高频超声及弹性成像在类风湿关节炎正中神经损害中的诊断价值
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摘要
目的探讨高频超声及弹性成像在类风湿关节炎(RA)患者正中神经损害中的诊断价值。方法对风湿病房200例RA患者,其中合并正中神经症状者21例(A组),无症状者179例(B组)与45例健康志愿者(C组)腕部正中神经横截面积(CSA)、横径(D1)、前后径(D2)以及腕管近端正中神经弹性硬度E值进行测量,比较各组间的差异。结果 RA患者正中神经受损后有明显的声像图改变,A组的CSA (11.83±2.79)mm~2较B组(9.36±1.87)mm~2和C组(8.91±1.60)mm~2大;在弹性成像弹性硬度E值方面,A组(69.43±19.01)kPa相对于B组(43.24±13.63)kPa和C组(38.13±13.26)kPa有统计学差异,B组和C组之间也有统计学差异。应用ROC曲线分析,CSA AUC=0.855,E值AUC=0.856,D1AUC=0.666,D2AUC=0.653。CSA联合E值AUC高达0.945。结论 RA可引起正中神经病变,弹性硬度值能更好地反映RA对神经的影响。CSA联合E值对类风湿关节炎正中神经损害有较高的诊断价值。
Objective To evaluate the value of high-frequency ultrasound(HFUS)and Sound Touch Elastrography(STE)in diagnosing median nerve damage in patients with rheumatoid arthritis(RA).Methods The median nerves were evaluated by HFUS and STE in 200 RA patients(Group A:RA patients with median nerve symptoms,21 cases;Group B:RA patients without median nerve symptoms,179 cases)and 45 non-RA patients(Group C).Measurement indexes include Cross-Sectional Area(CSA),transverse diameter(D1),anteroposterior diameter(D2)at the inlet and outlet of carpal tunnel of both sides,and the nerve stiffness values(E)at the prominent place of distal part of radius.These indexes were compared in different groups.Results There are obvious changes in the ultrasound images of damages median nerves.The CSA in group A is significantly bigger than that in group B and C.The nerve stiffness values(E)in group A is significantly higher than that in group B and C,and the statistical difference also exist between group B and C.Using ROC curve analysis,CSA AUC=0.855,nerve stiffness values(E)AUC=0.856,D1 AUC=0.666,D2 AUC=0.653.The AUC of the combination of CSA and nerve stiffness values(E)is 0.945.Conclusions RA can induce median nerve damage.The changes of nerve stiffness values(E)show the nerve influence of RA better.The combination of CSA and nerve stiffness values(E)owns high diagnostic value of median nerve damage in RA patients.
Objective To evaluate the value of high-frequency ultrasound(HFUS)and Sound Touch Elastrography(STE)in diagnosing median nerve damage in patients with rheumatoid arthritis(RA).Methods The median nerves were evaluated by HFUS and STE in 200 RA patients(Group A:RA patients with median nerve symptoms,21 cases;Group B:RA patients without median nerve symptoms,179 cases)and 45 non-RA patients(Group C).Measurement indexes include Cross-Sectional Area(CSA),transverse diameter(D1),anteroposterior diameter(D2)at the inlet and outlet of carpal tunnel of both sides,and the nerve stiffness values(E)at the prominent place of distal part of radius.These indexes were compared in different groups.Results There are obvious changes in the ultrasound images of damages median nerves.The CSA in group A is significantly bigger than that in group B and C.The nerve stiffness values(E)in group A is significantly higher than that in group B and C,and the statistical difference also exist between group B and C.Using ROC curve analysis,CSA AUC=0.855,nerve stiffness values(E)AUC=0.856,D1 AUC=0.666,D2 AUC=0.653.The AUC of the combination of CSA and nerve stiffness values(E)is 0.945.Conclusions RA can induce median nerve damage.The changes of nerve stiffness values(E)show the nerve influence of RA better.The combination of CSA and nerve stiffness values(E)owns high diagnostic value of median nerve damage in RA patients.
引文
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[2]王文利,林锦德,林礼务,等.实时超声评价正中神经活动度联合横截面积测量诊断腕管综合征[J].中国超声医学杂志,2015,31(12):1083-1085.
[3]OGUR T,YAKUT Z I,TEBER M A,et al.Ultrasound elastographic evaluation of the median nerve in pregnant women with carpal tunnel syndrome[J].Eur Rev Med Pharmacol Sci,2015,19(1):23-30.
[4]DIKICI A S,USTABASIOGLU F E,DELIL S,et al.Evaluation of the Tibial Nerve with Shear-Wave Elastography:A Potential Sonographic Method for the Diagnosis of Diabetic Peripheral Neuropathy[J].Radiology,2016,282(2):494-501.
[5]陈卫中,倪宗瓒,潘晓平,等.用ROC曲线确定最佳临界点和可疑值范围[J].现代预防医学,2005,32(7):729-731.
[6]OBUCHOWSKI N A.Receiver operating characteristic curves and their use in radiology[J].Radiology,2003,229(1):3-8.
[7]高培森,任水明,刘磊,等.高频超声在类风湿关节炎患者神经卡压诊断中的应用价值[J].中国医学科学院学报,2016,38(3):327-330.
[8]陈涛,郭稳,秦晓婷,等.腕管处正中神经超声成像研究[J].中国超声医学杂志,2014,30(2):162-166.
[9]TUCK R R,SCHMELZER J D,LOW P A.Endoneurial blood flow and oxygen tension in the sciatic nerves of rats with experimental diabeticneuropathy[J].Brain,1984,107(3):935-950.