常规超声及超声造影对血友病关节病变的评价价值及意义

发布时间：2018-05-31 12:05

本文选题：血友病 + 关节病变　；参考：《南方医科大学》2017年硕士论文

【摘要】：目的:以磁共振成像为参照,探讨常规超声对血友病关节病变的评估价值,并在此基础上进一步探讨超声造影对血友病关节病变的评价作用以及超声检查结果与患者临床检查指标的相关性,以期对临床诊断、疗效随访以及治疗方案选择提供参考依据。方法:1.对42例血友病患者的关节进行超声和磁共振成像检查(Magnetic Resonance Imaging,MRI),以MRI为参照,比较超声与MRI对关节病变检出的一致性;比较超声与MRI评分的差异以及一致性;比较超声检查操作者间的一致性以及操作者自身的重测稳定性。2.于入组时对75例血友病患者的75个关节进行常规超声检查及评分,评分项目包括关节积液/积血、滑膜增生、含铁血黄素沉积、软骨破坏、骨质破坏、彩色多普勒血流显像半定量评分;并对其中45例患者的45个关节进行超声造影检查及评分,评分为超声造影半定量评分。患者入组后开始进行规律预防治疗并进行为期4个月的随访,记录患者随访期间关节出血次数,根据随访期间有无关节出血将患者分为关节有出血组与关节无出血组。记录患者临床资料,包括年龄、身高、体重、最低凝血因子水平、初次替代治疗年龄、初次预防治疗年龄。比较血友病患者关节常规超声评分与临床资料的相关性;比较灰阶超声模式下和超声造影模式下测得滑膜厚度的差异;比较关节有出血组与关节无出血组滑膜厚度的差异以及超声检查各项评分的差异;比较超声检查各项评分与随访期间关节出血次数的相关性。结果:超声对血友病关节积液/积血、滑膜增生、含铁血黄素沉积、软骨破坏、骨质破坏以及关节面下骨囊肿的诊断敏感性为82.9%、97.0%、97.0%、90.0%、70.9%、14.0%;特异性为 94.1%、100.0%、100.0%、92.0%、94.7%、100.0%;假阳性率为 5.9%、0.0%、0.0%、8.0%、10.5%、100.0%;假阴性率为 17.0%、3.0%、3.0%、10.0%、29.0%、86.0%;符合率为 88.0%、97.3%、97.3%、90.7%、76.0%、42.7%。常规超声与MRI检出早期软组织病变以及软骨破坏的一致性优秀(k=0.761～0.885,P=0.000),检出骨质破坏的一致性中等(k=0.498,P=0.000),检出关节面下骨囊肿的一致性差(k=0.098,P=0.050)。常规超声与MRI对早期软组织病变以及软骨破坏的评分差异无统计学意义(P0.05～0.75),MRI对骨质破坏的评分较高,差异有统计学意义(P=0.03)。常规超声与MRI对早期软组织病变以及软骨破坏评分一致性为好至优秀(k=0.635～0.833,P=0.000),对晚期骨质破坏评分一致性为差(k=0.145,P=0.009)。对早期软组织病变和软骨破坏,操作者间的一致性和操作者自身重测稳定性均为好至优秀(k=0.676～0.885,P=0.000),对晚期骨质破坏,操作者间的一致性和自身重测稳定性均为中等(k=0.421～0.589,P=0.000)。除了关节积液/积血的评分以外,血友病患者年龄、身体质量指数(Body Mass Index,BMI)、初次替代治疗年龄以及初次预防治疗年龄与关节超声检查各项目评分呈正相关(r=0.19～0.67,P0.05);除关节积液/积血外,最低凝血因子浓度与关节超声检查各项目评分呈负相关(r=-0.304～-0.444,P=0.000)。超声造影模式下测得的滑膜厚度较灰阶超声模式下更厚,厚度分别约0.53±0.29cm、0.39±0.16cm,两者差异有统计学意义(P=0.012)。随访期间关节有出血组在CEUS模式下和灰阶超声模式下测得的滑膜厚度均较关节无出血组厚,厚分别约 0.62±0.31cm、0.33±0.11cm vs 0.44±0.16cm、0.30±0.12cm,差异有统计学意义(P =0.000;P =0.021);在6个没有彩色多普勒血流显像的关节滑膜中有3个可见造影增强信号。关节有出血组超声检查各项评分均较关节无出血组高,评分分别为0.38±0.75cm～6.86±3.49cm vs 0.10±0.42cm～4.42±3.86cm,两组差异有统计学意义(P=0.000～0.029);入组时超声检查各项目评分与随访期间关节出血次数呈正相关(r=0.17～0.63,P=0.000～0.030),其中CEUS评分相关性最高。结论:超声检查在血友病关节病变尤其是在关节早期软组织病变和关节软骨病变的评估中具有重要价值。超声检查各项目评分与患者临床检查指标存在相关性,结合超声检查结果能够更准确反应患者病情变化,指导临床治疗。血友病患者关节病变与临床出血风险密切相关,超声造影(CEUS)较常规超声能更清晰准确地评估滑膜增生程度及新生血管化程度,与出血风险相关性最高,对指导临床治疗具有重要意义。
[Abstract]:Objective: To evaluate the value of conventional ultrasound in the assessment of hemophilia joint lesions, and on the basis of this, the evaluation of ultrasonography on hemophilia joint lesions and the correlation between the results of ultrasound examination and the clinical examination index of patients were further discussed in order to make a clinical diagnosis, follow-up of curative effect and the choice of treatment options. Methods: 1. cases of 42 patients with hemophilia were examined by ultrasound and magnetic resonance imaging (Magnetic Resonance Imaging, MRI). The consistency of ultrasonic and MRI in detection of joint lesions was compared with MRI, and the difference between ultrasound and MRI scores and the uniformity were compared, and the consistency between the ultrasonic examination operators and the operation were compared. The author's own retest stability.2. was performed on 75 joints of 75 patients with hemophilia by routine ultrasound examination and score. The score included joint effusion / blood accumulation, synovial hyperplasia, hemoflavin deposition, cartilage destruction, bone destruction, and color Doppler flow imaging, and 45 joints in 45 of the patients. A half quantitative score of ultrasound contrast was performed by ultrasound contrast examination and score. After the patients entered the group, regular prophylaxis and follow-up were conducted for 4 months to record the number of joint bleeding during the follow-up period, and the patients were divided into joint bleeding group and joint without bleeding group. Data, including age, height, weight, the level of the lowest coagulation factor, primary replacement age, primary prophylaxis age. Comparison of the correlation between routine ultrasound score and clinical data in hemophilia patients; comparison of the difference in the thickness of the synovial membrane under the gray scale ultrasound model and the ultrasound contrast model; compared with the joint bleeding group and the joints. The difference in the thickness of the synovial membrane in the bleeding group and the differences in the scores of the ultrasound examination; the correlation between the scores of the ultrasound examination and the number of joint bleeding during the follow-up. Results: the diagnostic sensitivity of ultrasound to hemophilia joint effusion / haemorrhage, synovial hyperplasia, hemoflavin deposition, cartilage destruction, bone destruction, and subarticular cyst of the articular surface 82.9%, 97%, 97%, 90%, 70.9%, 14%, and the specificity of 94.1%, 100%, 100%, 92%, 94.7%, 100%; the false positive rate is the false negative rate; the coincidence rate is 42.7%. conventional ultrasound and MRI detection of early soft tissue lesions and cartilage destruction Good consistency (k=0.761 to 0.885, P=0.000), the consistency of bone destruction was moderate (k=0.498, P=0.000), and the consistency of the subarticular subarticular cysts was poor (k=0.098, P=0.050). There was no significant difference between conventional ultrasound and MRI on early soft tissue lesions and cartilage destruction (P0.05 ~ 0.75), and MRI had a higher score on bone destruction. The difference was statistically significant (P=0.03). The consistency of conventional ultrasound and MRI on early soft tissue lesion and cartilage damage score was good (k=0.635 to 0.833, P=0.000), and the consistency of the late bone destruction score was poor (k=0.145, P=0.009). The consistency between the early soft tissue and cartilage, the consistency between the operators and the operator's self retest The stability was good to excellent (k=0.676 ~ 0.885, P=0.000). For advanced bone destruction, the consistency between the operators and the self retest stability were moderate (k=0.421 to 0.589, P=0.000). In addition to the score of joint effusion / blood accumulation, the age of hemophilia, the body mass index (Body Mass Index, BMI), the initial replacement treatment age and the initial stage of treatment. There was a positive correlation between the age of the secondary prophylaxis and the scores of the joint ultrasound examination (r=0.19 ~ 0.67, P0.05). Except for the joint effusion / accumulation of blood, the minimum coagulation factor concentration was negatively correlated with the scores of each item (r=-0.304 ~ -0.444, P=0.000). The thickness of the synovial membrane under the mode of contrast ultrasound was thicker than that of the gray scale ultrasound model. The difference was 0.53 + 0.29cm, 0.39 + 0.16cm, and the difference was statistically significant (P=0.012). The thickness of the synovial membrane in the joint hemorrhagic group under the CEUS mode and the gray scale ultrasound mode were both 0.62 + 0.31cm, 0.33 + 0.11cm vs 0.44 + 0.16cm and 0.30 + 0.12cm respectively. The difference was statistically significant (P =0.000; P) 21); in 6 joint synovium without color Doppler flow imaging, there were 3 visible contrast enhancement signals. The scores of ultrasonic examination in the joint bleeding group were higher than those in the joint without bleeding group, and the scores were 0.38 + 0.75cm to 6.86 + 3.49cm vs 0.10 + 0.42cm to 4.42 + 3.86cm respectively. The difference between the two groups was statistically significant (P=0.000 ~ 0.029). The score of each item was positively correlated with the number of joint bleeding during the follow-up period (r=0.17 to 0.63, P=0.000 to 0.030), and the correlation of CEUS score was the highest. Conclusion: ultrasonography has important value in the assessment of hemophilia joint lesions, especially in the assessment of early joint soft tissue lesions and articular cartilage lesions. There is a correlation between the clinical examination indexes and the ultrasound examination results, which can reflect the patient's change more accurately and guide the clinical treatment. The joint lesions of the hemophilia patients are closely related to the risk of clinical bleeding. Contrast enhanced ultrasound (CEUS) can more clearly and accurately assess the degree of synovial hyperplasia and the degree of neovascularization, and the bleeding wind than the conventional ultrasound. The highest risk correlation is of great significance for guiding clinical treatment.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R554.1

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