超声对血清学阴性类风湿关节炎与骨性关节炎的鉴别诊断价值

Value of ultrasound in the differential diagnosis of seronegative rheumatoid arthritis and osteoarthritis

目的探讨超声在血清学阴性的类风湿关节炎(SNRA)与骨性关节炎(OA)鉴别诊断中的应用价值。方法回顾性分析以膝、肘、腕或近端指间关节疼痛为主诉的70例SNRA患者(SNRA组)和75例OA患者(OA组)的超声检查资料,比较两组骨侵蚀、滑膜增厚、滑膜血流信号等超声指标的差异。以临床诊断结果为标准,计算超声特征对RA的诊断效能。结果本研究纳入145例患者,共检查425个关节,其中OA组检查关节194个,SNRA组检查关节231个。两组间0-1级骨侵蚀中滑膜增厚程度、滑膜血流信号比较差异均有统计学意义(均P<0.01)。以临床随访6个月的诊断结果为标准,2-3级骨侵蚀判断RA的特异性为93.33%,敏感性为41.82%。结论应用超声识别骨侵蚀、滑膜炎等对鉴别SNRA与OA有重要意义。

Objective To explore the value of musculoskeletal ultrasound in the differential diagnosis of serologically negative rheumatoid arthritis(SNRA)and osteoarthritis(OA).Methods The ultrasound examination data of 70 patients with SNRA(SNRA group)and 75 patients with OA(OA group)with main complaints of knee,elbow,wrist,or proximal interphalangeal joint pain were retrospectively analyzed.The ultrasonic index differences such as bone erosion,synovial thickening and blood flow signals between the two groups were compared.Taking clinical diagnostic results as standard,the ultrasonic efficacy in the diagnosis of RA was calculated.Results A total of 425 joints were examined in 145 patients,including194 joints in the OA group and 231 joints in the SNRA group.There were statistically significant differences in the degree of synovial thickening and synovial blood flow signals in 0~1 degree bone erosion between the two groups(all P<0.01).Taking on the 6-month clinical follow-up diagnosis result as standard,the specificity and the sensitivity of 2~3 degree bone erosion to judge RA were 93.33%,41.82%.Conclusion The use of ultrasound to identify bone erosion and synovitis is of great significance to distinguish SNRA from OA.