类风湿关节炎寒热证候在腕关节超声中的表现特点

目的探讨类风湿关节炎（rheumatoid arthritis,RA）寒热证候在腕关节超声中的表现特点。方法65例RA患者按寒热证候辨证分为寒湿痹阻证（寒证组,29例）和湿热痹阻证（热证组,36例）。观察两组患者的腕关节超声的灰阶滑膜炎（滑膜炎）、能量多普勒（power doppler,PD）信号、腱鞘炎及骨侵蚀等参数,分析腕关节超声表现在RA寒热证候中的不同特点。结果寒证组RA患者关节超声的滑膜炎、PD、腱鞘炎及骨侵蚀阳性率分别为51.72%、20.68%、51.72%、37.93%,热证组分别为97.22%、91.67%、75.0%、63.89%。与寒证组比较,热证组滑膜炎、PD及骨侵蚀阳性率均增高,差异有统计学意义（P〈0.01,P〈0.01,P〈0.05）;两组腱鞘炎阳性率差异无统计学意义（P〉0.05）。与寒证组比较,热证组滑膜炎、PD及骨侵蚀在评分构成比方面比较,差异均有统计学意义（P〈0.01,P〈0.01,P〈0.05）;两组腱鞘炎评分构成比差异无统计学意义（P〉0.05）。ROC曲线结果显示：双腕关节滑膜炎计分〉1.5分,判断RA热证的敏感性为86.1%,特异性为62.1%;双腕PD计分〉1.5分时,判断RA热证的敏感性为80.0%,特异性为93.1%。结论 RA腕关节超声滑膜炎、PD及骨侵蚀阳性率热证明显高于寒证患者,尤其是严重者多见于热证患者。双腕关节滑膜炎或PD积分〉1.5分是RA热证的特征性表现。

Manifestations of Rheumatoid Arthritis Patients of Cold Syndrome and Heat Syndrome Using Wrist Ultrasound

Objective To explore distinctive manifestations of rheumatoid arthritis（ RA） patients of cold syndrome and heat syndrome using wrist joints ultrasound. Methods Totally 65 RA patients were syndrome typed as cold syndrome（ 29 cases,cold-damp blockage syndrome） and heat syndrome（ 36 cases,damp-heat obstruction syndrome）. Grey-scale synovitis,power doppler（ PD） signals,tenosynovitis,and bone erosion were observed using wrist ultrasound. Distinctive manifestations of cold syndrome and heat syndrome were analyzed using wrist ultrasound. Results In RA patients of cold syndrome,the positive rate of synovitis, PD, tenosynovitis, and bone erosion was 51. 72%,20. 68%,51. 72%, and37. 93%,respectively,while they were 97. 22%,91. 67%,75. 0%,and 63. 89%,respectively in RA patients of heat syndrome. Compared with patients of cold syndrome,the positive rate of synovitis,PD,and bone erosion increased in patients of heat syndrome（ P 〈0. 01,P 〈0. 01,P 〈0. 05）. There was no statistical difference in the positive rate of tenosynovitis between the two groups（ P 〈0. 05）. Compared with the cold syndrome group,there was statistical difference in the constituent ratio of synovitis,PD,and bone erosion in the heat syndrome group（ P 〈0. 01,P 〈0. 01,P 〈0. 05）,but with no statistical difference in the constituent ratio of tenosynovitis（ P 〉0. 05）. Results of the ROC curve showed that the sensitivity was 86. 1% and the specificity was 62. 1% in judging heat syndrome,when the total score of synovitis in two wrists was more than 1. 5; the sensitivity was 80. 0% and the specificity was 93. 1% in judging heat syndrome,when the total score of PD intwo wrists was more than 1. 5. Conclusions Positive rates of synovitis,PD,and bone erosion were significantly higher in RA patients of heat syndrome than those of cold syndrome. Especially serious manifestations were more often seen in RA patients of heat syndrome. The total score of synovitis or PD in the two wrist joints higher than 1. 5 was characteristic m