本文選題：類風(fēng)濕關(guān)節(jié)炎　切入點(diǎn)：超聲評分　出處：《福建醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討超聲評分法在評價(jià)類風(fēng)濕關(guān)節(jié)炎患者疾病活動(dòng)性的診斷價(jià)值。方法通過高頻超聲觀察39例類風(fēng)濕關(guān)節(jié)炎患者掌指關(guān)節(jié)、近端指間關(guān)節(jié)、腕關(guān)節(jié)、肘關(guān)節(jié)和膝關(guān)節(jié)的病變,包括滑膜厚度、滑膜血流、關(guān)節(jié)積液和骨侵蝕,根據(jù)病情的嚴(yán)重程度對上述各項(xiàng)指標(biāo)予以評分(0~3分),將雙側(cè)各個(gè)關(guān)節(jié)的評分相加為最終得分,探討超聲評分與DAS28評分及4種生化檢查(血沉ESR、C-反應(yīng)蛋白CRP、類風(fēng)濕因子RF、抗環(huán)瓜氨酸肽抗體Anti-CCP)之間的相關(guān)性。結(jié)果超聲評分與DAS28評分之間存在非常顯著的相關(guān)性(r=0.823,P0.01),超聲評分與CRP的相關(guān)性優(yōu)于DAS28評分與CRP的相關(guān)性(r超聲評分=0.692,r DAS28=0.526,P值0.01)。超聲評分各個(gè)子項(xiàng)目中滑膜厚度與DAS28評分及生化檢查(ESR、CRP)相關(guān)性最好(r DAS28=0.852,r ESR=0.779,r CRP=0.587,P值均0.01)。結(jié)論超聲評分法對類風(fēng)濕關(guān)節(jié)炎疾病活動(dòng)性的診斷與DAS28評分和血清學(xué)指標(biāo)(ESR、CRP)基本吻合,且超聲評分可能優(yōu)于DAS28評分,可做為該病早期診斷、病情判斷和預(yù)后觀察的一種有效方法。超聲評分各個(gè)子項(xiàng)目中滑膜厚度最能夠反映類風(fēng)濕關(guān)節(jié)炎疾病的活動(dòng)性。目的探討超聲造影對于類風(fēng)濕關(guān)節(jié)炎疾病活動(dòng)性的評估價(jià)值。方法選取12例類風(fēng)濕關(guān)節(jié)炎患者,充分暴露病變最嚴(yán)重的關(guān)節(jié),先在普通模式下運(yùn)用高頻超聲觀察并記錄相關(guān)指標(biāo)(包括滑膜厚度、滑膜血流、關(guān)節(jié)積液和骨侵蝕),根據(jù)病情的嚴(yán)重程度對上述各項(xiàng)指標(biāo)予以評分(0~3分),將雙側(cè)各個(gè)關(guān)節(jié)的評分相加為最終得分。后切換到造影模式,經(jīng)肘正中靜脈團(tuán)注造影劑聲諾維2.4ml,連續(xù)實(shí)時(shí)觀察增厚滑膜的增強(qiáng)情況,并獲取感興趣區(qū)的時(shí)間-強(qiáng)度曲線,分析曲線下面積(AUC)、峰值強(qiáng)度(PI)和達(dá)峰時(shí)間(TTP)參數(shù),探討各參數(shù)與超聲評分及4種生化檢查(ESR、CRP、RF、Anti-CCP)之間的相關(guān)性。結(jié)果超聲造影時(shí)間-強(qiáng)度曲線中的AUC和PI與超聲評分之間存在非常顯著的相關(guān)性(r AUC=0.832,r PI=0.809,P0.01),AUC和PI與ESR之間的相關(guān)性優(yōu)于超聲評分與ESR的相關(guān)性(r AUC=0.907,r PI=0.851,r超聲評分=0.836,P0.01),AUC和PI與CRP之間的相關(guān)性優(yōu)于超聲評分與CRP的相關(guān)性(r AUC=0.855,r PI=0.854,r超聲評分=0.692,P0.01)。結(jié)論超聲造影對類風(fēng)濕關(guān)節(jié)炎疾病活動(dòng)性的診斷與超聲評分和生化指標(biāo)(ESR、CRP)基本吻合,且超聲造影可能優(yōu)于超聲評分,更加能夠反映類風(fēng)濕關(guān)節(jié)炎疾病的活動(dòng)性,可以提供更多的客觀依據(jù)。
[Abstract]:Objective to evaluate the diagnostic value of ultrasonic scoring method in evaluating the activity of rheumatoid arthritis. Methods the metacarpophalangeal joint, proximal interphalangeal joint and wrist joint of 39 patients with rheumatoid arthritis were observed by high frequency ultrasound. The lesions of the elbow joint and the knee joint, including synovial thickness, synovial blood flow, joint effusion and bone erosion, were graded according to the severity of the disease. The scores of each joint were added to the final score. To investigate the correlation between ultrasound score and DAS28 score and four biochemical tests (erythrocyte sedimentation rate (ESR) C-reactive protein, rheumatoid factor RFand anti-cyclic citrullinated peptide antibody Anti-CCP.Results there was a very significant correlation between ultrasound score and DAS28 score. The correlation between ultrasound score and CRP was better than that between DAS28 score and CRP. The correlation between ultrasound score and CRP was 0.692r DAS280.526g P value 0.010.The correlation between synovial thickness and DAS28 score and biochemical examination was the best, and the correlation between r DAS280.852r ESR-0.779r CRP 0.587P was 0.01. conclusion the correlation between synovial thickness and DAS28 score and biochemical examination is better than that of DAS28 score and CRP. Conclusion the results show that the correlation between synovial thickness and DAS28 score and biochemical examination is better than that of DAS28 score and CRP. Conclusion the results show that the correlation between synovial thickness and DAS28 score and biochemical examination is better than that of DAS28 score and CRP. The diagnosis of the activity of rheumatoid arthritis by acoustic scoring method was consistent with the DAS28 score and the serological index (ESR CRP). Ultrasound score may be superior to DAS28 score and can be used as an early diagnosis of the disease. The synovial thickness of each sub-item of ultrasound score can best reflect the activity of rheumatoid arthritis disease. Objective to explore the value of contrast-enhanced ultrasonography in rheumatoid arthritis disease activity. Methods 12 patients with rheumatoid arthritis were selected. To fully expose the most seriously affected joints, observe and record the relevant indexes (including synovial thickness, synovial blood flow, etc.) using high frequency ultrasound in normal mode. According to the severity of the disease, the joint effusion and bone erosion were graded by 0 ~ 3 points, the scores of each joint were added as the final score, and then switched to the contrast mode. The enhancement of thickened synovium was observed continuously and in real time. The time-intensity curve of the area of interest was obtained, and the parameters of area under the curve, peak intensity (Pi) and peak time (TTP) were analyzed. To investigate the correlation between the parameters and the ultrasound score and the four biochemical tests, the correlation between AUC and Pi in the time-intensity curve of contrast-enhanced ultrasound and the ultrasound score was very significant. There was a very significant correlation between AUC and Pi in the time-intensity curve of contrast-enhanced ultrasound and the correlation between r AUC 0.832 r Pi 0.809 P0.01AUC and Pi and ESR. The correlation was better than that between ultrasound score and ESR. The correlation between AUC and Pi was better than that between ultrasound score and CRP. Conclusion Ultrasonography can be used to evaluate the activity of rheumatoid arthritis in patients with rheumatoid arthritis. Conclusion the correlation between ultrasound score and CRP is better than that between AUC score and CRP score. Conclusion Contrast-enhanced ultrasonography is useful for rheumatoid arthritis (RA) activity in patients with rheumatoid arthritis (rheumatoid arthritis). Conclusion Ultrasonography can improve the activity of rheumatoid arthritis by contrast-enhanced echocardiography in patients with rheumatoid arthritis (RA), especially in patients with rheumatoid arthritis (RA). The diagnosis of sex basically coincided with ultrasound score and biochemical index (ESR-CRP). Contrast-enhanced ultrasonography may be superior to ultrasound score, which can reflect the activity of rheumatoid arthritis and provide more objective basis.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R445.1;R593.22

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