超微血流成像及能量多普勒超声在类风湿关节炎临床缓解期中的应用研究

目的比较超微血流成像(SMI)和能量多普勒超声(PDUS)在类风湿关节炎(RA)临床缓解期监测关节滑膜血流中的临床应用价值。方法选取40例RA临床缓解期患者和20例健康志愿者,对其双侧腕关节、掌指关节及近端指指关节行超声检查,观察PDUS和SMI检测RA患者缓解情况,记录PDUS和SMI对关节滑膜内血流的显示和分级情况,比较两种检测方法对滑膜血流分级的一致性及显示率。结果 40例RA临床缓解期患者中,PDUS显示16例存在活动性滑膜炎,缓解率60.0%(24/40);SMI显示25例存在活动性滑膜炎,缓解率37.5%(15/40);两种检测方法比较差异有统计学意义(χ~2=4.053,P=0.044)。SMI和PDUS对20例健康志愿者关节滑膜血流的显示率均为0,对40例RA临床缓解期患者关节滑膜血流的显示率分别为12.72%和8.64%,差异有统计学意义(χ~2=7.718,P=0.005)。Kappa检验显示PDUS与SMI对关节滑膜血流分级一致性较好(Kappa=0.741,P<0.01)。结论在RA临床缓解期,SMI和PDUS可通过检测手腕关节滑膜血流提示病情、指导治疗,均有较好的临床应用价值;SMI较PDUS能更敏感地发现手腕关节滑膜中的血流信号。

Application of superb microvascular imaging and power Doppler ultrasound in rheumatoid arthritis in clinical remission

ObjectiveTo investigate the application value of superb microvascular imaging(SMI) and Power Doppler ultrasound(PDUS)in monitoring synovium blood flow in finger and wrist joints with rheumatoid arthritis(RA)in clinical remission.MethodsThe bilateral wrist,metacarpophalangeal joint and proximal phalangeal joint of 40 RA patients in clinical remission and 20 healthy volunteers were examined by ultrasound.The blood flow grading results of PDUS and SMI on thickened synovial membrane were recorded.The difference of synovial blood flow and its classification between the two methods was observed,and the consistency of the results of synovial blood flow classification between the two methods was compared.ResultsIn the 40 patients with RA in clinical remission,PDUS showed blood flow signal in synovium of joint in 16 patients,the remission rate was 60%(24/40),SMI showed blood flow signal in synovium of joint in 25 patients,the remission rate was37.5%(15/40),there was significant difference between the two methods(χ~2=4.053,P=0.044).In the 20 healthy volunteers,the detection rate of synovial blood flow by SMI and PDUS was 0.However,in the 40 patients with RA,the synovial blood flow display rates of SMI and PDUS were 12.72% and 8.64%,respectively,and the difference was statistically significant(χ~2=7.718,P=0.005).The results of synovial blood flow grading by PDUS and SMI were consistent by Kappa test(Kappa=0.741,P<0.01).ConclusionIn the clinical remission stage of RA,SMI and PDUS both have great clinical application value,but SMI is more sensitive than PDUS in detecting the blood flow signal in the synovial membrane of finger and wrist joints.