超微血管成像技术在类风湿性关节炎患者手腕关节中的应用价值

目的比较超微血管成像技术(SMI)和能量多普勒(PDUS)在评估类风湿性关节炎(RA)患者急性期和临床缓解期手腕关节滑膜内血管增生的应用价值。方法选择经临床诊断RA患者80例,其中男性25例,女性55例;年龄43~78岁,平均年龄55.5岁;急性期35例,临床缓解期45例。急性期患者中男性10例,女性25例;年龄43~76岁,平均年龄55.3岁。临床缓解期患者中男性15例,女性30例;年龄45~78岁,平均年龄55.6岁。同时采用PDUS和SMI两种超声成像方法检测手腕关节增厚滑膜内的血管增生显示率、血流分级和检查时长,评估血流分级与28个关节的疾病活动度评分(DAS28)的相关性。结果无论是急性期还是临床缓解期患者,SMI较PDUS血流信号显示率(急性期,88.46%vs53.85%;临床缓解期,86.49%vs 54.04%)和血流分级(急性期,3级50.00%vs 11.54%;临床缓解期,3级59.46%vs10.81%)明显增加,检查时长缩短(急性期,4.4 min±0.8 min vs 8.2 min±1.3 min;临床缓解期,4.6 min±0.7 min vs8.5 min±1.4 min)(P <0.05)。经Spearman检验发现,SMI显示血流信号分级与DAS28有较好的一致性(R=0.768、0.723,P=0.011、0.015)。对SMI显示血流信号患者进行强化干预后,血管显示率和血流信号分级均明显减少,DAS28也明显下降(P <0.05)。结论 SMI和PDUS是显示RA手腕关节滑膜内血管增生的重要方法,SMI较PDUS能够更加准确、方便显示血流信号,定量评估血流分级,与炎症活动度有较好的一致性,对指导临床制定正确的干预策略提供重要参考依据。

Application value of super mircovascular imaging technology in wrist joints of patients with rheumatoid arthritis

Objective To compare application value of super mircovascular imaging(SMI) and power Doppler ultrasonography(PDUS) in assessing intrasynovial vascular proliferation of wrist joints in patients with rheumatoid arthritis(RA) at acute and remission stages. Methods A total of 80 RA patients were enrolled, which included 25 males and 55 females, aged 43-78 years old with mean age of 55.5 years old. Thirty-five cases were in acute stage(10 males and 25 females, aged 43-76 years old with mean age of 55.3 years old) and 45 cases were in clinical remission stage(15 males and 30 females, aged 45-78 years old with mean age of 55.6 years old). The PDUS and SMI methods were used to detect vascular proliferation rate, blood flow grading and examination duration in thickening synovium of wrist joints. Correlation between blood flow grading and disease activity score of 28 joints(DAS28) was further evaluated. Results Compared with PDUS, both in acute stage and clinical remission stage, blood flow signal display rate(acute stage: 88.46 % vs 53.85 %;clinical remission stage: 86.49 % vs 54.04 %) and blood flow grading(acute stage in grade 3: 50.00 % vs 11.54 %;clinical remission stage in grade 3: 59.46 % vs 10.81 %) of SMI were increased significantly, examination duration of SMI was significantly decreased(acute stage: 4.4 minutes ± 0.8 minutes vs 8.2 minutes ± 1.3 minutes;clinical remission stage: 4.6 minutes ± 0.7 minutes vs 8.5 minutes ± 1.4 minutes)(P < 0.05). The SMI showed good consistency of blood flow signal grading with DAS28 by Spearman test(R = 0.768, 0.723, P = 0.011, 0.015). After intensive intervention in patient with SMI blood flow signals, vascular display rate, blood flow signal grading and DAS28 were significantly decreased(P < 0.05). Conclusion It is demonstrated that SMI and PDUS are important methods to detect vascular proliferation in synovium of RA wrist joints. Compared with PDUS, SMI is more accurate and convenient to display blood flow signals, and quantitatively evaluate blood flow grading. It has good consistency with inflammation activity, which provides important reference to guide clinical intervention strategies.