高频超声及超声造影在血清学阴性类风湿关节炎诊断中的预测价值

The predictive value of high frequency ultrasound and contrast-enhanced ultrasonography in diagnosis of seronegative rheumatoid arthritis

目的探讨高频超声及超声造影(CEUS)在血清学阴性类风湿关节炎(SNRA)诊断中的价值。方法选择2018年7月—2020年6月首次在本院风湿免疫科就诊的60例最终确诊的类风湿性关节炎(RA)患者作为研究对象。根据血清学抗体表达情况分为SNRA组(20例)和血清学阳性类风湿关节炎SPRA组(40例)两组。比较两组患者血清指标、超声下肌骨指标、超声造影相关参数(峰值强度PI、曲线下面积AUC、达峰时间TTP),分析获得CEUS相关参数预测SNRA组患者的临床界值。结果SNRA组患者的血沉ESR、CRP、CCP、RF等指标水平均低于SPRA组,差异具有统计学意义(P<0.05);SNRA组和SPRA组患者在滑膜厚度、滑膜血流、骨侵蚀以及骨侵蚀处血流等指标水平比较,差异具有统计学意义(P<0.05);而在滑膜积液及骨赘指标水平比较,差异无统计学意义(P>0.05);CEUS模式下,SNRA组患者的PI、AUC及TTP等参数指标水平均低于SPRA组,差异具有统计学意义(P<0.05);骨侵蚀、骨侵蚀处血流连续性及滑膜血流分别与PI、AUC呈正相关(P<0.05);TTP、PI预测SNRA组患者的临床界值分别为28.75秒、7.5 db(P<0.05)。结论超声造影有助于SNRA组患者的早期诊断,骨侵蚀处血流连续性可能是鉴别SNRA的重要参数。

Objective To explore the value of high frequency ultrasound and contrast-enhanced ultrasonography(CEUS)in diagnosis ofseronegative rheumatoid arthritis(SNRA).Methods A total of 60 patients who visited rheumatology department of our hospital for the first time due to joint symptoms and were finally diagnosed with rheumatoid arthritis(RA)between July 1st 2018 and June 30th 2020 were enrolled as study objects.And RA patients were divided into two groups of SNRA group and seropositive RA(SPRA)group according to serological antibody expression,including 20 SNRA patients and 40 SPRA patients.The differences of serum indicators,musculoskeletal indexes under ultrasound,related parameters of CEUS(Peak intensity,PI;area under the curve,AUC;time to peak,TTP)were compared between the two groups,and the cut-off values of CEUS related parameters in the prediction of SNRA were obtained.Results The levels of ESR,CRP,CCP and RF in SNRA group were significantly lower than those in the SPRA group,the differences were statistically significant(P<0.05).There were statistically significant differences in synovial thickness,synovial blood flow,bone erosion and blood flow at bone erosion between SNRA group and SPRA group(P<0.05).However,there were no significant difference in synovial effusion and osteophyte(P>0.05).In CEUS mode,differences in PI,AUC,and TTP between SPRA and SNRA group were statistically significant(P<0.05).Bone erosion,continuity of blood flow at bone erosion,and synovial blood flow were positively correlated with PI and AUC(P<0.05).The cut-off value of TTP,PI in predicting SNRA was 28.75 seconds and 7.5dB(P<0.05),respectively.Conclusions CEUS is helpful for the early identification of SNRA,and blood flow continuity at bone erosion may be an important parameter for the identification of SNRA.