超声评估血友病A性膝关节和踝关节病的临床研究

Clinical study of ultrasonic evaluation of knee and ankle joints hemophilia A arthropathy

目的观察血友病A性膝关节和踝关节病的超声特征及临床意义。方法 2015年1月—2016年6月在浙江中医药大学附属第一医院就诊的28例血友病A患者的55个膝关节和55个踝关节行超声探查并评分,分析血友病A患者关节滑膜增厚超声评分与软骨改变超声评分的相关性,以及膝关节超声评分与踝关节超声评分的相关性。结果全部28例患者均为男性,中位年龄33.4(6~69)岁。膝关节超声评分与踝关节平均超声评分分别为5.16±0.67和3.87±0.57,差异有统计学意义(P<0.01),且膝关节和踝关节骨侵蚀发生率差异存在统计学意义(P<0.05)。轻型与中间型、重型血友病A患者关节超声评分差异存在统计学意义(P<0.01),但中间型和重型血友病A患者关节超声评分差异无统计学意义(P=0.134)。<18岁和≥18岁年龄组关节超声评分别为3.50±1.00、4.87±0.482,差异无统计学意义(P=0.169)。膝关节超声评分与踝关节超声评分有一定正相关性,差异有统计学意义(r=0.479,P<0.01);滑膜厚度超声评分与软骨改变超声评分存在显著正相关性,差异有统计学意义(r=0.728,P<0.01)。结论超声可有效识别血友病A性膝关节和踝关节病病变,是评估血友病A性膝关节和踝关节病简便易行、安全有效、快捷低廉的检测手段,具有较强的临床实用价值。

Objective To investigate the characteristics and clinical significance of ultrasonography in haemophilic A ar- thropathy of knee and ankle joints. Methods The knee （ n = 55 ） and ankle joints （ n = 55 ） of 28 patients with the diagno- sis of haemophilic A in our hospital from January ,2015 to June ,2016 were evaluated with ultrasonography and scored ac- cording to MELCHIORRE ultrasound score. The correlations between ultrasound score synovial hypertrophy, knee joints and cartilage damage, ankle joints were analyzed respectively. Results There were 28 male patients with median age 33.4 （6 -69） years old enrolled in this study. The average ultrasound score of knee and ankle joints were 5.16 ± 0.67 and 3.87 ±0.57 respectively,which had significant statistically （P 〈0.01 ）,and the incidence of bone erosion of knee and ankle joints had statistical significance（P 〈0.05 ）. The significant difference of ultrasound score was found between mild and moderate, severe haemophilia A（ P 〈 0.01 ）, but had no statistical significance between moderate and severe hae- mophilia A（P =0. 134）. The ultrasound score according to age 〈 18 and ≥18 years old groups were 3.50 ± 1.00,4.87 ± 0. 482 respectively, which had no statistical significance （ P = 0. 169 ）. A positive correlation between knee and ankle joints of ultrasound score was demonstrated（ r = 0. 479, P 〈 0.01 ） ; a significant positive correlation between synovial hypertro- phy and cartilage damage of ultrasound score was demonstrated （ r = 0. 728, P 〈 0.01 ）. Conclusion Ultrasound can ef- fectively identify haemophilia A joint lesions of knee and ankle joints, which was a fast, effective, safe and available in- spection method in the assessment of haemophilia A arthropathy of knee and ankle joints and had remarkable clinical practical value.