014 to Jan 2015,patients complained of knee arthritis in our hospital were divided into inflammatory group and non- inflammatory group according to white blood cell（ WBC） count of synovial fluid. Three directional of insuprapatellar,medial and lateral were evaluated by color Doppler. Blood flow divided into grade 0,Ⅰ,Ⅱ,Ⅲ and single section,total score were compared. Results A total of 53 patients of knee arthritis were enrolled,included 31 patients with non- inflammatory and 22 patients with inflammatory group. Color doppler signal score of non- inflammatory group were lower than inflammation group（ P〈0. 05）. The highest score was the lateral longitudinal（ P〈0. 05）. There was no significant difference in medial and lateral longitudinal between two groups（ P〉0. 05）. Area under curve（ AUC） of ROC was 0. 743（ 95% CI = 0. 605 - 0. 853,P = 0. 0003）,which means cutoff score was 3,sensitivity and specificity were 61. 29% and 77. 27% respectively. Conclusion Color Doppler differentiate inflammation and non- inflammatory arthritis effectively,but it is difficult to determine the definitive cutoff point. Confirmed diagnosis should combine with comprehensive clinical data.