关节彩超对系统性红斑狼疮中医证型及病情活动的评估价值
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摘要
目的探讨关节彩超对不同中医证型的系统性红斑狼疮(SLE)病情活动的评估意义。方法102例不同证型(据诊疗方案分为热毒血瘀型、气血亏虚型、脾肾阳虚型、肝肾阴虚型,为了方便统计,我们将热毒血瘀型记为实证,将后3种证型记为虚证)的SLE患者按有无关节症状分为两组,利用关节彩超观察手、腕、膝、足部关节腔内滑膜炎症、血流信号及骨质破坏程度,根据滑膜分级、多普勒信号和骨侵蚀程度来评估关节炎症并计分。收集所有患者实验室炎性指标和自身抗体结果,并进行病情活动度(SLEDAI)评分,统计分析患者关节彩超评分与实验室炎性指标、关节疼痛数、SLEDAI评分及有无症状的相关性。结果相比于无症状者,患者的关节超声评分和C3含量这两项指标差异有统计学意义(P <0. 05);实证和虚证患者间超声评分差异有统计学意义(P <0. 05),但有或无症状患者间评分差异无统计学意义(P> 0. 05);患者关节疼痛数与超声评分呈显著正相关(B=0. 124,P=0. 003),实验室检测指标中仅C4含量与超声评分呈负相关(B=-4. 018,P=0. 048)。结论关节彩超可作为评估SLE患者证型和病情活动的技术手段之一,尤其对实证(热毒血瘀型)患者具有一定的鉴别意义。
引文
[1]Salliot C,Denis A,Dernis E,et al.Ultrasonography and detection of subclinical joints and tendons involvements in Systemic Lupus erythematosus(SLE)patients:A cross-sectional multicenter study[J].Joint Bone Spine,2018,S1297-319X(18)30016-2.
[2]毕亚男,肖长虹,曹艳艳,等.类风湿关节炎辩证分型与关节高频超声表现的相关性研究[J].中国中西医结合杂志,2015,35(1):19-24.
[3]Noriki S,Kinoshita K,Inai K,et al.Newly recognized cerebral infarctions on postmortem imaging:a report of three cases with systemic infectious disease[J].BMC Med Imaging,2017,17(1):4.
[4]Reijnierse M,Helm-Mil AV,Eshed I,et al.Magnetic Resonance Imaging of Rheumatoid Arthritis:Peripheral Joints and Spine[J].Semin Musculoskelet Radiol,2018,22(2):127-146.
[5]Tan YK,stergaard M,Conaghan PG.Imaging tools in rheumatoid arthritis:ultrasound vs magnetic resonance imaging[J].Rheumatology,2012,51:36-42.
[6]Hmamouchi I,Bahiri R,Srifi N,et al.A comparison of ultrasound and clinical examination in the detection of flexor tenosynovitis in early arthritis[J].BMC Musculoskelet Disord,2011,8,12:91.
[7]Zhang BB,Zhou YJ,Du J,et al.Comparison of very-high-frequency ultrasound assessment of radial arterial wall layers after first and repeated transradial coronary procedures[J].J Geriatr Cardiol,2017,14(4):245-253.
[8]Dhn UM,Ejbjerg BJ,Court-Payen M,et al.Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions?A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints[J].Arthritis Res Ther,2006,8(4):R110.
[9]Szkudlarek M,Klarlund M,Narvestad E,et al.Ultrasonography of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis:a comparison with magnetic resonance imaging,conventional radiography and clinical examination[J].Arthritis Res Ther,2006,8(2):R52.
[10]Iagnocco A,Ceccarelli F,Rizzo C,et al.Ultrasound evaluation of hand,wrist and foot joint synovitis in systemic lupus erythematosus[J].Rheumatology(Oxford),2014,53(3):465-472.
[11]刘维,刘晓亚,张宏博,等.系统性红斑狼疮中医证型与实验室指标关系的探讨[J].中国中西医结合杂志,2008,28(2):115-117.
[12]吴国琳,李天一,韩咏梅,等.系统性红斑狼疮患者中医辨证与疾病活动指数的相关性研究[J].中国中医基础医学杂志,2006,12(11):853-854.
[13]陈炳忠.68例系统型红斑狼疮中医证型与免疫学指标的关系[J].河南中医药学刊,2006,21(1):40-41.
[2]毕亚男,肖长虹,曹艳艳,等.类风湿关节炎辩证分型与关节高频超声表现的相关性研究[J].中国中西医结合杂志,2015,35(1):19-24.
[3]Noriki S,Kinoshita K,Inai K,et al.Newly recognized cerebral infarctions on postmortem imaging:a report of three cases with systemic infectious disease[J].BMC Med Imaging,2017,17(1):4.
[4]Reijnierse M,Helm-Mil AV,Eshed I,et al.Magnetic Resonance Imaging of Rheumatoid Arthritis:Peripheral Joints and Spine[J].Semin Musculoskelet Radiol,2018,22(2):127-146.
[5]Tan YK,stergaard M,Conaghan PG.Imaging tools in rheumatoid arthritis:ultrasound vs magnetic resonance imaging[J].Rheumatology,2012,51:36-42.
[6]Hmamouchi I,Bahiri R,Srifi N,et al.A comparison of ultrasound and clinical examination in the detection of flexor tenosynovitis in early arthritis[J].BMC Musculoskelet Disord,2011,8,12:91.
[7]Zhang BB,Zhou YJ,Du J,et al.Comparison of very-high-frequency ultrasound assessment of radial arterial wall layers after first and repeated transradial coronary procedures[J].J Geriatr Cardiol,2017,14(4):245-253.
[8]Dhn UM,Ejbjerg BJ,Court-Payen M,et al.Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions?A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints[J].Arthritis Res Ther,2006,8(4):R110.
[9]Szkudlarek M,Klarlund M,Narvestad E,et al.Ultrasonography of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis:a comparison with magnetic resonance imaging,conventional radiography and clinical examination[J].Arthritis Res Ther,2006,8(2):R52.
[10]Iagnocco A,Ceccarelli F,Rizzo C,et al.Ultrasound evaluation of hand,wrist and foot joint synovitis in systemic lupus erythematosus[J].Rheumatology(Oxford),2014,53(3):465-472.
[11]刘维,刘晓亚,张宏博,等.系统性红斑狼疮中医证型与实验室指标关系的探讨[J].中国中西医结合杂志,2008,28(2):115-117.
[12]吴国琳,李天一,韩咏梅,等.系统性红斑狼疮患者中医辨证与疾病活动指数的相关性研究[J].中国中医基础医学杂志,2006,12(11):853-854.
[13]陈炳忠.68例系统型红斑狼疮中医证型与免疫学指标的关系[J].河南中医药学刊,2006,21(1):40-41.