高频多普勒超声在早期类风湿关节炎病人手部小关节炎诊断中的应用

The application value of high frequency Doppler ultrasound in the diagnosis of osteoarthritis of the hand in patients with early rheumatoid arthritis

目的:探讨早期类风湿关节炎(ERA)病人手部小关节高频多普勒超声(HFUS)表现,并分析其临床应用价值。方法:收集40例ERA病人作为观察组,选择同期体检健康者40名作为对照组,采用HFUS检查第1～5近端指间关节(PIP)及第1～5掌指关节(MCP),记录HFUS表现,包括滑膜增厚、滑膜血管翳、关节积液、肌腱鞘炎、骨侵蚀等改变,对比2组差异;另外观察组行手部X线片检查,比较2种检查方法病例阳性率和关节异常检出率。结果:HFUS检查,观察组MCP及PIP滑膜厚度分别为(1. 65±0. 39) mm、(1. 18±0. 47) mm,显著高于对照组的(1. 01±0. 35) mm、(0. 88±0. 34) mm(P <0. 01)。观察组HFUS检查阳性病例40例,阳性率100. 00%,异常关节检出635个,检出率79. 38%; X线片检查阳性病例12例,阳性率30. 00%,异常关节检出225个,检出率28. 13%; HFUS检查阳性病例检出率和异常关节检出率均高于X线片检查(P <0. 01)。结论:HFUS检查能够显示ERA病人手部小关节的滑膜炎、关节积液等异常,阳性率高,且具有经济、方便、安全的优势,可为临床诊断提供良好的参考价值。

Objective： To investigate the manifestation of early rheumatoid arthritis（ERA） using high frequency Doppler ultrasound（HFUS）,and analyze its clinical application value.Methods： Forty patients with ERA and 40 health examination people at the same time were divided into the observation group and control group,respectively.The proximal interphalangeal joint（PIP） and metacarpophalangeal joint（MCP） from 1 to 5 were detected using HFUS.The synovial thickening,synovial vascular pannus,joint effusion,tendonitis and bone erosion of HFUS manifestations between two groups were compared.The hand in observation group was detected using X-ray.The positive rate of case and abnormal rate of joint between two detection methods were compared.Results： The results of HFUS showed that the synovial thickness of MCP and PIP in observation group[（1.65±0.39）mm and （1.18±0.47）mm] were significantly higher than those in control group[（1.01±0.35）mm and （0.88±0.34）mm],respectively（ P 〈0.01）.Forty positive cases were detected using HFUS in observation group,and the positive rate of which was 100%.Six hundred and thirty-five abnormal joints were detected using HFUS in observation group,and the positive rate of which was 79.38%.Twelve positive cases were detected using X-ray in observation group,and the positive rate of which was 30.00%.Two hundred and twenty-five abnormal joints were detected using X-ray in observation group,and the positive rate of whcih was 28.13%.The detection rates of positive case and abnormal joint using HFUS were higher than those using X-ray（ P 〈0.01）.Conclusions： HFUS detection can show the synovial thickening and joint effusion,which has high positive rate,is economic,convenient and safe,and can provide a good reference value in clinic.