不同超声方法对类风湿关节炎滑膜炎的诊断价值

Diagnostic value of different ultrasound methods for rheumatoid arthritis synovitis

目的探讨不同超声方法对类风湿关节炎滑膜炎患者的诊断价值。方法选取2020年7月至2021年6月湖州市第三人民医院收治的疑似类风湿关节炎滑膜炎患者50例,均给予能量多普勒超声(power Doppler ultrasound,PDUS)和超声造影(contrast enhanced ultrasound,CEUS)检查,以28个关节疾病活动度评分(disease activity score in 28 joints,DAS28)结果作为“金标准”,评价两种超声方法的诊断效能。对确诊患者给予药物治疗,1个月后评价患者预后。结果50例疑似类风湿关节炎滑膜炎患者经DAS28确诊32例,确诊率为64.00%。PDUS、CEUS及二者联合诊断类风湿关节炎滑膜炎与DAS28诊断的符合率分别为60.00%、60.00%和78.00%。CEUS联合PDUS诊断类风湿关节炎滑膜炎的敏感度和特异性均高于单一CEUS和PDUS检查(P<0.05)。治疗1个月后,患者的C反应蛋白、红细胞沉降率、DAS28及视觉模拟评分法评分均显著低于治疗前(P<0.05)。结论CEUS联合PDUS用于类风湿关节炎滑膜炎患者的检出率较高,且诊断效能提升,可用于指导临床诊疗。

Objective To explore the diagnostic value of different ultrasound methods for rheumatoid arthritis synovitis.Methods Fifty patients with suspected rheumatoid arthritis synovitis admitted to Huzhou Third People’s Hospital from July 2020 to June 2021 were selected,all of whom underwent power Doppler ultrasound(PDUS)and contrast enhanced ultrasound(CEUS)examinations.The results of disease activity score in 28 joints(DAS28)were used as the“gold standard”to evaluate the diagnostic efficacy of the two ultrasound methods.The confirmed patients were given drug therapy and the prognosis was evaluated 1 month later.Results Among 50 suspected patients with rheumatoid arthritis synovitis,32 cases were confirmed by DAS28,the diagnosis rate was 64.00%.The coincidence rates of PDUS and CEUS alone and combined with DAS28 in the diagnosis of rheumatoid arthritis synovitis were 60.00%,60.00%and 78.00%.The sensitivity and specificity of CEUS combined with PDUS in the diagnosis of rheumatoid arthritis synovitis were higher than that of CEUS and PDUS alone(P<0.05).After one month of treatment,C reactive protein,erythrocyte sedimentation rate,score of DAS28 and visual analogue scale were significantly lower than before treatment(P<0.05).Conclusion The detection rate of CEUS combined with PDUS in patients with rheumatoid arthritis synovitis is higher,and the diagnostic efficacy is improved,which can be used to guide clinical diagnosis and treatment.