类风湿关节炎多关节病变的超声诊断

Ultrasonic Diagnosis of Rheumatoid Arthritis Polyarthropathy

目的利用高频超声对类风湿关节炎(RA)患者进行多关节观察,探讨高频超声在RA的诊断价值。方法收集2014年3~11月在天津中医药大学附属第一医院、2019年1~6月在天津医科大学总医院空港医院就诊的50例RA患者(RA组),另选取35名健康志愿者为对照组(NC组)。采用高频超声测量RA组与NC组多关节滑膜厚度,观察RA组血管翳、关节积液、肌腱病变、软骨与骨质破坏情况。结果两组双侧腕关节、第二掌指关节、第三掌指关节、第二近端指间关节、第三近端指间关节、膝关节、踝关节的滑膜厚度比较,差异有统计学意义(P<0.05),RA组滑膜较NC组明显增厚,增厚滑膜以低回声为主,薄厚不均,表面不光滑、毛糙;RA组50例患者共700个关节,检测到46例患者共368个滑膜增厚;37例患者共245个血管翳,41例患者共314个关节积液;26例患者共137个肌腱腱鞘病变;19例患者共88个关节软骨与骨质破坏。结论高频超声对RA患者多关节滑膜增厚具有一定诊断价值,对RA患者滑膜血管翳、积液、肌腱腱鞘、软骨与骨质破坏有较高检出率。

Objective To use high-frequency ultrasound to observe multiple joints in patients with rheumatoid arthritis(RA),and to explore the diagnostic value of high-frequency ultrasound in RA.Methods Collected 50 cases of RA patients(RA group)who attended the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from March to November 2014,and from January to June 2019 at the Konggang Hospital of Tianjin Medical University General Hospital.Another 35 healthy volunteers were selected as the control group(NC group).High-frequency ultrasound was used to measure the thickness of the multi-joint synovium in the RA group and the NC group,and observe the pannus,joint effusion,tendinopathy,cartilage and bone destruction in the RA group.Results The synovial thickness of the two groups of bilateral wrist joints,second metacarpophalangeal joints,third metacarpophalangeal joints,second proximal interphalangeal joints,third proximal interphalangeal joints,knee joints,and ankle joints were compared,the difference was statistically significant(P<0.05).The synovium in the RA group was significantly thicker than that in the NC group.The thickened synovium was mainly hypoechoic,uneven in thickness,and the surface was not smooth and rough;there were 700 patients in the RA group in 50 patients joints,46 patients with 368 synovial thickening were detected;37 patients with 245 pannus,41 patients with 314 joint effusion;26 patients with 137 tendon sheath disease;19 patients with 88 Joint cartilage and bone destruction.Conclusion High-frequency ultrasound has a certain diagnostic value for multi-joint synovial thickening in RA patients.It has a high detection rate for synovial pannus,effusion,tendon sheath,cartilage and bone destruction in RA patients.