彩超对强直性脊柱炎骶髂关节炎和肌腱端病的诊断价值

发布时间：2018-04-21 05:39

本文选题：强直性脊柱炎 + 骶髂关节　；参考：《昆明医科大学》2014年硕士论文

【摘要】：目的通过使用彩色多普勒超声(color Doppler ultrasound, CDUS)观察强直性脊柱炎(ankylosing spondylitis, AS)患者以及健康志愿者的骶髂关节和肌腱端的二维超声图像及血流,探讨CDUS对评估AS患者骶髂关节炎及肌腱端病的价值。并通过对活动期AS患者及其治疗后稳定期观察其上述指标,探讨CDUS对评估AS炎症活动性的价值。方法 1.使用彩色多普勒超声,对86例AS患者以及30例健康志愿者的双侧骶髂关节和周围韧带、肌腱端,双下肢股四头肌腱附着端、髌韧带髌骨附着端,髌韧带胫骨附着端、跟腱附着端、足底筋膜附着端等部位进行彩色多普勒超声检查。经统计学分析两组观察指标间的差异,探讨CDUS诊断骶髂关节炎和肌腱端病的价值。 2.选取30例活动期AS患者,经风湿免疫科规范治疗后,病情达到稳定,使用CDUS重复检查骶髂关节及肌腱端,观察指标与治疗前完全相同,对比治疗前后声像图变化,经统计学分析,探讨以上指标评估AS活动性的价值。结果 1.AS组与健康对照组骶髂关节及周围韧带、肌腱附着端异常情况比较(P0.05),差异有统计学意义。 2.AS组与健康对照组骶髂关节血流丰富程度及血流RI差异有统计学意义(P0.05),根据ROC曲线可知,曲线下最大面积为0.916(P0.01),以RI=0.695为最佳临界点,其诊断AS的灵敏度为90.9%,特异度为81.3%。 3.AS组与健康对照组下肢肌腱端的彩色超声检查中,发现AS组肌腱端增厚高于其它异常表现；AS组中滑膜炎以股四头肌腱发现率高,增厚、回声改变、钙化、骨侵蚀及骨赘、血流异常以跟腱发现率高。各组肌腱端异常与健康对照组比较,差异有统计学意义(P0.05)。 4.活动期AS患者治疗前后骶髂关节血流丰富程度及血流RI差异有统计学意义(P0.05)。根据ROC曲线可知,曲线下最大面积为0.898(P0.01),以RI=0.71为最佳临界点,其诊断AS活动期的灵敏度为81.5%,特异度为89.3%。5.活动期AS患者治疗前后下肢各肌腱端厚度、滑膜厚度及滑囊积液、回声改变、血流情况比较差异有统计学意义(P0.05),钙化、骨侵蚀及骨赘情况比较差异无统计学意义(P0.05)。结论 1.AS组骶髂关节血流显示率较高,血流丰富程度较高,血流RI多数呈低阻,健康对照组血流显示率较低,血流丰富程度较低,血流RI多数呈高阻。血流丰富程度及血流RI值可以作为辅助诊断AS患者骶髂关节炎的指标。 2.彩色多普勒超声能清晰显示AS患者肌腱端病的多种病理改变,如肌腱端增厚、滑膜炎症(包括滑膜增生、滑膜血管翳的形成和滑囊积液)、肌腱端回声改变、钙化、骨侵蚀及骨赘改变、血流等,在AS的早期阶段就可以发现肌腱端炎,为临床诊断提供客观依据。 3.活动期AS组治疗前后对比,骶髂关节血流丰富程度及血流RI、肌腱端厚度、滑膜厚度及滑囊积液、回声改变、血流等指标治疗前后有明显变化,彩超可以较敏感的评估AS病情活动性及监测疗效。 4.彩色多普勒超声诊断AS患者肌腱端病敏感性高,对骶髂关节炎有一定辅助诊断价值,可以评估疾病活动性及监测患者疗效。是辅助AS患者早期诊断、鉴别诊断及评估疗效的有效影像学检查方法,值得在临床工作中推广应用。
[Abstract]:objective
Color Doppler ultrasound (CDUS) was used to observe the two dimensional ultrasound images and blood flow of the sacroiliac joint and tendon end of the ankylosing spondylitis (ankylosing spondylitis, AS) and the healthy volunteers. The value of CDUS to evaluate the sacroiliitis and tendon end disease of the patients in AS was evaluated and the AS patients in the active phase of AS were used. After treatment, the above indexes were observed and the value of CDUS in evaluating the activity of AS was evaluated.
Method
1. color Doppler ultrasound was used in 86 cases of AS patients and 30 healthy volunteers with bilateral sacroiliac and peripheral ligaments, tendon end, double leg femoral four tendon attachment end, patellar tendon attachment end, patellar tendon attachment end, Achilles tendon attachment end, plantar fascia attachment end and other parts were examined by color Doppler ultrasound. The differences between the two groups were analyzed, and the value of CDUS in diagnosing sacroiliac arthritis and tendons disease was discussed.
2. to select 30 patients with active AS, after the standard treatment of the rheumatology department, the condition was stable, the sacroiliac joint and the tendon end were repeated by CDUS. The observation index was the same as before the treatment. The changes of the sound image before and after the treatment were compared, and the value of the above indexes to evaluate the activity of AS was evaluated by statistical analysis.
Result
There was a significant difference between the 1.AS group and the healthy control group (P0.05).
There was a significant difference in the blood flow and blood flow RI between the 2.AS group and the healthy control group (P0.05). According to the ROC curve, the maximum area under the curve was 0.916 (P0.01), and RI=0.695 was the best critical point. The sensitivity of the diagnosis of AS was 90.9% and the specificity was 81.3%..
In group 3.AS and the color ultrasound examination of the tendon end of the lower limbs of the healthy control group, it was found that the thickening of the tendon end of the AS group was higher than that of the other abnormal manifestations. In group AS, the rate of detection of the four tendon of the femoral head was high, thickening, echo change, calcification, bone erosion and osteophyte, and the abnormal blood flow was found in the Achilles tendon. The abnormal tendon end of each group was compared with the healthy control group, the difference was compared with the healthy control group. There was a statistical significance (P0.05).
There was a significant difference in the blood flow and blood flow RI of the sacroiliac joint before and after the treatment of the 4. active AS patients (P0.05). According to the ROC curve, the maximum area under the curve was 0.898 (P0.01), and RI=0.71 was the best critical point. The sensitivity of the diagnosis of AS activity was 81.5%, and the specificity was the lower extremity tendons of the AS patients in 89.3%.5. active stage before and after treatment. There was a significant difference in the thickness of the end, the thickness of the synovial membrane and the effusion of the capsule, the echo change and the blood flow (P0.05). There was no significant difference in calcification, bone erosion and osteophyte (P0.05).
conclusion
In group 1.AS, the blood flow of sacroiliac joint was high, blood flow was rich, blood flow RI was low, blood flow was low, blood flow was low, blood flow was low, and most of blood flow RI was high. Blood flow and blood flow RI could be used as a marker for diagnosis of sacroilitis in AS patients.
2. color Doppler ultrasound can clearly show a variety of pathological changes of the AS patients with tendon end disease, such as the thickening of the tendon end, synovial inflammation (including synovial hyperplasia, formation of synovial pannus and synovial fluid), the change of the echo of the tendon, calcification, bone erosion and osteophyte change, blood flow, and so on. In the early stage of AS, the clinical diagnosis can be found. Provide an objective basis.
3. active AS group before and after treatment, the blood flow of sacroiliac joint and blood flow RI, the thickness of the tendon, the thickness of the synovial membrane and the fluid, the echo change, the blood flow and so on. The color Doppler ultrasound can be more sensitive to evaluate the activity of AS and monitor the curative effect.
4. color Doppler ultrasound diagnosis of AS patients with high sensibility of tendon end disease is of great value for the diagnosis of sacroilitis. It can evaluate the activity of the disease and monitor the curative effect of the patients. It is an effective imaging examination method to assist the early diagnosis of AS patients, to differentiate the diagnosis and to evaluate the curative effect. It is worth popularizing and applying in the clinical work.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R593.23

【参考文献】