超声在类风湿关节炎临床诊断中的应用研究

发布时间：2019-02-18 16:35

【摘要】：目的：探讨超声检查在评估类风湿关节炎（rheumatoid arthritis，RA）诊断中的应用价值。方法： 77例临床疑诊RA的患者分别进行超声检查及临床方法诊断RA。超声通过检测患侧腕关节，第2、3掌指关节(metacarpophalangeal joints,MCP)，第2、3近端指间关节(proximal interphalangeal joints, PIP），第2、5跖趾关节（metatarsophalangeal joints, MTP）等7个关节，观察滑膜增生、滑膜内血流信号、骨侵蚀及关节积液4项指标，以4步半定量分级系统中滑膜病变为主的病例超声提示RA。对两种方法进行对比分析。同时对这4项指标进行等级评分，评分总和与同期血清学指标进行单因素相关Pearson分析。结果：超声提示RA55例，非RA22例，临床诊断RA53例，非RA24例。超声提示和临床诊断两种方法间的差异无统计学意义（P=0.774）。滑膜血流评分总和、积液评分总和与血沉(erythrocyte sedimentationrate，ESR)成正相关（r值分别是0.739、0.564，P值均=0.000）。结论：（1）高频超声可较清楚显示骨质破坏、关节积液、滑膜增生及增生滑膜内血流信号并进行超声分级。（2）超声同时应用4项指标对类风湿关节炎进行提示的方法同临床诊断基本吻合，且其滑膜血流评分总和及积液评分总和与血清学指标存在正相关性，超声可作为RA的筛查方法，，为临床早期确诊提供更多影像学依据，值得推广应用。（3）部分患者超声提示结果可以早于实验室诊断。
[Abstract]:Objective: to evaluate the value of ultrasonography in the diagnosis of rheumatoid arthritis (rheumatoid arthritis,RA). Methods: 77 patients with suspected RA were examined by ultrasound and diagnosed with RA. by clinical methods. Ultrasound was used to detect the synovial hyperplasia and intrasynovial blood flow signal of 7 joints, including wrist joint, metacarpophalangeal joint (metacarpophalangeal joints,MCP), interphalangeal joint (proximal interphalangeal joints, PIP), metatarsophalangeal joint (metatarsophalangeal joints, MTP) and metatarsophalangeal joint (metatarsophalangeal joints, MTP). Four indexes of bone erosion and joint effusion. RA. was revealed by ultrasound in synovial lesions in a four-step semi-quantitative grading system. The two methods are compared and analyzed. At the same time, the four indexes were graded, the sum of the scores and the serological indexes of the same period were analyzed by univariate Pearson. Results: RA55, non-RA22, RA53 and non-RA24 were diagnosed by ultrasonography. There was no significant difference between ultrasound indication and clinical diagnosis (P0. 774). The sum of synovial blood flow score and accumulative fluid score were positively correlated with erythrocyte sedimentationrate,ESR (r = 0. 739 卤0. 564 P = 0.000). Conclusion: (1) High-frequency ultrasound can clearly display the blood flow signal in synovial membrane of bone destruction, joint effusion, synovial hyperplasia and hyperplasia. (2) the methods of indicating rheumatoid arthritis with four indexes of ultrasound were in good agreement with clinical diagnosis, and the sum of synovial blood flow score and accumulated fluid score were positively correlated with the serological indexes. Ultrasound can be used as a screening method for RA and provide more imaging evidence for clinical early diagnosis. (3) the ultrasonic findings of some patients can be diagnosed earlier than the laboratory diagnosis.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1

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