超声造影在类风湿关节炎腕关节炎活动期病变中的诊断价值

Value of contrast-enhanced ultrasonography in the diagnosis of rheumatoid arthritis wrist

目的探讨超声造影在类风湿性腕关节炎活动期病变中的诊断价值。方法选取温州市中心医院在2015年1月—2016年11月收治的以腕关节肿痛为主诉就诊的类风湿性关节炎患者30例(54个腕关节),设为观察组,另选取同期做类风湿筛查的健康体检者23例(共46个腕关节),设为对照组。采用彩色多普勒超声检测2组腕关节滑膜厚度,检测增生滑膜有无血流信号、关节有无骨质侵蚀、有无关节积液;对观察组患者腕关节进行超声造影检查(CEUS),分析检查结果与DAS28、EST、CRP、RF的相关性。结果 (1)观察组患者54个腕关节中出现滑膜增厚51个、关节积液33个、骨质侵蚀29个,对照组46个腕关节中,出现滑膜增厚3个、关节积液4个、关节侵蚀1个,比较差异具有统计学意义(P<0.05);2组平均滑膜厚度比较差异有统计学意义(t=15.731,P<0.001);(2)观察组51个滑膜增厚关节中,42个检出血流信号,对照组3个滑膜增厚关节中,1个检出血流信号,差异具有统计学意义(P<0.001);(3)滑膜厚度和CEUS分级与ESR、CRP、DAS28评分呈正相关,与RF、Anti-CCP无相关性;超声造影TIC定量分级与滑膜厚度、CEUS灌注分级呈正相关。结论超声造影能够清晰显示腕关节内滑膜形态学改变,定量分析滑膜内血流灌注情况,与血清学指标及疾病活动度呈正相关,在早期诊断类风湿性关节炎腕关节活动期病变中具有较高的临床价值。

Objective To evaluate the diagnostic value of contrast-enhanced ultrasound （CEUS） in the pathogenesis of rheumatoid arthritis. Methods Total 30 patients （54 wrist joints） of rheumatoid arthritis treated with wrist pain were se- lected from January, 2015 to November, 2016. The patients were treated with the same time. There were 23 healthy pa- tients （46 wrist joints） in the hospital. The color Doppler uhrasonography was used to detect the synovial thickness of the wrist joint in the two groups. The correlation between DAS28, EST, CRP and RF was analyzed by uhrasonography （CEUS） in the wrist of the observation group. Results （1）There were 51 （94.44%） , 33 cases （61.11% ） of joint effusion, 29 （53.73%） of bone lesions and 46 wrist There were 3 （6.52%） , synovial fluid （7.14%） and joint erosion （2.17%） , and the difference was statistically significant （P 〈 0.05 ）. The mean synovial thickness of the observation group was （3.23± 1.27 ） mm, and the mean synovial thickness was （ 1.37 ± 0.65 ） mm in the group. The difference was statistically significant （t = 15. 731, P 〈0.001 ）. （2）In the observation group, 52 cases of synovial thickening were detected. The detection rate was 82.35%, among which 17 were Grade I , 18 were Grade Ⅱ and 7 were Grade Ⅲ. The detection rate was 33.33% and the signal intensity was grade Ⅰ , and the difference was statistically significant （ P 〈 0. 001 ）. （3）There was no correlation with RF and Anti-CCP. Ultrasound contrast TIC quantitative grading was positively correlated with synovial thickness and CEUS perfusion grade. Conclusion Uhrasonography can clearly show the changes of synovial membrane in the wrist, and quantitatively analyze the perfusion of synovial fluid. It is positively correlated with serological parameters and disease activity. In the early diagnosis of rheumatoid arthritis wrist activity has a high clinical value.