血友病性关节病HEAD-US半定量超声评估量表的临床应用及优化探索

Clinical application and optimization of HEAD-US quantitative ultrasound assessment scale for hemophilic arthropathy

【摘要】目的评价HEAD—US评估量表在血友病性关节病临床应用的可行性，提出优化的超声评估量表HEAD—US—C。方法2015年7月至2017年8月期间，91例血友病患者接受1035例次关节超声检查，分别采用Melchiorre、HEAD．US、HEAD—US—C量表进行评分，分析与血友病关节健康评分量表（HJHS）评分之问的相关性并比较上述量表评价血友病性关节病的敏感性。结果91例患者均为男性，中位年龄16（4～55）岁，血友病A86例，血友病B5例。1035例次关节检查Melchiorre、HEAD．US、HEAD．US—C量表的评分[M（P25，R75）]分别为2（0,6）、1（0,5）、2（0,6），均与HJHS评分之间存在相关关系（相关系数分别为0．747、0．762、0．765，尸值均〈0．001）。Melchiorre、HEAD，US—C、HEAD—US评分量表的阳性率分别为63．O％（95％CI59．7％-65．9％）、59．5％（95％CI56．5％-62．4％）、56．6％（95％CI53．6％-59．6％），差异有统计学意义（P〈0．001）。336例次无症状关节（HJtlS评分0分）Melchiorre、HEAD—US—C、HEAD．US评分量表的阳性率分别为25．0％（95％CI20．6％-29．6％）、17．00／0（95％CI12．6％～21．1％）、11．9％（95％C18．4％～15．7％）（P〈0．001）。40例有关节出血症状的血友病患者（107例次）关节fn血前、出血后超声评分差异有统计学意义（P〈0．05）。HEAD—US—C与HEAD—US评分的变化幅度比较，差异有统计学意义（P〈O．001）。结论与Melchiorre比较，HEAD—US、HEAD—US—C与HJHS之间具有相似的良好的相关性。HEAD．US—C评分量表较HEAD—US更为敏感，尤其适合亚临床状态血友l腐眭关节病的评估。

Objective To assess the feasibility of HEAD-US scale in the clinical application of hemophilic arthropathy （HA） and propose an optimized ultrasound scoring system. Methods From July 2015 to August 2017, 1 035 joints ultrasonographic examinations were performed in 91 patients. Melchiorre, HEAD-US （Hemophilic Early Arthropathy Detection with UltraSound） and HEAD-US-C （HEAD-US in China） scale scores were used respectively to analyze the results. The correlations between three ultrasound scales and Hemophilia Joint Health Scores （HJHS） were evaluated. The sensitivity differences of the above Ultrasonic scoring systems in evaluation of HA were compared. Results All the 91 patients were male, with median age of 16 （4-55） years old, including 86 cases of hemophilia A and 5 cases hemophilia B. The median （P25, P75） of Melchiorre, HEAD-US and HEAD-US-C scores of 1 035 joints were 2（0,6）, 1 （0,5） and 2（0,6）, respectively, and the correlation coefficients compared with HJHS was 0.747, 0.762 and 0.765 respectively, with statistical significance （P〈0.001）. The positive rates of Melchiorre, HEAD-US-C and HEAD-US scale score were 63.0% （95%CI 59.7%-65.9%）, 59.5% （95%CI 56.5%-62.4% ） and 56.6% （95% CI 53.6%-59.6% ） respectively, and the difference was statistically significant （P 〈 0.001）. Even for 336 cases of asymptomatic joints, the positive rates of Melchiorre, HEAD- US-C and HEAD-US scale score were 25.0% （95%C/20.6%-29.6%）, 17.0% （95%CI 12.6%-21.1%） and 11.9% （95%CI 8.4%-15.7%） respectively, and the difference was statistically significant （P 〈 0.001）. There were significant changes （P〈0.05） in the ultrasonographic score of HA before and after onset of hemorrhage in 107 joints of 40 patients. The difference in variation amplitude of HEAD-US-C scores and HEAD-US scores before and after joint bleeding was statistically significant （P〈0.001）. Conclusion Compared with Melchiorre, there were similar good correlations between HEAD-US, HEAD-US-C and HJHS. HEAD-US ultrasound scoring system is quick, convenient and simple to use. The optimized HEAD- US-C scale score is more sensitive than HEAD-US, especially for patients with HA who have subclinical state, which make up for insufficiency of sensitivity in HEAD-US scoring system