超声鉴别儿童化脓性关节炎与幼年特发性关节炎的临床价值

Clinical value of ultrasound in differentiating suppurative arthritis and juvenile idiopathic arthritis in children

目的探讨超声鉴别儿童化脓性关节炎(SA)与幼年特发性关节炎(JIA)关节病变的临床价值。方法回顾性分析经临床确诊的100例化脓性关节炎(SA组,共100个关节)和45例幼年特发性关节炎(JIA组,共105个关节)患儿资料,分析并比较两组超声指标的差异;采用多因素Logistic回归分析筛选鉴别SA与JIA的独立影响因素;绘制受试者工作特征(ROC)曲线分析各超声指标单独及联合应用鉴别SA与JIA的诊断效能。结果SA组与JIA组关节腔积液、滑膜增厚、滑膜厚度、滑膜血流分级比较,差异均有统计学意义(均P<0.001)。多因素Logistic回归分析显示,关节腔积液、滑膜厚度及滑膜血流分级均为鉴别SA与JIA的独立影响因素(均P<0.05)。ROC曲线分析显示,关节腔积液、滑膜厚度及滑膜血流分级鉴别SA与JIA的曲线下面积分别为0.781、0.935、0.910;三者联合应用的曲线下面积为0.972,灵敏度为90.5%,特异度为99.0%。结论超声在鉴别儿童SA与JIA关节病变中有一定的临床价值,联合应用多个超声指标能有效提高鉴别诊断效能。

Objective To investigate the clinical value of ultrasound in differentiating joint lesions between suppurative arthritis(SA)and juvenile idiopathic arthritis(JIA)in children.Methods The clinical data of 100 children with SA(SA group,involving 100 joints)and 45 children with JIA(JIA group,involving 105 joints)were retrospectively analyzed.The ultrasonic indicators between the two groups were analyzed and compared.Multiple Logistic regression analysis was used to screen the influencing factors for differentiating SA and JIA.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the diagnostic efficacy of individual ultrasound indicators and their combined application in differentiating SA and JIA.Results There were statistically significant differences in joint effusion,synovial thickening,synovial thickness and synovial blood flow classification between SA group and JIA group(all P<0.001).Multiple Logistic regression analysis showed that articular effusion,synovial thickness and synovial blood flow classification were the independent influencing factors for differentiating SA and JIA(all P<0.05).ROC curve analysis showed that the areas under the curve of articular effusion,synovial thickness and synovial blood flow classification were 0.781,0.935 and 0.910,respectively.The area under the curve of the combined application of these three in differentiating SA and JIA was 0.972,sensitivity was 90.5%,and specificity was 99.0%.Conclusion Ultrasound has certain clinical value in differentiating joint lesions between SA and JIA in children.The combined application of multiple ultrasound indicators can improve the efficiency of differential diagnosis.