类风湿关节炎手腕部骨侵蚀声像图表现浅析

Analysis of ultrasonography of bone erosions in hands and wrists of rheumatoid arthritis

目的分析类风湿关节炎(RA)手腕部骨侵蚀的声像图表现,探讨肌骨超声在其检测中的临床应用价值。方法对76例经2010年美国风湿病协会/欧洲抗风湿病联盟诊断标准确诊的RA患者行手腕部(包括腕关节、掌指关节和近端指间关节)肌骨超声检查,观察有无滑膜炎、腱鞘炎和骨侵蚀,记录骨侵蚀部位和数量;对各关节病变超声表现进行半定量分级并计算总评分,分析骨侵蚀与滑膜炎、腱鞘炎评分的相关性。结果 76例RA患者超声检出49例,共86处发生骨侵蚀病变。手腕部关节骨侵蚀数量与手腕部滑膜炎灰阶超声(GSUS)评分和能量多普勒超声(PDUS)评分均呈正相关(r=0.579、0.765,均P<0.01),与腱鞘炎GSUS评分和PDUS评分均无显著相关性。骨侵蚀评分与手腕部滑膜炎GSUS评分和PDUS评分均呈正相关(r=0.634、0.828,均P<0.01),与腱鞘炎GSUS评分和PDUS评分均无显著相关。结论肌骨超声能有效检测RA手腕部骨侵蚀病变,且骨侵蚀的发展与关节滑膜炎活动性的发展程度密切相关。

Objective To analyze the ultrasonography of bone erosions in hands and wrists in patients with rheumatoid arthritis（RA）, and to evaluate the clinical application value of musculoskeletal ultrasound in the detection of bone erosion. Methods Musculoskeletal ultrasonography of hands and wrists（including wrist,metacarpophalangeal and proximal interphalangeal joints） was performed on 76 patients with RA,who were confirmed by 2010 ACR/EULAR.The locations and amounts of bone erosion were recorded.Ultrasonography of each joint lesion was semi-quantitatively graded and total scores were calculated.The relationships between bone erosion and scores of synovitis and tenosynovitis were analyzed.Results Bone erosion was detected in 49 cases among 76 patients with RA,with a total of 86 lesions.The number of bone erosion was positively correlated with synovitis scores of both gray-scale ultrasonography（GSUS） and power Doppler ultrasonography（PDUS）, r were 0.579 and 0.765 （both P〈0.01 ）.The GSUS score of bone erosion was also positively correlated with synovitis scores of both GSUS and PDUS, r were 0.634 and 0.828（both P〈0.01 ）.There was no significant correlation between bone erosion parameters and tenosynovitis scores. Conclusion Musculoskeletal ultrasonography can effectively detect bone erosion lesions of hands and wrists in patients with RA. The development of bone erosion is closely related to the severity of joint synovitis, especially the activity of inflammation.