剪切波弹性成像评估血友病性关节病患者软骨早期受损的初步研究

Evaluation of early cartilage damage in patients with hemophiliac knee arthropathy by shear wave elastography:a preliminary study

目的应用剪切波弹性成像(SWE)评估血友病性关节病患者膝关节软骨早期受损情况,探讨其临床应用价值。方法选取于我院就诊的膝关节反复出血的男性血友病A患者26例(病例组,其中轻度3例,中度4例,重度19例)和男性健康志愿者30例(对照组),两组均行膝关节二维超声获取内侧髁、股骨髁间和外侧髁处关节软骨厚度(d1、d2、d3),采用血友病性关节病超声评估量表(HEAD-US-C)进行评分;SWE获取内侧髁、股骨髁间和外侧髁处关节软骨杨氏模量平均值(E1、E2、E3)及剪切波速度(SWV1、SWV2、SWV3)。比较病例组与对照组,以及不同程度血友病性关节病患者上述参数的差异。分析SWV参数与HEAD-US-C评分的相关性。结果病例组d1、d2、d3、E2、E3、SWV2、SWV3均较对照组减低,差异均有统计学意义(均P<0.05),两组E1、SWV1比较差异均无统计学意义。且中、重度血友病性关节病患者E2、E3及SWV2、SWV3均较轻度患者减低,差异均有统计学意义(均P<0.05);中、重度患者上述参数比较差异均无统计学意义。轻、中、重度患者HEAD-US-C评分比较差异有统计学意义(P=0.004),且中、重度患者HEAD-US-C评分高于轻度患者,差异均有统计学意义(均P<0.05)。相关性分析显示,血友病性关节病患者E1、E2、E3、SWV1、SWV2、SWV3均与HEAD-US-C评分呈负相关(均P<0.001)。结论SWE可以定量检测血友病性关节病患者膝关节软骨硬度,能早期评估软骨受损情况,具有较好的临床应用价值。

Objective To evaluate early cartilage damage of the knee joints in patients with hemophilic arthropathy by shear wave elastography(SWE),and to explore its clinical application value.Methods Twenty-six male hemophilia A patients with recurrent knee bleeding(case group,including 3 mild cases,4 moderate cases,and 19 severe cases)and 30 male healthy volunteers(control group)from our hospital were enrolled.Two-dimensional ultrasound was performed to obtain the thickness of articular cartilage at the medial condyle,femoral inter-condyle,and lateral condyle(d1,d2,d3).The Ultrasound Assessment of the Joint in Hemophilia(HEAD-US-C)of hemophilic arthropathy was used to score.The average Young’s modulus(E1,E2,E3)and shear wave velocity(SWV1,SWV2,SWV3)of articular cartilage at the medial condyle,femoral intercondyle,and lateral condyle were obtained by SWE.Differences of above parameters between the case group and control group,as well as among patients with different degrees of hemophilic arthropathy were compared.The correlation between SWE parameters and HEAD-US-C score were analyzed.Results The d1,d2,d3,E2,E3,SWV2 and SWV3 in the case group were lower than those in the control group(all P<0.05),there were no significant difference in E1 and SWV1 between the two groups.The E2,E3,SWV2 and SWV3 in the the moderate cases and the severe cases were lower than those in the mild cases(all P<0.05),while there were no significant difference in these parameters between the moderate cases and the severe cases.The difference of the HEAD-US-C score among the mild,moderate,and severe cases were statistically significant(P=0.004),and the HEAD-US-C score in the moderate and severe cases was significantly higher than that in the mild cases(both P<0.05).Correlation analysis showed that E1,E2,E3,SWV1,SWV2,SWV3 were negatively correlated with HEAD-US-C score in patients with hemophilic arthropathy(all P<0.001).Conclusion SWE can quantitatively detect the cartilage stiffness of the knee joint in patients with hemophilic arthropathy and early assess cartilage damage,which has good clinical application value.