岭南地区类风湿关节炎辨证分型与超声造影相关性研究

Correlation Study on Syndrome Differentiation and Classification and ContrastEnhanced Ultrasound of Rheumatoid Arthritis in Lingnan Area

目的:探讨类风湿关节炎(RA)辨证分型与超声造影(CEUS)的相关性,探究CEUS在岭南地区RA中的诊断价值。方法:选取60例RA患者,根据辨证分型分为湿热痹阻证组21例,寒湿痹阻证组20例,肝肾亏虚组19例,对腕关节滑膜进行肌骨超声及CEUS获取参数。结果:在关节积液、滑膜血流指标中,湿热痹阻证患者指标值均高于其余两组,差异有统计学意义(P<0.05)。CEUS状态下,湿热痹阻、寒湿痹阻、肝肾亏虚滑膜血流增强强度(EI)呈递减状态,组间组内比较,差异均具有统计学意义(P<0.05)。结论:通过CEUS增强强度的标识,可以清晰显示出3个证型的差别,且与造影剂增强强度的半定量评价具有良好的相关性。CEUS可检测出更多滑膜微小血管,精确反映微血流灌注情况,可作为岭南地区RA的辨证分型的客观依据及评价手段。

Objective: To discuss the correlation of syndrome differentiation and classification and contrast-enhanced ultrasound(CEUS) of rheumatoid arthritis(RA),and the diagnostic value of CEUS on RA in Lingnan region. Methods:A total of 60 cases of RA patients were divided into the damp-heat obstruction syndrome group, the cold-damp obstruction syndrome group and the liver-kidney depletion syndrome group according to the syndrome differentiation and classification, with 21, 20 and 19 cases in each group respectively. The parameters of synovial membrane of wrist joint were obtained by musculoskeletal ultrasonography and CEUS. Results: The values of joint fluid and synovial blood flow in the damp-heat obstruction syndrome group were higher than those in the other two groups, the difference being significant(P<0.05). Under CEUS state,the enhanced intensity(EI) of synovial blood flow in the damp-heat obstruction syndrome group,the cold-damp obstruction syndrome group and the liver-kidney depletion syndrome group were decreased gradually, differences being significant between and within the two groups(P<0.05). Conclusion:The CEUS enhanced intensity can clearly show the difference of the three syndromes, which has a good correlation with the semi quantitative evaluation of enhanced intensity of contrast agent. CEUS can detect more synovial microvessels,accurately reflect the micro blood perfusion,and can be used as the objective basis and evaluation means for the syndrome differentiation and classification of RA in Lingnan region.