外周附着点超声检查在脊柱关节炎中的应用价值

发布时间：2018-01-20 22:12

  本文关键词： 脊柱关节炎 彩色多普勒超声 附着点炎 类风湿关节炎　出处：《石河子大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:了解脊柱关节炎(SpA)患者肌腱附着点炎的发生率、超声表现特点,探讨超声在SpA中的诊断价值。方法:收集2015年12月至2016年12月新疆自治区人民医院门诊及住院SpA患者80例为观察组,收集同期类风湿关节炎(RA)患者50例(RA组),健康志愿者50例(HC组)为对照组,通过二维彩色多普勒超声分别对三组研究对象上肢2个肌腱附着点(肱二头肌长头腱,冈上肌肌腱)及下肢5个肌腱附着点(股四头肌肌腱止点、髌腱起点、髌腱止点、跟腱、跖底筋膜)进行超声检查及超声评分,对相关数据进行统计学分析。结果:(1)80例SpA患者共1112处附着点(2人拒绝行上肢检查),超声检查发现118处异常,临床检查发现29处异常,二者差异有统计学意义(P0.01)。(2)SpA患者包括AS组50例,非AS组30例(未分化脊柱关节炎12例、银屑病关节炎15例、反应性关节炎3例),AS组696处附着点,超声发现76处异常,非AS组416处附着点超声发现42处异常,二者差异无统计学意义(P0.05)。(3)SpA组患者1112处附着点118处(10.61%)异常,RA组患者700处附着点29处(4.1%)异常,HC组700处附着点8处(1.14%)异常,SpA组与RA组及HC组差异均有统计学意义(P0.05);在下肢附着点检查中,SpA组发现滑囊炎46处(38.98%),骨侵蚀31处(27.84%),肌腱增厚16处(13.56%),是最常见的表现形式,RA组和HC组滑囊炎分别为3处和2处,HC组骨侵蚀1处,两对照组均未发现肌腱增厚,SpA组与RA组、HC组差异均有统计学意义(P0.05);SpA组患者跟腱、髌腱止点、髌腱起点、股四头肌肌腱止点,肱二头肌长头腱异常率分别为(65.25%,15.25,0.85%,0.85%,17.80%);(4)超声GUESS评分与患者BASDAI、背痛VAS、晨僵时间、血沉、CRP等疾病活动性指标并无明显相关性(P0.05),与外周关节有一定相关性(P0.05);(5)应用Logistic对超声评分进行回归分析,结果显示:对SpA诊断有预测作用的是跟腱评分和滑囊炎评分(P0.05)。结论:超声可以发现SpA患者肌腱附着点异常;跟腱和髌腱止点最常被累及,表现形式以滑囊炎、骨侵蚀、肌腱增厚最常见。跟腱评分和滑囊炎评分在SpA诊断预测中有重要意义。
[Abstract]:Objective: To investigate the spinal arthritis (SpA) patients with tendon enthesitis incidence, ultrasound features, explore the value of ultrasonography in diagnosis of SpA. Methods: from December 2015 to December 2016, the Xinjiang Autonomous Region People's hospital out-patient and hospitalization in patients with SpA 80 cases in observation group were collected in the same period of rheumatoid arthritis (RA) in 50 cases (RA group) and 50 healthy volunteers (group HC) as control group, using two-dimensional color Doppler ultrasound respectively in three groups of subjects 2 upper limb tendon attachment point (tendon of long head of biceps supraspinatus tendon) and lower limb 5 tendon attached point (unit four biceps tendon, patellar tendon starting point, patellar tendon, Achilles tendon, plantar fascia) by ultrasound and ultrasound score, statistical analysis of related data. Results: (1) 80 cases of SpA patients with a total of 1112 attachment points (2 refused to upper limb examination), ultrasound examination found 118 abnormal clinical examination found 29 寮傚父,浜岃，

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