高频超声在类风湿性关节炎局部病变诊断与疗效评价中的应用

发布时间：2018-05-12 04:17

本文选题：高频肌肉骨骼超声 + 类风湿性疾病　；参考：《新乡医学院》2017年硕士论文

【摘要】：目的:类风湿性关节炎(rheumatoid arthritis,RA)是以慢性关节炎为主要临床表现的多种因素共同引起的自身免疫病。随着RA病程中免疫反应反复发作,常伴有以渐进性关节功能异常损害为主要表现的关节病理改变。迄今为止,对RA病因发生至今尚存在不少的疑问与不解之处;建立一种能早期诊断RA患者关节功能异常及关节损害的技术与方法,是研究RA的发生、诊断与治疗亟待解决的问题。高频肌肉骨骼超声,简称高频肌骨超声(Musculoskeletal ultrasound,MSUS)检测可应用于关节病变诊断的研究,为RA患者发病机制的研究探索,以及诊断和治疗提供了一种特有评价手段,特别是高频超声能准确获得关节病变相应的相关数据,客观地应用于评价RA局部病变的发生、发展与转归,以及进一步的诊断与治疗评价。本研究旨在探讨高频超声在评价类风湿性关节炎局部病变中诊断与治疗的应用价值。方法:以美国风湿病协会(American Rheumatism Association,ACR)1987年修订的RA诊断为标准,随机选取2014年1月~2014年12月在郑州大学第二附属医院接受诊断和治疗的RA患者64例。参照国际超声标准,切面留取患者双膝关节、双踝关节、双腕关节超声图像;采用8~12MHz频率的线阵探头进行采图,检测使用相同的多普勒预设定参数,多切面观察病变关节滑囊有无积液,测量滑膜厚度,评估滑膜内血流信号灌注分级,分析临床表现与超声表现的相关性,每项数据重复测量3次取得的平均值为最终测量值。对64例患者进行了12周的标准疗程治疗,每例均于入院当天及治疗后28天测定红细胞沉降率(erythrocyte sedimentation rate,ESR)和C-反应蛋白(C-reactive protein,CRP)。选取同一时期入郑州大学第二附属医院体检的健康志愿者30例为对照组,无关节肿痛及损伤病史,超声检查方法及参数同治疗组。结果:1.治疗前64例RA患者中,膝关节病变56例、腕关节病变28例,踝关节病变30例;与健康组对比,病变关节均有明显的滑膜增厚,滑囊积液及增厚滑膜内血流信号增多的超声图像特征;2.64例RA患者治疗后病变关节,膝关节、踝关节、腕关节的最大滑囊积液深度、滑膜厚度、彩色多普勒血流量等超声图像的特征数据,与治疗前相比均有显著好转,差异有统计学意义(分别P0.05);3.比较研究结果还发现,膝关节、腕关节、踝关节滑膜厚度、CDFI及临床表现均与病程有明显的正相关性改变,有统计学意义(分别P0.05)。结论:1.高频超声可早期发现RA患者的滑膜改变,在临床诊断中具有重要的应用价值;2.在RA的治疗前后对比评价中,高频超声具有一定优势,既能准确反映出治疗前后病变关节滑囊积液量、滑膜厚度、滑膜血流量灌注的变化情况,又能及时的评估其疗效和病情反复情况,具有很好的临床应用前景。
[Abstract]:Objective: rheumatoid arthritis (RA) is an autoimmune disease caused by chronic arthritis. With the repeated attack of immune response in the course of RA, the pathological changes of joint are often accompanied by progressive abnormal joint function. So far, there are still many questions and puzzles about the etiology of RA. To establish a technique and method for early diagnosis of joint dysfunction and joint damage in patients with RA is to study the occurrence of RA. Diagnosis and treatment are urgent problems. High frequency musculoskeletal ultrasound (MSUSS) can be used in the diagnosis of joint diseases, which provides a special evaluation method for the pathogenesis, diagnosis and treatment of RA. In particular, high-frequency ultrasound can accurately obtain the relevant data of joint lesions, and can be used objectively to evaluate the occurrence, development and outcome of RA local lesions, as well as the further diagnosis and treatment evaluation. The purpose of this study was to evaluate the value of high-frequency ultrasound in the diagnosis and treatment of local lesions of rheumatoid arthritis. Methods: 64 RA patients who were diagnosed and treated in the second affiliated Hospital of Zhengzhou University from January 2014 to December 2014 were randomly selected according to the criteria of American Rheumatism Association (ACR) revised in 1987. Referring to the international ultrasound standard, the ultrasound images of the knee joint, ankle joint and wrist joint of the patient were left on the section plane. The images were taken using a linear array probe with 8~12MHz frequency, and the same Doppler pre-set parameters were detected. The synovial thickness was measured, the perfusion grade of blood flow signal in synovium was evaluated, and the correlation between clinical manifestation and ultrasonic manifestation was analyzed. The average value of 3 times repeated measurement of each data was the final measurement value. 64 patients were treated with standard course of treatment for 12 weeks. Erythrocyte sedimentation rate (sedimentation) and C-reactive protein (C-reactive protein) were measured on the day of admission and 28 days after treatment. Thirty healthy volunteers who entered the second affiliated Hospital of Zhengzhou University in the same period were selected as control group. There was no history of joint swelling and pain, ultrasonic examination method and parameters were the same as those in the treatment group. The result is 1: 1. In 64 patients with RA before treatment, 56 cases had knee joint disease, 28 cases had wrist joint disease, 30 cases had ankle joint disease, compared with the healthy group, the pathological joint had obvious synovial thickening. Ultrasonographic features of increased blood flow signal in synovial thickening and synovial fluid accumulation in synovial thickening. 2.The maximum depth of synovial fluid accumulation and synovial thickness of the diseased joint, knee joint, ankle joint and wrist joint after treatment in 64 patients with RA. The characteristic data of color Doppler blood flow and other ultrasound images were significantly improved compared with those before treatment, and the difference was statistically significant (P0.05 / 3, respectively). The results also showed that CDFI and clinical manifestations of knee joint wrist joint and ankle synovial thickness were significantly correlated with the course of disease (P 0.05). Conclusion 1. High frequency ultrasound can detect synovial changes in RA patients early and has important value in clinical diagnosis. In the comparative evaluation of RA before and after treatment, high frequency ultrasound has some advantages, which can accurately reflect the changes of synovial fluid, synovial thickness and synovial blood flow perfusion before and after treatment. It can evaluate its curative effect and repeated condition in time, so it has a good prospect of clinical application.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R593.22

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