超声微血流成像技术在临床缓解期类风湿性关节炎诊断中的应用

Application of superb microvascular imaging technology in diagnosing rheumatoid arthritis in the clinical remission stage

目的:观察超声微血流成像(superb mircovascular imaging,SMI)技术对类风湿性关节炎(rheumatoid arthritis,RA)临床缓解期患者滑膜细小血管的显示情况。方法:应用SMI观察42例临床缓解期RA患者滑膜血流的量和滑膜血流分级,以超声造影(contrast enhanced ultrasound, CEUS)血流模式为对照,比较这2种超声检查间的差异,并分析2种检查评估的血流分级与炎症指标红细胞沉降率(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C reactive protein,CRP)间的相关性。结果:SMI及CEUS检查对临床缓解期RA患者滑膜血流的检出率(血流分级1级以上者)分别为73.8%、83.3%,两者对滑膜血流的检出率差异无统计学意义(P=0.160),两者间一致性较强(Kappa=0.723,P<0.001);两者对滑膜血管的血流分级结果差异也无统计学意义(P=0.083),呈中等一致性(Kappa=0.654,P<0.001)。患者接受进一步强化治疗后,SMI检查发现的滑膜血流数均较强化治疗前明显减少(P<0.001)。亚临床滑膜炎患者的SMI血流半定量评分与炎性指标CRP、ESR间也无相关性,这种结果均与CEUS表现一致。结论:SMI检查可灵敏地探测到滑膜的微小血管,发现炎症指标不升高的局部炎症,评价效能与CEUS一致,相对CEUS,其应用简便,可用于RA缓解期病情监测。

Objective: To investigate the display of small synovial vessels in patients with rheumatoid arthritis(RA at the clinical remission stage by ultrasonic micro flow imaging superb mircovascular imaging(SMI). Methods: Forty-two RA patients at the remission stage were examined by SMI to observe the display of synovial blood flow and synovial blood flow classification. Contrast enhanced ultrasound(CEUS) blood flow pattern was served as a control and the differences in results between the SMI and CEUS were compared. The correlation of SMI or CEUS with CRP and ESR were analyzed.Value of SMI to find subclinical synovitis in RA patients at the clinical remission stage were evaluated. Results: Among the RA patients at clinical remission stage, the detection rate of synovial blood flow by SMI and CEUS(those with blood flow grade above 1) were 73.8% and 83.3%, respectively. There was no significant difference in the detection of synovial blood flow between the two groups(P=0.160). There is a strong consistency between them(Kappa=0.723, P<0.001). There was also no significant difference in blood flow classification between the two methods(P=0.083), there is a moderate consistency between the two methods(Kappa=0.654, P<0.001). The numbers of synovial blood flow found by SMI or CEUS after further intensive treatment were significantly lower than that before intensive treatment(P<0.001). There was no significant correlation between the semi quantitative score of blood flow of subclinical synovitis assessed by CEUS or SMI and the inflammatory factors of CRP and ESR. Conclusions: SMI can sensitively detect the microvessels in the synovium, esspescial for those local inflammation without increase of ESR or CRP. The evaluation efficiency is consistent with that of contrast-enhanced ultrasound, which is a simple method that can be used to detect the disease in remission stage.