腕指关节高频超声在类风湿关节炎诊断及鉴别诊断中的应用价值

Value of High-Frequency Ultrasound of Wrist and Finger Joint in the Diagnosis and Differential Diagnosis of Rheumatoid Arthritis

目的:探讨腕、指关节高频超声(high-frequency ultrasound,HFUS)在类风湿关节炎(reheumatoid arthritis,RA)与手骨关节炎(osteoarthritis,OA)诊断及鉴别诊断中的价值,分析超声半定量评分在评估RA疾病活动度中的应用价值。方法:选取RA患者54例,手骨关节炎患者30例作为对照组,分别行腕关节、掌指关节、近指关节超声检查,检测两组滑膜厚度、滑膜血流、骨侵蚀及腱鞘炎,并对RA组上述4项观察指标进行超声半定量评分,同时记录RA组患者ESR、CRP、RF、CCP抗体、DAS28评分,分析超声评分与临床指标之间的相关性。结果:RA组在滑膜增生、滑膜血流、骨侵蚀、腱鞘炎方面较OA组明显增多(P<0.01);超声半定量评分与DAS28评分存在正相关(r=0.550,P<0.05)。结论:高频超声对RA及手OA患者诊断及鉴别诊断有一定价值;超声半定量评分可以反映RA疾病活动度。

Objective:To investigate the value of high-frequency ultrasound(HFUS)of wrist and finger joint in the diagnosis and differential diagnosis of rheumatoid arthritis(RA)and hand osteoarthritis(OA).And to analyze the value of semi-quantitative ultrasound score in the assessment of disease activity of RA.Methods:54 patients with RA were enrolled,and 30 patients with hand OA were selected as control group.Wrist joints,metacarpophalangeal and proximal interphalangeal joints were examined by high-frequency ultrasound.The thickness of synovial membranes,synovial blood flow,bone erosion and tenosynovitis were measured.Semi-quantitative ultrasound scores of the above four indexes were calculated.And laboratory characteristics were carefully recorded,including ESR,CRP,RF,anti-CCP and DAS28 scores in the RA group.The correlation between ultrasound scores and clinical indicators were analyzed.Results:RA group was significantly more than OA group with synovial hyperplasia,synovial blood flow,bone erosion and tenosynovitis(P<0.01).There were significant positive correlation between semi-quantitative ultrasound score and DAS28 score(r=0.550,P<0.05).Conclusion:High-frequency ultrasound was valuable in the diagnosis and differential diagnosis of RA and hand OA.Semi-quantitative ultrasound score can reflect the disease activity in RA.