血友病性关节病的超声分析

Ultrasonic Analysis of Hemophilic Arthropathy

目的:分析血友病性关节病的超声特征与患者疾病的相关性。方法:随机选择2018年12月-2020年12月至笔者所在医院进行A型血友病治疗的患者60例,所有患儿均给予超声检查,比较不同轻重程度患儿的HEAD-US-C评分、HJHS 2.1评分差异、超声特征。使用Pearson相关性分析,观察HEAD-US-C评分和HJHS 2.1评分的相关性。结果:重度组患儿HEAD-US-C评分中关节积液或积血、滑膜增生、含铁血黄素、软骨下骨或关节边缘化、软骨缺失、部分关节软骨缺失各项评分,以及HJHS 2.1评分关节肿胀、肿胀持续时间、肌肉萎缩、屈曲度降低、伸展度降低、摩擦音、关节疼痛、总体步态等各项评分均高于轻度组和中度组,差异有统计学意义(P<0.05);重度组患儿关节病变超声显示滑膜增厚、关节积液、滑膜血管增生、含铁血色素沉着、软骨下、软骨改变所占比例均高于轻度组和中度组,差异有统计学意义(P<0.05),观察HEAD-US-C评分和HJHS 2.1评分的相关性,使用Pearson相关性分析发现关节积液或积血、滑膜增生、含铁血黄素、软骨下骨或关节边缘化、软骨缺失、部分关节软骨缺失与关节肿胀、肿胀持续时间、肌肉萎缩、屈曲度降低、伸展度降低、活动摩擦音、关节疼痛、总体步态均呈正相关(P<0.05)。结论:血友病性关节病患者的超声特征以滑膜增厚、关节积液发病率最高,同时超声HEAD-US-C评分与代表临床症状的HJHS 2.1评分具有相关性,因此超声特征能够成为反映患者关节病情程度的重要依据。

Objective:To analyze the correlation between ultrasound and hemophilia.Method:A total of 60 patients with type A hemophilia treated in our hospital from December 2018 to December 2020 were randomly selected.All children were given ultrasound examination.The differences of HEAD-US-C score,HJHS 2.1 score and ultrasound characteristics of children with different severity were compared.Pearson correlation analysis was used to observe the correlation between HEAD-US-C score and HJHS 2.1 score.Result:The HEAD-US-C scores of severe group included joint effusion or hematocele,synovial hyperplasia,hemosiderin,subchondral bone or joint marginalization,cartilage loss,partial articular cartilage loss,and HJHS 2.1 scores of joint swelling,duration of swelling,muscle atrophy,reduction of flexion,reduction of abduction,friction sound,joint pain,and overall gait scores were higher than those of mild group and moderate group (P<0.05).The proportion of synovial thickening,joint effusion,synovial vascular hyperplasia,hemosiderosis,subchondral and cartilaginous changes in severe group was higher than that in mild group and moderate group (P<0.05).Pearson correlation analysis was used and the correlation between HEAD-US-C score and HJHS 2.1 score was observed.The synovial hyperplasia,hemosiderin,subchondral bone or joint marginalization,cartilage loss,partial articular cartilage loss were positively correlated with joint swelling,swelling duration,muscle atrophy,decreased flexion,decreased extension,active fricative sound,joint pain and overall gait (P<0.05).Conclusion:The incidence rate of synovial thickening and joint effusion is the highest in hemophilic arthropathy patients,and the HEAD-US-C score is correlated with the HJHS 2.1 score representing clinical symptoms.Therefore,ultrasound features can be an important basis for the degree of joint disease in patients with hemophilia arthropathy.