超声在类风湿关节炎的应用及进展

类风湿关节炎(RA)是一种以滑膜关节进展性损害为主要特征的慢性炎症性病变。肌骨超声(MSUS)在类风湿关节炎的诊断和监测治疗等方面起着越来越重要的作用,它能在关节炎症的早期阶段就发现滑膜炎,软骨的破坏和骨质侵蚀等。而能量多普勒超声(CDE)正逐渐成为评估RA活动性和进展性的一个有效的方法。超声新技术如:超声造影(CEUS)、三维超声(3DUS)、三维能量多普勒超声(3D-PDUS)等方法为RA的早期诊断、治疗监测及预后评估提供了更为敏感和准确的途径。本文将就MSUS在RA的应用及一些研究进展做一综述。     

沿海居民类风湿性关节炎相关血清学指标与肌骨超声半定量评分的相关性分析

目的探讨沿海居民类风湿性关节炎(RA)相关血清学指标与肌骨超声(MSUS)半定量评分的相关性。方法选取2022年1月至2023年6月秦皇岛市第一医院风湿免疫科收治的沿海居民RA患者100例作为研究对象, 依据28处关节疾病活动度(DAS28)评分法将患者分为4组:高活动期组、中活动期组、低活动期组和缓解期组。采用MSUS半定量分级对各组腕关节, 第2、3掌指关节, 第2、3近端指间关节及第2、5跖趾关节等关节进行评分, 比较各组患者相关血清学指标类风湿因子(RF)、红细胞沉降率(ESR)、C反应蛋白(CRP)水平, 采用Pearson相关性分析MSUS半定量评分与DAS28评分、RF、ESR、CRP的相关性, 使用受试者工作曲线(ROC)分析MSUS半定量评分对RA的诊断价值。结果随着病情加重, RA患者DAS28评分增加, 血清RF、ESR、CRP水平呈现明显上升趋势, 且骨侵蚀评分、滑膜增生评分、关节积液评分、滑膜内血流信号评分及总分比较, 高活动期组评分>中活动期组评分>低活动期组评分>缓解期组评分(P<0.05或P<0.01)。RA患者MSUS半定...     

DCE-MRI定量与半定量分析在类风湿关节炎活动度评估中的应用研究进展

类风湿关节炎（RA）是以多发性和对称性增生性滑膜炎为主要表现的慢性全身性自身免疫性疾病,由于炎症反复加重、缓解,引起关节软骨和关节囊的破坏,最终导致关节强直畸形。早期诊断治疗是改善预后的关键。现就DCE-MRI原理及其在RA活动度评价中的应用情况进行综述。     

肌骨超声对痛风性关节炎患者骨破坏程度的评估价值探究

目的 分析肌骨超声（MSUS）对痛风性关节炎（GA）患者骨破坏程度的评估价值。方法 选定本院2019年4月至2022年4月接诊的56例GA患者作为观察组，选取同期56例与GA临床表现相似的其他疾病患者作为对照组，2组均接受MSUS检查，对比2组受累关节情况、超声特征。对观察组患者根据MSUS表现分组，将20例无聚集体患者作为观察1组，将26例聚集体患者作为观察2组，将10例痛风石患者作为观察3组，检测、比较3组超声参数、血清骨破坏因子指标，Spearman相关性分析超声参数与骨破坏因子的相关性。结果观察组关节受累情况与对照组比较，差异无统计学意义（P>0.05）。观察组超声特征腱鞘炎（13.8%）、滑膜骨化（16.9%）、滑膜增生（24.6%）与对照组（10.4%、13.4%、28.4%）比较，差异无统计学意义（P>0.05）。观察组韧带内高回声点（23.1%）、痛风石（15.4%）、骨侵蚀率（29.2%）高于对照组（4.5%、0、14.9%），观察组双边征（7.7%）、软组织肿胀率（18.5%）低于对照组（20.9%、35.8%），差异有统计学意义（P<0.05）。...     

新型炎性反应指标CRP/Alb与类风湿关节炎活动度的相关性

 目的 探讨新型炎性反应标志物血清C-反应蛋白/白蛋白(CRP/Alb)比值与类风湿关节炎(rheumatoid arthritis,RA)疾病活动性之间相关性。方法 回顾性收集150例RA患者的人口学资料与实验室检查结果,根据DAS28-ESR分为RA缓解期(DAS28≤3.2)42例和疾病活动期(DAS28>3.2)108例,比较CRP/Alb等炎性反应指标组间差异及其与RA活动度相关性。结果 RA活动期患者中PLR、NLR与CRP/Alb显著高于RA缓解期患者。CRP/Alb与RA疾病活动度DAS28、红细胞沉降率及PLR、NLR之间呈显著正相关性,ROC曲线显示CRP/Alb用于预测RA活动性曲线下面积为0.748,最佳截断值为0.0951,其敏感性为90.5%,特异性为57.1%。结论 CRP/Alb与RA患者疾病活动性显著相关,具有较好的RA活动性诊断预测价值。     

急性心衰患者红细胞分布宽度与超声心动图参数的相关性分析

目的探讨急性心衰患者红细胞分布宽度(RDW)与超声心动图参数之间的相关性。方法将89例急性心衰患者按RDW值等分为A、B、C三组,对其化验结果和超声心动图参数进行对比分析。结果 C组(>14.5%)的E/E’明显高于A组(<12.5%)(P<0.001)。对RDW的单因素分析和E/E’的多元线性回归分析表明RDW与E/E’之间存在显著的相关性。结论急性心衰患者较高水平的RDW与升高的E/E’之间存在相关,推测RDW与升高的LVFP也相关。     

血浆BNP和超声心动图参数与扩张型心肌病慢性心力衰竭患者心功能分级的相关性分析

目的 分析扩张型心肌病慢性心力衰竭患者的心功能分级和血浆脑钠肽(BNP)及超声心动图参数的相关性.方法 2018年3月-2019年5月随机抽取符合扩张型心肌病慢性心力衰竭的患者80例,按照NYHA分级将患者按照心功能分级分为Ⅱ级患者30例,Ⅲ级患者28例,ⅣV级患者22例,对所有的患者均进行血浆脑钠肽的测定,比较不同心...     

定量超声成像评价骨性关节炎软骨成分含量与超声参数值的相关性

目的应用定量超声成像测量骨性关节炎软骨的超声参数,并分析其与蛋白多糖和胶原蛋白含量的相关性。资料与方法将21块表面光滑无损伤的猪髌骨关节软骨样本随机平均分为3组:正常组不做任何处理;胰蛋白酶消化组(Trypsin组)在0.25%胰蛋白酶溶液中浸泡4h,以消化软骨组织内的蛋白多糖;胶原蛋白酶消化组(Collagenase组)在30U/ml胶原蛋白酶溶液中浸泡24h,以消化组织中的胶原蛋白,从而建立经酶退化的软骨离体退化模型来模拟自然骨性关节炎软骨的退化。采用中心频率为10MHz的超声系统依次扫描3组样本,计算软骨表面的超声参数:粗糙度系数(URI)、反射系数(RC)。结果与正常组URI[(9.56±2.44)μm]相比,Trypsin组URI[(43.68±10.33)μm]显著增大(P<0.01), Collagenase组URI[(54.40±10.92)μm]亦显著增大(P<0.01),但两消化组间差异无统计学意义(P>0.05);而Trypsin组RC([4.20±0.75)%]与Collagenase组RC([2.934±0.57)%]均显著小于正常组[(7.274±2.44)%](P<0.01),且两消化组间差异有统计学意义(P<0.05)。结论定量超声成像所分析的软骨表面超声参数URI和RC可以评估退化软骨中蛋白多糖和胶原蛋白成分的缺失情况。     

比较生物型假体与骨水泥型半髋置换治疗对老年股骨颈骨折患者骨代谢指标及应激指标的影响

目的 探讨老年股骨颈骨折患者采用生物型假体与骨水泥型半髋置换治疗对骨代谢指标及应激指标的影响。方法 选取2020年1月-2022年1月治疗的老年股骨颈骨折患者共计40例,按照假体类型的不同分成观察组(20例)和对照组(20例),对照组给予骨水泥型假体半髋置换治疗,观察组给予生物型假体半髋置换治疗,比较两组临床疗效、骨代谢指标、应激指标及并发症。结果 观察组(95.00%)治疗优良率较对照组(70.00%)更高(P<0.05);两组治疗后骨碱性磷酸酶(BALP)、Ⅰ型前胶原羧基端肽(PICP)、总Ⅰ型胶原氨基端延长肽(tPINP)水平提高(P<0.05),观察组水平较对照组更高(P<0.05);两组治疗后促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)、皮质醇(COR)水平提高(P<0.05),但观察组水平较对照组更低(P<0.05);观察组(10.00%)并发症发生率较对照组(40.00%)更低(P<0.05)。结论 老年股骨颈骨折患者采用生物型假体半髋置换治疗,与骨水泥型半髋置换治疗相比,临床疗效更高,可有效改善患者骨代谢指标,减少术后并发症,对...     

Radio-synovectomy in chronic synovitis of the knee joint in patients with rheumatoid arthritis

The influence of intra-articular (i.a.) colloidal 198Au (5 mCi) or 90Y-silicate (5 mCi) on synovitis of the knee joint in patients older than 45 years with rheumatoid arthritis (RA), who had been treated since 1970 in our hospital, was investigated. Of the 89 knee joints of 77 patients studied, 65 had no or minimal radiological abnormalities of the knee joint treated (group I), whereas 24 patients had moderate to severe changes (group II). Before and at regular intervals after radio-synovectomy the clinical response was scored using pain, hydrops and warmth as parameters. The results indicated that 1 year after treatment the percentage of knee joints with a favourable response was greater in group I than in group II (58% versus 25%, P = 0.001). This difference was still present 3 years after treatment. Clinical response showed no correlation with initial inflammatory activity as measured by 99mTc-pertechnetate uptake measurements. However, in group I, those patients with an ESR below 60 mm/h, measured just before radio-synovectomy, more often had a favourable response than those with an ESR in excess of 60 mm/h (P = 0.01). No or only slight complications of radio-synovectomy were noted, whereas leakage of radioactivity from the knee joints was minimal. It is concluded that radio-synovectomy is an effective and safe procedure in those patients with rheumatoid synovitis of the knee joint without the presence of significant radiological damage and the absence of active systemic disease.     

Pharyngeal function in patients with rheumatoid arthritis of the cervical spine and temporomandibular joint

Pharyngeal function was studied in 31 patients with rheumatoid arthritis. Eighteen of these patients had dysphagia. Cervical spine abnormalities were present in 14. Destruction of the capitulum and/or ramus of the mandible was registered in 9. Pharyngeal dysfunction was revealed in 20. Patients with a vertical dislocation of the C1-C2 in relation to the occipital bone and patients with destruction of the capitulum and/or ramus of the mandible had an increased frequency of pharyngeal dysfunction. Pharyngeal dysfunction is thought to be due to mechanical factors and caused by derangements of muscular attachments and turning points.     

Multidetector computed tomography findings of the sternoclavicular joint in patients with rheumatoid arthritis

We evaluated the multidetector computed tomography (MDCT) findings of the sternoclavicular joint in patients with rheumatoid arthritis (RA) and compare them with general population. Chest MDCT scans of RA patients were reviewed. The control group was formed from age and sex-matched individuals. The most common CT findings were cortical irregularity, joint space narrowing, and osteophytes in study group. There were no statistically significant differences in the MDCT findings between the two groups except that osteophytes were observed more often in the control group. It is difficult to distinguish between the involvement of RA and age-related degenerative changes at the sternoclavicular joint.     

肌肉骨骼超声联合生物力学在痛风性关节炎无症状高尿酸血症期及急性期中的应用

目的：结合生物力学分析不同步态急性痛风患者及无症状高尿酸血症（HUA）患者发病部位及超声特征,提高痛风超声诊断准确率。方法：通过GaitWatch三维步态动作捕捉与训练系统测定的足偏角度将急性痛风组患者分为正常步态和外八字步态各50例,超声检查所有受累关节;另选取无症状HUA患者50例,超声检查其双侧肩、腕、掌指、膝、踝、足跖趾关节;分析各组超声下双轨征、痛风石、强回声沉积、骨侵蚀、滑膜增生及关节腔积液的发生率;采用t检验及χ²检验进行统计学处理。结果：无症状HUA组和急性痛风组最常累及关节均为第一跖趾关节,急性痛风组中外八字步态患者外踝关节受累仅次于第一跖趾关节。无症状HUA组超声检查阴性比例高于急性痛风组,急性痛风组各超声特征发生率均高于无症状HUA组（均P<0.05）。结论：从生物力学角度分析不同人群痛风的好发部位,通过超声筛查,可避免不典型痛风的漏诊。     

Assessing rheumatoid arthritis with ultrasound of the hands

OBJECTIVE: The purpose of this video article is to show the sonographic techniques and findings in evaluating the joints of the hands in patients with possible inflammatory arthritis and to review the sonographic appearance and grading of synovitis. CONCLUSION: This video article shows the value of a targeted approach for musculoskeletal ultrasound of the hand and wrist in patients with rheumatoid arthritis. On completion of this video article, the participant should be able to develop an appropriate diagnostic and therapeutic approach using ultrasound for the treatment of patients with rheumatoid arthritis.     

牛痘疫苗致炎兔皮提取物注射液对类风湿关节炎关节疼痛的疗效观察

目的探讨牛痘疫苗致炎兔皮提取物注射液（商品名：恩再适）对类风湿关节炎关节疼痛症状改善作用。方法恩再适注射液9ml加入0.9%生理盐水100ml静脉输注,1次/日,连续7天。结果治疗前（D0）患者VAS评分平均为8.2±1.2,治疗1天（D1）后VAS均值为5.6±1.3（P〈0.01）,治疗3天（D3）VAS均值为4.2±1.6（P〈0.01）,治疗7天（D7）降为2.6±1.2（P〈0.01）。其中显效16例,有效10例,无效4例,显效率为53.33%,总有效率86.67%。所有患者药物输注过程中未出现明显不适,一周时复查血、尿、肝肾功能检查均未发现明显异常。结论恩再适对RA的关节疼痛具有显著缓解作用,可以作为类风湿关节炎的镇痛药物。     

Direct coronal computed tomography of the temporomandibular joint in patients with rheumatoid arthritis.

Direct coronal computed tomography (CT) of the temporomandibular joint (TMJ) was performed in 26 patients with rheumatoid arthritis (RA) and 26 control subjects. Erosions and cysts of the mandibular condyle had a significantly higher frequency in the RA group than in the control group (p < 0.05) but there was no significant difference in the incidence of other abnormalities. Bone changes were bilateral in RA. A wide range of CT abnormalities was present in patients with RA and in the control group. There are no CT abnormalities specific for RA, but the incidence of erosions and cysts of the mandibular condyle was significantly higher in the RA group and should suggest the diagnosis.     

膝关节类风湿关节炎与骨关节炎MRI对比研究

目的对比分析晚期膝关节类风湿关节炎(RA)和膝关节骨关节炎(OA)的MRI表现。资料与方法对2010年7月—2012年8月经我院确诊的膝关节RA病人33例(共40个膝关节)和OA病人58例(共60个膝关节)行MRI检查并分组,统计RA组和OA组半月板、关节软骨、软骨下骨、滑膜病变的发病率和发病程度,比较两组间统计学差异。结果 RA组内、外侧半月板各部位损伤程度均重于OA组(均P<0.05);RA组胫股外侧关节软骨病变程度重于OA组(股骨外侧髁和胫骨外侧平台的Z值分别为5.702和7.534,均P<0.05),两组的髌股关节及胫股内侧关节软骨病变程度的差异无统计学意义(P>0.05);RA组的胫股内、外侧关节软骨下骨病变程度重于OA组(股骨内、外侧髁的χ2值分别为6.730和23.938,胫骨内、外侧平台的χ2值分别为12.033和41.017;均P<0.05),两组的髌股关节软骨下骨病变的差异无统计学意义(P>0.05)。RA组膝关节共有97.5%(39/40个膝关节)的滑膜弥漫性增厚,其中半数(20个膝关节)有关节裸区骨质结构破坏;OA组共有21.7%(13/60个膝关节)的滑膜增厚,范围较局限,无一例关节裸区骨质结构破坏。结论膝关节RA可造成滑膜弥漫肥厚,易造成半月板弥漫破坏、关节软骨及骨质广泛受累。膝关节OA可造成滑膜局限增厚,病变易累及内侧半月板后角和体部、胫股内侧关节及髌股关节。     

Involvement of the temporomandibular joint in rheumatoid arthritis

A tomographic investigation was performed on 51 randomly-selected rheumatic patients, according to American Rheumatism Association criteria. Fourteen males and 37 females, aged 26 to 73 (mean age 50.9) were examined in order to identify the prevalence of temporo-mandibular joint involvement. By means of a special examination form, a contemporary clinical survey of both signs and symptoms of mandibular dysfunction was also conducted: the data were used for calculating the Helkimo anamnestic and clinical dysfunction indices. As for X-ray diagnosis, and original linear and angular analysis was proposed to measure the relationship between condyle and fossa in intercuspal position and during opening: the anterior joint space often increased and protrusive condylar path was reduced in more than 41% of patients. Structural changes were also evaluated by classifying the shape of both the condyle and the glenoid fossa (rounded, wedge-shaped and flattened). A special score was used to quantify these morphological features: only 4% of the whole of joints resulted uninjured. The most involved joint portions were the articular tubercle and the anterior condylar pole. Many cases were demonstrated of marked resorption and remodelling of the condyle, of increased joint space and erosion of the fossa; in other instances, reduced joint spaces and sclerosis were observed, depending on associated degenerative arthritis (usually more painful). Sex and age differences were not significant. Severity of clinical dysfunction and seriousness of the lesions coincided, whereas subjective symptoms were relatively independent. At any rate, the survey demonstrated a clear prevalence of structural, as well as functional, involvement of the temporo-mandibular joint in rheumatoid arthritis and suggested a more careful and multimodal therapeutic approach.     

Value of contrast-enhanced ultrasound in rheumatoid arthritis

The purpose of this review is to describe the spectrum of sonographic findings in rheumatic diseases with respect to the diagnostic potential using US contrast media which prove activity or inactivity in synovial tissue where new treatment regimes target. Synovial activity can be found in non-erosive and erosive forms of primary and secondary osteoarthritis, and in inflammatory forms of joint diseases like rheumatoid arthritis and peripheral manifestations of spondyloarthritis including, ankylosing spondylitis, Reiter's syndrome, psoriatic arthritis and enteropathic arthritis. It can also be present in metabolic and endocrine forms of arthritis, in connective tissue arthropathies like systemic lupus erythematosus or scleroderma and in infectious arthritis. Ultrasound should be used as first-line imaging modality in suspected early cases of RA and other forms of arthritis, whereas contrast-enhanced ultrasound (CEUS) can further enable for sensitive assessment of vascularity which correlates with disease activity.