超微血管成像在诊断早期类风湿关节炎患者腱鞘炎中的应用价值

Application value of superb microvascular imaging in the diagnosis of tenosynovitis in early rheumatoid arthritis patients

目的探讨超微血管成像技术（SMI）在诊断早期类风湿关节炎患者尺侧腕伸肌腱鞘炎的价值。方法两位超声医师分别对40例病程〈2年且DAS28〉2．6的类风湿关节炎患者行双侧腕关节超声检查；记录能量多普勒（PDI）和超微血管成像模式下腕关节尺侧腕伸肌腱鞘内的血流信号。采用Kappa检验分析两名医师应用超微血管成像诊断尺侧腕伸肌腱鞘内血流信号分级的一致性；χ^2检验比较两种成像模式下尺侧腕伸肌腱鞘内血流信号显示率的差异，采用等级变量非参数检验秩和检验比较其血流等级的差异；对SMI尺侧腕伸肌腱鞘内血流评分与DAS28行相关性分析。结果两名医师应用超微血管成像诊断腱鞘内血流信号分级的一致性高（Kappa=0．8，P〈0．05）。40例早期且处于活动期的类风湿关节炎患者，共80个尺侧腕伸肌；PDI腱鞘内血流信号检出率为36．3％（29／80），SMI血流信号的检出率为56．3％（45／80）；SMI的腱鞘内血流信号显示率高于PDI（χ^2=11．0，P〈0．05）。PDI尺侧腕伸肌腱鞘内血流信号为0、Ⅰ、Ⅱ、Ⅲ级的数目分别为51、21、6、2；SMI其血流信号为0、Ⅰ、Ⅱ、Ⅲ级的数目分别为35、17、20、8；SMI评价的腱鞘内血流信号等级显著高于PDI（Z=-2．6，P〈0．05）。超微血管成像模式下腱鞘内血流总和与DAS28间成正相关（r=0．7，P〈0．05）。结论超微血管成像技术在不同检查者之间的一致性好，且可以提高早期类风湿关节炎患者腱鞘内血流信号的检出率，为类风湿关节炎早期诊断及疾病活动性评估提供重要的参考价值。

Objective To investigate the value of superb microvascular imaging （SMI） in the diagnosis of ulnar extensor tendon sheath inflammation of patients with early rheumatoid arthritis. Methods Two ultrasonographers respectively performed bilateral wrist joint ultrasonography for 40 patients with rheumatoid arthritis patients with disease duration 〈 2 years and DAS28 〉 2.6. The blood flow signals in the extensor tendon sheath of the wrist joint were recorded by PDI and superb mierovascular imaging. A Kappa test was used to analyze the consistency of the blood flow signal classification in the extensor tendon sheath of the ulnar wrist of the two physicians. The difference of the blood flow signal display rate was compared between the two imaging modalities, and the rank and test were used to compare the difference of blood flow grade. The relationgship between blood flow score and DAS28 line in SMI ulnar extensor tendon sheath was analyzed. Results The consistency of the blood flow signal classification in the tendon sheath was diagnosed by two physicians using SMI （Kappa = 0. 8, P 〈 0. 05 ）. In 40 patients with early and active rheumatoid arthritis, there were 80 ulnar extensor muscles. The detection rate of blood flow in PDI tendon sheath was 36.3% （29/80） , and the detection rate of SMI blood flow was 56. 3 % （45/80）. The blood flow signal in the tenosynovium of SMI was higher than that of PDI （ χ^2 = 11.0, P 〈 0. 05 ）. The number of blood flow signal in the ulnar extensor tendon sheath using PDI whose grade was 0,Ⅰ , Ⅱ, Ⅲ was 51,21,6 and 2 respectively. When using SMI, the number was 35, 17, 20 and 8 respectively. The level of blood flow signal in the tenosynovium of SMI was significantly higher than that of PDI （ Z = - 2. 6, P 〈 0. 05 ）. The total blood flow in the tendon sheath in the SMI mode was positively correlated with DAS28 （ r = 0.7, P 〈 0.05 ）. Conclusions Superb microvascular imaging has good consistency between the different examiners, and can improve the detection rate of blood flow signal in the tendon sheath of patients with early rheumatoid arthritis, which provides important reference value for the early diagnosis of rheumatoid arthritis and the assessment of the activity of disease.