多普勒超声与超声造影评价兔类风湿性关节炎模型滑膜病变

Doppler ultrasound and CEUS in evaluation of synovial changes based on rabbit model

目的探讨多普勒超声与CEUS评估兔类风湿性关节炎（RA）模型膝关节滑膜病理改变及早期诊断活动性滑膜炎的价值。方法将30只新西兰兔随机分为两组,对模型组（n=25）以卵蛋白诱导建立双膝关节RA模型,对照组（n=5）相应时间点仅注射生理盐水。对两组均于多普勒超声和CEUS检查后进行病理检查。以病理检查为金标准,评价多普勒超声及CEUS对活动性滑膜炎的诊断效能,并分析多普勒超声血流分级、CEUS增强程度分级与滑膜炎病理评分的相关性。结果模型组23只兔建模成功,46个膝关节均出现不同程度红肿,模型组多普勒超声与CEUS均可反映滑膜炎症。对照组膝关节均无明显变化。多普勒超声对兔RA模型膝关节活动性滑膜炎的诊断敏感度、特异度、准确率分别为80.56%（29/36）、60.00%（6/10）、76.09%（35/46）;CEUS分别为94.44%（34/36）、90.00%（9/10）、93.47%（43/46）;两种方法的敏感度、特异度、准确率差异均有统计学意义（χ^2=6.35、4.25、5.11,P均〈0.05）。多普勒超声血流分级（rs=0.557,P〈0.05）、CEUS增强程度分级（rs=0.715,P〈0.01）均与滑膜炎病理评分呈正相关。结论多普勒超声和CEUS均可反应兔RA模型膝关节滑膜病理改变,CEUS对活动性滑膜炎的诊断效能更优。

Objective To investigate value of Doppler ultrasound and CEUS in assessing rheumatoid arthritis（RA）activity and synovial pathology changes based on rabbit model.Methods A total of 30 New Zealand rabbits were divided into 2groups,including 25 in model group and 5in contrast group.RA models were established on rabbits in model group induced by egg-protein.Meanwhile saline injections were performed on rabbits in contrast group.After Doppler ultrasound and CEUS,pathological examinations were done to evaluate the activity of RA.Taking pathological results as the golden standard,the diagnostic efficiency of Doppler ultrasound and CEUS for active synovitis were compared.And the correlations of Doppler ultrasound flow scores,CEUS enhanced scores and pathological scores were studied.Results RA models were established successfully in 23 of 25rabbits in model group.And all the 46 knees of RA rabbits were manifested as redness and swollen.Both of Doppler ultrasound and CEUS could reflect synovial inflammation.The manifestations of contrast group were negative.Synovium could not be displayed by Doppler ultrasound and CEUS.The sensitivity,specificity and accuracy of Doppler ultrasound in finding active synovitis was 80.56%（29/36）,60.00%（6/10）and 76.09%（35/46）,respectively.And the sensitivity,specificity and accuracy was 94.44%（34/36）,90.00%（9/10）and 93.47%（43/46）for CEUS,respectively.The differences of sensitivity,specificity and accuracy were statistically significant between Doppler ultrasound and CEUS（χ^2=6.35,4.25,5.11,all P〈0.05）.Doppler ultrasound flow scores were positively correlated with pathological scores（rs=0.557,P〈0.05）,and the positive correlations were also found between CEUS enhanced scores and pathological scores（rs=0.715,P〈0.01）.Conclusion Both of Doppler ultrasound and CEUS can reflex synovitis pathological changes of knees in RA rabbit models.CEUS shows better diagnostic efficiency for active synovitis.