超声评分法和超声造影在类风湿关节炎的应用研究

发布时间：2018-03-17 13:02

本文选题：类风湿关节炎　切入点：超声评分　出处：《福建医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的探讨超声评分法在评价类风湿关节炎患者疾病活动性的诊断价值。方法通过高频超声观察39例类风湿关节炎患者掌指关节、近端指间关节、腕关节、肘关节和膝关节的病变,包括滑膜厚度、滑膜血流、关节积液和骨侵蚀,根据病情的严重程度对上述各项指标予以评分(0~3分),将双侧各个关节的评分相加为最终得分,探讨超声评分与DAS28评分及4种生化检查(血沉ESR、C-反应蛋白CRP、类风湿因子RF、抗环瓜氨酸肽抗体Anti-CCP)之间的相关性。结果超声评分与DAS28评分之间存在非常显著的相关性(r=0.823,P0.01),超声评分与CRP的相关性优于DAS28评分与CRP的相关性(r超声评分=0.692,r DAS28=0.526,P值0.01)。超声评分各个子项目中滑膜厚度与DAS28评分及生化检查(ESR、CRP)相关性最好(r DAS28=0.852,r ESR=0.779,r CRP=0.587,P值均0.01)。结论超声评分法对类风湿关节炎疾病活动性的诊断与DAS28评分和血清学指标(ESR、CRP)基本吻合,且超声评分可能优于DAS28评分,可做为该病早期诊断、病情判断和预后观察的一种有效方法。超声评分各个子项目中滑膜厚度最能够反映类风湿关节炎疾病的活动性。目的探讨超声造影对于类风湿关节炎疾病活动性的评估价值。方法选取12例类风湿关节炎患者,充分暴露病变最严重的关节,先在普通模式下运用高频超声观察并记录相关指标(包括滑膜厚度、滑膜血流、关节积液和骨侵蚀),根据病情的严重程度对上述各项指标予以评分(0~3分),将双侧各个关节的评分相加为最终得分。后切换到造影模式,经肘正中静脉团注造影剂声诺维2.4ml,连续实时观察增厚滑膜的增强情况,并获取感兴趣区的时间-强度曲线,分析曲线下面积(AUC)、峰值强度(PI)和达峰时间(TTP)参数,探讨各参数与超声评分及4种生化检查(ESR、CRP、RF、Anti-CCP)之间的相关性。结果超声造影时间-强度曲线中的AUC和PI与超声评分之间存在非常显著的相关性(r AUC=0.832,r PI=0.809,P0.01),AUC和PI与ESR之间的相关性优于超声评分与ESR的相关性(r AUC=0.907,r PI=0.851,r超声评分=0.836,P0.01),AUC和PI与CRP之间的相关性优于超声评分与CRP的相关性(r AUC=0.855,r PI=0.854,r超声评分=0.692,P0.01)。结论超声造影对类风湿关节炎疾病活动性的诊断与超声评分和生化指标(ESR、CRP)基本吻合,且超声造影可能优于超声评分,更加能够反映类风湿关节炎疾病的活动性,可以提供更多的客观依据。
[Abstract]:Objective to evaluate the diagnostic value of ultrasonic scoring method in evaluating the activity of rheumatoid arthritis. Methods the metacarpophalangeal joint, proximal interphalangeal joint and wrist joint of 39 patients with rheumatoid arthritis were observed by high frequency ultrasound. The lesions of the elbow joint and the knee joint, including synovial thickness, synovial blood flow, joint effusion and bone erosion, were graded according to the severity of the disease. The scores of each joint were added to the final score. To investigate the correlation between ultrasound score and DAS28 score and four biochemical tests (erythrocyte sedimentation rate (ESR) C-reactive protein, rheumatoid factor RFand anti-cyclic citrullinated peptide antibody Anti-CCP.Results there was a very significant correlation between ultrasound score and DAS28 score. The correlation between ultrasound score and CRP was better than that between DAS28 score and CRP. The correlation between ultrasound score and CRP was 0.692r DAS280.526g P value 0.010.The correlation between synovial thickness and DAS28 score and biochemical examination was the best, and the correlation between r DAS280.852r ESR-0.779r CRP 0.587P was 0.01. conclusion the correlation between synovial thickness and DAS28 score and biochemical examination is better than that of DAS28 score and CRP. Conclusion the results show that the correlation between synovial thickness and DAS28 score and biochemical examination is better than that of DAS28 score and CRP. Conclusion the results show that the correlation between synovial thickness and DAS28 score and biochemical examination is better than that of DAS28 score and CRP. The diagnosis of the activity of rheumatoid arthritis by acoustic scoring method was consistent with the DAS28 score and the serological index (ESR CRP). Ultrasound score may be superior to DAS28 score and can be used as an early diagnosis of the disease. The synovial thickness of each sub-item of ultrasound score can best reflect the activity of rheumatoid arthritis disease. Objective to explore the value of contrast-enhanced ultrasonography in rheumatoid arthritis disease activity. Methods 12 patients with rheumatoid arthritis were selected. To fully expose the most seriously affected joints, observe and record the relevant indexes (including synovial thickness, synovial blood flow, etc.) using high frequency ultrasound in normal mode. According to the severity of the disease, the joint effusion and bone erosion were graded by 0 ~ 3 points, the scores of each joint were added as the final score, and then switched to the contrast mode. The enhancement of thickened synovium was observed continuously and in real time. The time-intensity curve of the area of interest was obtained, and the parameters of area under the curve, peak intensity (Pi) and peak time (TTP) were analyzed. To investigate the correlation between the parameters and the ultrasound score and the four biochemical tests, the correlation between AUC and Pi in the time-intensity curve of contrast-enhanced ultrasound and the ultrasound score was very significant. There was a very significant correlation between AUC and Pi in the time-intensity curve of contrast-enhanced ultrasound and the correlation between r AUC 0.832 r Pi 0.809 P0.01AUC and Pi and ESR. The correlation was better than that between ultrasound score and ESR. The correlation between AUC and Pi was better than that between ultrasound score and CRP. Conclusion Ultrasonography can be used to evaluate the activity of rheumatoid arthritis in patients with rheumatoid arthritis. Conclusion the correlation between ultrasound score and CRP is better than that between AUC score and CRP score. Conclusion Contrast-enhanced ultrasonography is useful for rheumatoid arthritis (RA) activity in patients with rheumatoid arthritis (rheumatoid arthritis). Conclusion Ultrasonography can improve the activity of rheumatoid arthritis by contrast-enhanced echocardiography in patients with rheumatoid arthritis (RA), especially in patients with rheumatoid arthritis (RA). The diagnosis of sex basically coincided with ultrasound score and biochemical index (ESR-CRP). Contrast-enhanced ultrasonography may be superior to ultrasound score, which can reflect the activity of rheumatoid arthritis and provide more objective basis.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R445.1;R593.22

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