超声微血管成像技术在类风湿关节炎滑膜血管翳中的应用

Application of ultrasound microangiography in pannus of rheumatoid arthritis

目的探讨超声微血管成像技术(SMI)在类风湿关节炎(RA)滑膜血管翳中的诊断价值。方法选取承德市中心医院2016年12月至2018年10月RA患者50例,均实施SMI及能量多普勒(PDI)检查,测定所有患者膝关节滑膜厚度、血流信号,对血流信号予以分级,并指导患者口服来氟米特及甲氨蝶呤,参照病情及机体状况给予激素和非甾体类抗炎药物(共治疗3个月)治疗。统计SMI及PDI对关节增生滑膜血流信号呈现情况、血流分级情况,统计分析RA患者关节疾病活动度评分(DAS28)分值和SMI血流信号分级间关联性,并统计比较本组RA患者治疗前及疗程结束后相关指标[抗环胍氨酸肽(CCP)抗体、类风湿因子(RF)、C反应蛋白(CRP)、红细胞沉降率(ESR)、滑膜厚度]水平。结果本组50例RA患者关节滑膜增厚80个关节,SMI血流信号显示率(86.25%)高于PDI(63.75%)(P<0.01)。SMI及PDI关节增生滑膜血流分级间均存在显著差异(P<0.01)。Spearman检验可知,SMI血流信号分级与DAS28分值间存在显著正相关关系(r=0.818,P<0.01)。疗程结束后本组抗CCP抗体、RF、CRP、ESR水平较治疗前降低,滑膜厚度较治疗前减小(P<0.01)。结论SMI检查可有效评估RA患者增生滑膜血管翳状况,其和RA病变活动度间存在显著正相关关系,且可评估疾病治疗情况,能为RA病变活动度与严重程度、治疗效果评估提供客观参考依据。

Objective To investigate the diagnostic value of superb micro-vascular imaging(SMI)in pannus of rheumatoid arthritis.Methods A total of 50 patients with RA who received treatment in Chengde Central Hospital from December 2016 to October 2018 were selected and examined by SMI and Doppler flow imaging(PDI).The synovium thickness and blood flow signals of all patients were measured,and the blood flow signals were graded.The patients were instructed to take leflunomide and methotrexate orally,and hormone and non-steroidal anti-inflammatory drugs(3 months in total)were given according to their condition and body condition cure.The correlation between DAS28 score of RA patients and SMI blood flow signal grade was statistically analyzed,and the related indexes[anticoagulant peptide(CCP),rheumatoid factor(RF),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),synovium thickness]were compared before and after the treatment.Results In this group,the synovium of 50 RA patients was thickened 80 joints,the blood flow signal display rate of SMI was higher than that of PDI(86.25%vs 63.75%,P<0.01).There was significant difference in the grade of bload flow signals between SMI and PDI(P<0.01).Spearman test showed that there was a significant positive correlation between SMI blood flow signal grading and DAS28 score(r=0.818,P<0.01).After the treatment,the levels of anti CCP antibody,RF,CRP and ESR decreased,and the synovial thickness decreased(P<0.01).Conclusion SMI can effectively evaluate the condition of hyperplastic synovium and pannus in RA patients,which has a significant positive correlation with the activity of RA lesions,and can evaluate the disease treatment,which can provide an objective reference for the evaluation of activity and severity of RA lesions and treatment effect.