肌骨超声检查对血清阴性类风湿关节炎与骨关节炎的鉴别诊断价值
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摘要
目的探讨肌骨超声鉴别诊断血清阴性类风湿关节炎(rheumatic arthritis,RA)与骨关节炎(osteoarthritis,OA)的临床价值。方法选取2015年6月至2017年7月在浙江省绍兴市人民医院临床确诊的血清阴性RA患者和OA患者各40例,通过肌骨超声观察肌腱、滑膜、关节面、关节腔以及骨面情况,测量最厚处滑膜厚度,记录RA患者的疾病活动分数(disease activity score28,DAS28)评分,利用彩色多普勒及能量多普勒超声观察滑膜内血流信号及形态并进行组间比较。结果 RA组骨髓水肿、关节积液、滑膜炎与肌腱腱鞘炎检出率明显高于OA组,滑膜厚度及血流信号高于OA组,差异均有显著性(P<0.05)。RA患者滑膜厚度、血流信号等级随着DAS28评分的增长而增高(P<0.05)。结论肌骨超声对RA与OA的病理改变具有较高的敏感性,可定量测定滑膜厚度及血流信号等级,有利于两者的鉴别诊断及监测RA的病情活动度。
Objective To investigate musculoskeletal ultrasound in differential diagnosis of seronegative rheumatoid arthritis(RA) and osteoarthritis(OA) value. Method Serum RA negative patients in our hospital diagnosed OA patients and 40 cases in each. The observation of the tendon, synovium, articular surface, bone and joint cavity the surface, measuring the thickest synovial thickness, DAS28 scores were recorded, using color Doppler and power Doppler ultrasound blood ? ow signals and morphology of synovial joint effusion. Result In group RA, bone marrow edema, synovitis and tendon Tenosynovitis detection rate was signi? cantly higher than OA group(P<0.05); RA group of synovium thickness and blood ? ow signal is higher than that of OA group(P<0.05); RA patients with synovial thickness, blood ? ow signal level increased with the increase of DAS28 score(P<0.05). Conclusion Musculoskeletal ultrasound has a high sensitivity to the change of the RA and OA pathology. Quantitative determination of synovium thickness and blood flow signal, the differential diagnosis and monitoring the disease activity of RA.
Objective To investigate musculoskeletal ultrasound in differential diagnosis of seronegative rheumatoid arthritis(RA) and osteoarthritis(OA) value. Method Serum RA negative patients in our hospital diagnosed OA patients and 40 cases in each. The observation of the tendon, synovium, articular surface, bone and joint cavity the surface, measuring the thickest synovial thickness, DAS28 scores were recorded, using color Doppler and power Doppler ultrasound blood ? ow signals and morphology of synovial joint effusion. Result In group RA, bone marrow edema, synovitis and tendon Tenosynovitis detection rate was signi? cantly higher than OA group(P<0.05); RA group of synovium thickness and blood ? ow signal is higher than that of OA group(P<0.05); RA patients with synovial thickness, blood ? ow signal level increased with the increase of DAS28 score(P<0.05). Conclusion Musculoskeletal ultrasound has a high sensitivity to the change of the RA and OA pathology. Quantitative determination of synovium thickness and blood flow signal, the differential diagnosis and monitoring the disease activity of RA.
引文
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[3]Zufferey P,Rebell C,Benaim C,et al.Ultrasound can be useful to predict an evolution towards rheumatoid arthritis in patients with infl ammatory polyarthralgia without anticitrullinated antibodies[J].Joint Bone Spine,2017,84(3):299-303.
[4]Janta I,Stanciu D,Hinojosa M,et al.Structural damage in rheumatoid arthritis:comparison between tendon evaluated by ultrasound and radiographic damage[J].Rheumatology(Oxford),2016,55(6):1042-1046.
[5]Haraoui B,Smolen JS,Aletaha D,et al.Treating Rheumatoid Arthritis to Target:multinational recommendations assessment questionnaire[J].Ann Rheum Dis,2011,70(11):1999-2002.
[6]王鑫,赵琴,邓肇达,等.老年类风湿性关节炎治疗进展[J].中国骨伤,2017,30(6):576-580.
[7]Aletaha D,Smolen JS.Joint damage in rheumatoid arthritis progresses in remission according to the Disease Activity Score in 28 joints and is driven by residual swollen joints[J].Arthritis Rheum,2011,63(12):3702-3711.
[8]Folfz V,Gandjbakhch F,Etchepare F,et al.Power Doppler but not low fi ed MRI predict and radiographic disease Progression in rheumatoid arhritis with low disease activity[J].Arthritis Rheum,2012,64(10):67-76.
[9]Ten Cate DF,Luime JJ,Swen N,et al.Role of ultrasonography in diagnosing early rheumatoid arthritis and remission of rheumatoid arthritis-a systematic review of the literature[J].Arthritis Res Ther,2013,15(1):R4.