高分辨力超声在类风湿性关节炎小关节病变的应用价值

发布时间：2018-04-18 16:22

本文选题：类风湿性关节炎 + 小关节　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：探讨高分辨力超声在类风湿性关节炎（RheumatoidArthritis，RA）手指小关节病变中的诊断价值。资料和方法：选择在大连市中心医院住院的类风湿性关节炎患者为研究对象，诊断均符合美国风湿病学会1987年修订的类风湿关节炎诊断标准（ARA，1987），共40例患者720个手指小关节为RA组，同时以正常人20例360个手指小关节为对照组，应用高分辨力超声分别检查两组双手1～5掌指关节（Metacarpophalangealjoint,MCP）和2～5近端指间关节（Proximal interphalangeal joint,PIP），观察并记录关节滑膜厚度及血流情况，关节积液的范围及透声情况，关节软骨及软骨下骨关节面是否光滑，表面和内部情况，有无缺损。通过与对照组对比观察类风湿性关节炎手指小关节病变的高分辨力彩色多普勒超声表现，总结类风湿性关节炎手指小关节病变的超声特征，其中20例患者同时进行核磁共振检查(MagfleticResonance Imaging,MRI），比较高分辨力超声与核磁共振类风湿性关节炎手指小关节病变检查的阳性率。结果：1.手指小关节病变的超声检查结果： 1.1滑膜增厚：检出40例共358个滑膜增厚，，分别占患者总数的100%（40/40）和受检关节总数的49.72%（358/720），掌指关节和近端指间关节检出率分别为58.50%（234/400）、38.75%（124/320）。 1.2关节腔积液：检出29例310个关节存在关节腔积液，分别占患者总数的72.50%（29/40）和受检关节总数的43.06%（310/720）、MCP、PIP的检出率分别为46.00%（184/400），39.38%（126/320）。 1.3滑膜血管翳：按血流信号I级以上为阳性，RA组17例85个关节为阳性血流信号,分别占患者总数的42.50%（17/40）和受检关节总数的11.81%（85/720）,MCP、PIP的检出率分别为16.50%（66/400），5.94%（19/320）。 1.4骨损坏：检出11例79个病变关节有软骨及软骨下骨质侵蚀，分别占患者总数的27.50%（11/40）和受检关节总数的10.97%（79/720），MCP、PIP的检出率分别为14.00%（56/400），7.19%（23/320）。 2.手指小关节病变的MRI检查结果： 2.1滑膜增厚：检出14例共241个滑膜增厚，分别占患者总数的70.00%（14/20）和受检关节总数的66.94%（241/360）。 2.2关节腔积液：检出12例167个关节存在关节腔积液，分别占患者总数的60.00%（12/20）和受检关节总数的46.39%（167/360）。 2.3骨损坏：检出8例65个病变关节有软骨及软骨下骨质侵蚀，分别占患者总数的40.00%（8/20）和受检关节总数的18.06%（65/360）。 3．比较结果： 3.1高分辨力超声检查滑膜厚度比较： RA组滑膜厚度均较对照组明显增厚，两者比较差异有统计学意义（P0.01）。 3.2高分辨力超声和MRI检查结果比较:20例RA患者滑膜厚度、关节腔积液、骨损坏两种影像学检查阳性率比较，差异均无统计学意义（P0.05）。结论：1．高分辨力超声可以检出类风湿性关节炎关节滑膜增厚及关节积液，可做为超声诊断类风湿性关节炎手指小关节病变的重要指标。 2．彩色多普勒血流显像检测滑膜内血流信号分布情况是判断类风湿性关节炎滑膜炎症程度及炎症活动性的重要指标。 3．高分辨力超声检出关节软骨和软骨下骨骨质的侵蚀情况是判断类风湿性关节炎手指小关节病变程度的重要参考。
[Abstract]:Objective : To investigate the diagnostic value of high resolution ultrasound in the diagnosis of small joint lesions of finger joints of rheumatoid arthritis ( RA ) .

Materials and Methods : The diagnostic criteria of rheumatoid arthritis ( ARA , 1987 ) , which was revised in 1987 by American College of Rheumatology , were selected for the study of rheumatoid arthritis patients hospitalized in Dalian Central Hospital .

Results : 1 . Ultrasonic examination results of small finger joint lesions :

1.1 synovial thickening : Among the 40 cases , 358 synovial thickening were detected , accounting for 49.72 % ( 40 / 40 ) of total patients and 49.72 % ( 358 / 720 ) of the total number of joints , 58.50 % ( 234 / 400 ) and 38.75 % ( 124 / 320 ) respectively .

1.2 Joint cavity effusion : There were 29 cases of articular cavity effusion in 29 cases , accounting for 72.50 % ( 29 / 40 ) of total number of patients and 43.06 % ( 310 / 720 ) of the total number of joints . The detection rate of MCP and PIP was 46.00 % ( 184 / 400 ) and 39.38 % ( 126 / 320 ) , respectively .

1.3 In RA group , 17 cases 85 joints were positive blood flow signals , accounting for 42.50 % ( 17 / 40 ) and 11.81 % ( 85 / 720 ) , MCP and PIP were 16.50 % ( 66 / 400 ) and 5.94 % ( 19 / 320 ) , respectively .

1.4 Bone damage : There were 11 cases of 79 lesions , which accounted for 27.50 % ( 11 / 40 ) of the total number of patients and 10.97 % ( 79 / 720 ) of the total number of joints . The detection rate of MCP and PIP was 14.00 % ( 56 / 400 ) and 7.19 % ( 23 / 320 ) , respectively .

2 . MRI findings of small finger joint lesions :

2.1 The thickness of synovial membrane : 14 cases were found to be thickened , accounting for 70.00 % ( 14 / 20 ) of the total number of patients and 66.94 % ( 241 / 360 ) of the total number of joints .

2.2 Joint cavity effusion : There were 12 cases of 167 joints with joint cavity effusion , accounting for 60.00 % ( 12 / 20 ) of total number of patients and 46.39 % ( 167 / 360 ) of total number of joints .

2.3 Bone damage : 8 cases of 65 lesions were detected with cartilage and bone erosion , accounting for 40.00 % ( 8 / 20 ) of the total number of patients and 18.06 % ( 65 / 360 ) of the total number of joints .

3 . Comparison Results :

3.1 Compared with the control group , the thickness of synovial membrane in RA group was significantly increased compared with the control group ( P0.01 ) .

3.2 The results of high resolution ultrasonography and MRI showed that 20 patients with RA had no statistical significance ( P0.05 ) .

Conclusion : 1 . High - resolution ultrasound can detect synovial thickening and joint effusion of rheumatoid arthritis joint synovial membrane , and can be used as an important index for the diagnosis of small joint disease of finger joint of rheumatoid arthritis .

2 . The distribution of blood flow signal in synovial fluid by color Doppler flow imaging is an important index to judge the degree of rheumatoid arthritis and the activity of inflammation .

3 . The high - resolution ultrasonography is an important reference for the determination of the degree of small joint lesion of the finger facet of rheumatoid arthritis .

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R593.22

【参考文献】