腕关节高频超声在类风湿性关节炎中医各证型临床应用价值

Application of High Frequency Ultrasonography of Wrist Joint in Rheumatoid Arthritis

目的 :探讨腕关节高频超声诊断类风湿性关节炎(RA)的价值及其不同超声表现辅助中医辨证分型的临床应用价值。方法 :选取2015年3月—2016年10月确诊为RA的患者,5种主要的中医证型(湿热痹阻证、寒湿痹阻证、肾气虚寒证、肝肾阴虚证、瘀血痹阻证)各30例,应用高频超声检查其双侧腕关节,分析其超声声像图特点,包括腕关节滑膜的厚度、滑膜内彩色血流信号分布情况及骨侵蚀情况,研究其声像图特点与中医各证型间的相关性。结果 :各证型腕关节滑膜均有不同程度增厚,其中湿热痹阻证滑膜增厚最明显,因此滑膜厚度可作为RA的重要诊断指标;腕关节滑膜内血流信号分布由多到少依次为湿热痹阻证>寒湿痹阻证>肝肾阴虚证>瘀血痹阻证>肾气虚寒证,因此滑膜内血流分布情况可作为中医辨证分型及活动性判断的参考依据;RA慢性期(肾气虚寒证、肝肾阴虚证、瘀血痹阻证)骨侵蚀明显,而急性期(湿热痹阻证、寒湿痹阻证)骨侵蚀不明显,因此骨侵蚀可作为RA急慢性临床分期的客观指标。结论 :RA中医证型不同,腕关节的超声声像图特点不尽相同,腕关节高频超声可为传统中医辨证分型界定客观化、标准化、规范化的指标,指导临床用药治疗,以提高中医药诊疗的准确性。

Objective ：To investigate the value of wrist high frequency ultrasonography in the diagnosis of rheumatoid arthritis（RA）and its clinical value of different ultrasonic manifestations in TCM syndrome differentiation. Methods ：Selected patients were diagnosed with RA in rheumatology department of our hospital from March 2015 to October 2016,5 main syndromes（dampness heat blockage syndrome,cold dampness syndrome,Qi deficiency syndrome,liver kidney Yin deficiency,blood stasis syndrome）30 cases,applied high frequency ultrasonography of the bilateral wrist joint analysis of the ultrasonographic characteristics,including synovial thickness,wrist synovium of color Doppler signals and the distribution of bone erosion,the correlation between ultrasonographic features and TCM syndrome type. Results ：Syndrome type of wrist synovium had different degree of thickening of the dampness heat blockage syndrome synovial thickening was most obvious,so the synovial thickness can be used as an important diagnostic index RA;wrist synovium blood flow within the signal distribution followed by the more to less dampness heat blockage syndrome cold dampness syndrome liver kidney Yin deficiency blood stasis syndrome Qi deficiency syndrome,so the distribution of blood flow within the synovial membrane can be used as the TCM syndrome type and activity of reference for judgment;In RA chronic stage（Qi deficiency syndrome,liver kidney Yin deficiency,blood stasis syndrome）,bone erosion was obvious,but bone erosion was not obvious in acute stage（dampness heat blockage syndrome,cold dampness syndrome）. Therefore,bone erosion can be used as an objective index for acute and chronic clinical stages of RA. Conclusion ：With different RA TCM syndromes,ultrasonographic features of the wrist is not the same,wrist high frequency ultrasound can be as traditional TCM defined objective and standardized indicators to guide the clinical medication treatment,in order to improve the accuracy of the diagnosis and treatment of traditional Chinese medicine.