摘要
目的探讨高频超声在早期类风湿性关节炎诊断中的应用价值。方法回顾性分析我院早期类风湿性关节炎患者62例,记录常规病史、体格检查、血液生化检查[包括血沉(ESR)、C反应蛋白(CRP)、类风湿性因子(RF)、抗环瓜氨酸抗体(CCP)],行双侧手、腕部彩超与MRI检查。超声评估包括炎症性评估(滑膜增厚、滑膜能量多普勒血流信号、关节腔积液、腱鞘炎)及关节结构破坏性评估(骨侵蚀),各超声指标进行半定量分级,掌指关节及近端指间关节取评分最高者为代表。结果超声在滑膜炎、关节腔积液及腱鞘炎的诊断方面与MRI接近,差异无统计学意义(P>0.05),在骨侵蚀的诊断方面,MRI优于超声,差异有统计学意义(P<0.05),在骨髓水肿的诊断方面,超声均未能检出,MRI则具有较高的阳性率(54.84%,P<0.05);能量多普勒超声(PDUS)与灰阶超声(GSUS)在滑膜炎的诊断中差异有统计学意义(χ~2=7.84,P<0.05),GSUS敏感性优于PDUS。结论超声对早期类风湿性关节炎的滑膜炎、关节腔积液、腱鞘炎及骨侵蚀诊断有很高的可靠性,是诊断早期RA的首选检查方法。
Objective To evaluate the value of high frequency ultrasound in the diagnosis of early rheumatoid arthritis. Methods A total of 62 patients with early rheumatoid arthritis were retrospectively analyzed. Routine medical history were recorded, and physical examination were taken. Blood biochemical tests including ESR, C-reactive protein （CRP）, rheumatoid factor （RF） and anti-ring citrulliue antibody （CCP）, line bilateral hand were examined, and color doppler uhrasnund and MRI examination of bilateral hand and wrist were taken. Ultrasound assessment including an assessment of inflammation, joint effusion, tenosynovitis and joint structural destructive assessment-bone erosion. The highest score of melaearpnphalangeal joint and proximal interphalangeal joint was kaen as the representative. Results Ultrasound was similar Io MR1 in the diagnosis of synovitis, joint effusion and tenosynovitis, and the difference was not statistically signifieanl （P〉0.O5）.MRI was superior to ultrasound in tile diagnosis of bone erosion, and the difference was statistically significant （P〈0.05）.While ultrasound could not detect bone malTow edema, MRI had a high positive rate in the diagnosis of bone marrow edema （54.84%, P〈0.05）. The difference between PDUS and GSUS in the diagnosis of synovitis was statistically signifieant （χ2=7.84, P〈0.05）, and the sensitivity of GSUS was better than that of PDUS. Conclusion Ultrasonngraphy is very reliable in the diagnosis of early rheumatoid arthritis synovitis, joint effusion, tennsynovitis and bone erosion, which is the first method to diagnose early RA.
出处
《中国现代医生》
2017年第7期106-110,F0003,共6页
China Modern Doctor
关键词
超声
早期RA
MRI
评分
Ultrasound
Early rheumatoid arthritis
MRI
Score
