膝骨关节炎患者膝关节超声应用及血清25-羟基维生素D水平的研究

发布时间：2018-01-23 18:47

本文关键词： 膝骨关节炎超声检查 25-羟基维生素D　出处：《青海大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨血清25-羟基-维生素D水平、膝关节超声表现分别与膝骨关节炎是否存在相关性;探讨血清25-羟基-维生素D水平与膝关节超声表现是否存在相关性,有可能为早期膝骨关节炎的诊疗方法提供新思路。方法:选取2015年11月至2016年11月于青海大学附属医院就诊的明确诊断为膝骨关节炎患者30例为膝骨关节炎组(KOA组)。同时选取同时期在青海省西宁市虎台社区服务中心健康体检的骨密度测量与病例组无明显差别的健康志愿者30例为对照组。所有受试者均进行血清25-羟基维生素D水平的测量及双侧膝关节超声检查,分别记录两侧关节软骨厚度、滑膜厚度及髌上囊积液,并将双膝超声检查结果取其重侧膝关节超声声像图测量值记录结果。结果:1.KOA组软骨声像图测量厚度低于对照组,差别有统计学意义(P0.05);KOA组滑膜声像图测量厚度和髌上囊积液超声声像图测量值高于对照组,差别有统计学意义(P0.01)。2.KOA组血清25-羟基维生素D水平明显低于对照组,差别有统计学意义(P0.01)3.超声测量膝关节软骨厚度、滑膜厚度及髌上囊积液深度对膝骨关节炎诊断的灵敏度分别为53.33%、36.67%、56.67%,特异度分别为76.67%、96.67%、73.33%。4.所有受试者行膝关节超声检查软骨厚度正常的受试者中血清25-羟基维生素D水平高于软骨厚度变薄的受试者,差别有统计系意义(P0.01);滑膜轻度增厚的受试者中血清25-羟基维生素D水平低于滑膜无增厚的受试者,差别有统计系意义(P0.05);髌上囊积液的深度与血清25-羟基-维生素D水平差别无统计学意义(P0.05)。5.以25-羟基维生素D水平17.885作为临界值时,ROC曲线下面积为0.909,血清25-羟基维生素D水平诊断骨关节炎的灵敏感性、特异性分别为90.00%、73.33%(P0.01)。6.血清25-羟基维生素D水平与软骨厚度呈正相关关系(r=0.340,p0.01),与滑膜厚度呈负相关关系(r=-0.324,p0.05),与髌上囊积液无相关性(r=-0.207,p0.05)。7.经过血清25-羟基维生素D水平与年龄、性别、软骨厚度、滑膜厚度及髌上囊积液的多元回归分析,结果显示软骨及滑膜厚度是血清25-羟基维生素D水平的独立影响因素(P0.01)。结论:1.软骨、滑膜和髌上囊积液超声检查联合血清25-羟基维生素D水平可作为早期协助诊断KOA的测量指标。2.血清25-羟基维生素D水平与膝关节中软骨和滑膜病变有一定的相关性。
[Abstract]:Objective: to investigate the correlation between serum 25-hydroxy-vitamin D and knee joint osteoarthritis. To investigate the correlation between serum 25-hydroxy-vitamin D level and ultrasonic manifestation of knee joint. It is possible to provide new ideas for the diagnosis and treatment of early knee osteoarthritis. From November 2015 to November 2016, 30 patients with knee osteoarthritis were selected from the affiliated Hospital of Qinghai University. (. KOA group). At the same time, 30 healthy volunteers who had no significant difference in bone mineral density measurement and case group were selected as control group. All the subjects were given serum 25-hydroxyl hydroxide in the same period of health examination at Hutai community service center in Xining city, Qinghai province. Measurement of vitamin D level and ultrasonic examination of bilateral knee joint. The thickness of articular cartilage, synovial thickness and superpatellar sac effusion were recorded. Results: 1. The thickness of cartilage in the KOA group was lower than that in the control group, and the difference was statistically significant (P 0.05). The thickness of synovial sonogram and the ultrasonic image of suprapatellar sac in KOA group were higher than those in control group. The difference was statistically significant (P 0.01) .2.The serum level of 25-hydroxyvitamin D in KOA group was significantly lower than that in control group. The difference was statistically significant (P 0.01). The sensitivity of ultrasonic measurement of articular cartilage thickness, synovial thickness and the depth of suprapatellar sac fluid in the diagnosis of knee osteoarthritis were 53.33% and 36.67%, respectively. The specificity was 76.67% and 96.67% respectively. All subjects underwent ultrasound examination of the knee joint with normal cartilage thickness. The serum levels of 25-hydroxyvitamin D were higher than those with thinner cartilage thickness. The difference has statistical significance (P 0.01). The serum levels of 25-hydroxyvitamin D in subjects with mild synovial thickening were lower than those without synovial thickening (P 0.05). There was no significant difference between the depth of suprapatellar sac effusion and serum 25-hydroxy-vitamin D level. The area under the ROC curve was 0.909. The sensitivity and specificity of serum 25-hydroxyvitamin D level in the diagnosis of osteoarthritis were 90.00%, respectively. The serum levels of 25-hydroxyvitamin D were positively correlated with the thickness of cartilage. There was a negative correlation with synovial thickness, but no correlation with suprapatellar sac effusion. P0.05. 7.The multivariate regression analysis between serum 25-hydroxyvitamin D level and age, sex, cartilage thickness, synovial thickness and suprapatellar sac fluid was performed. The results showed that the thickness of cartilage and synovial membrane was an independent influence factor of serum 25-hydroxyvitamin D level. Conclusion: 1. Ultrasonic examination of synovial and suprapatellar sac fluid combined with serum 25-hydroxyvitamin D level can be used as an early diagnostic index of KOA .2.Serum 25-hydroxyvitamin D level and cartilage and synovial membrane of knee joint. The pathological changes have certain correlation.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R684.3

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