本文選題：類風(fēng)濕性關(guān)節(jié)炎 + 小關(guān)節(jié)�。� 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：探討高分辨力超聲在類風(fēng)濕性關(guān)節(jié)炎（RheumatoidArthritis，RA）手指小關(guān)節(jié)病變中的診斷價值。 資料和方法：選擇在大連市中心醫(yī)院住院的類風(fēng)濕性關(guān)節(jié)炎患者為研究對象，診斷均符合美國風(fēng)濕病學(xué)會1987年修訂的類風(fēng)濕關(guān)節(jié)炎診斷標(biāo)準(zhǔn)（ARA，1987），共40例患者720個手指小關(guān)節(jié)為RA組，同時以正常人20例360個手指小關(guān)節(jié)為對照組，應(yīng)用高分辨力超聲分別檢查兩組雙手1～5掌指關(guān)節(jié)（Metacarpophalangealjoint,MCP）和2～5近端指間關(guān)節(jié)（Proximal interphalangeal joint,PIP），觀察并記錄關(guān)節(jié)滑膜厚度及血流情況，關(guān)節(jié)積液的范圍及透聲情況，關(guān)節(jié)軟骨及軟骨下骨關(guān)節(jié)面是否光滑，表面和內(nèi)部情況，有無缺損。通過與對照組對比觀察類風(fēng)濕性關(guān)節(jié)炎手指小關(guān)節(jié)病變的高分辨力彩色多普勒超聲表現(xiàn)，總結(jié)類風(fēng)濕性關(guān)節(jié)炎手指小關(guān)節(jié)病變的超聲特征，其中20例患者同時進(jìn)行核磁共振檢查(MagfleticResonance Imaging,MRI），比較高分辨力超聲與核磁共振類風(fēng)濕性關(guān)節(jié)炎手指小關(guān)節(jié)病變檢查的陽性率。 結(jié)果：1.手指小關(guān)節(jié)病變的超聲檢查結(jié)果： 1.1滑膜增厚：檢出40例共358個滑膜增厚，，分別占患者總數(shù)的100%（40/40）和受檢關(guān)節(jié)總數(shù)的49.72%（358/720），掌指關(guān)節(jié)和近端指間關(guān)節(jié)檢出率分別為58.50%（234/400）、38.75%（124/320）。 1.2關(guān)節(jié)腔積液：檢出29例310個關(guān)節(jié)存在關(guān)節(jié)腔積液，分別占患者總數(shù)的72.50%（29/40）和受檢關(guān)節(jié)總數(shù)的43.06%（310/720）、MCP、PIP的檢出率分別為46.00%（184/400），39.38%（126/320）。 1.3滑膜血管翳：按血流信號I級以上為陽性，RA組17例85個關(guān)節(jié)為陽性血流信號,分別占患者總數(shù)的42.50%（17/40）和受檢關(guān)節(jié)總數(shù)的11.81%（85/720）,MCP、PIP的檢出率分別為16.50%（66/400），5.94%（19/320）。 1.4骨損壞：檢出11例79個病變關(guān)節(jié)有軟骨及軟骨下骨質(zhì)侵蝕，分別占患者總數(shù)的27.50%（11/40）和受檢關(guān)節(jié)總數(shù)的10.97%（79/720），MCP、PIP的檢出率分別為14.00%（56/400），7.19%（23/320）。 2.手指小關(guān)節(jié)病變的MRI檢查結(jié)果： 2.1滑膜增厚：檢出14例共241個滑膜增厚，分別占患者總數(shù)的70.00%（14/20）和受檢關(guān)節(jié)總數(shù)的66.94%（241/360）。 2.2關(guān)節(jié)腔積液：檢出12例167個關(guān)節(jié)存在關(guān)節(jié)腔積液，分別占患者總數(shù)的60.00%（12/20）和受檢關(guān)節(jié)總數(shù)的46.39%（167/360）。 2.3骨損壞：檢出8例65個病變關(guān)節(jié)有軟骨及軟骨下骨質(zhì)侵蝕，分別占患者總數(shù)的40.00%（8/20）和受檢關(guān)節(jié)總數(shù)的18.06%（65/360）。 3．比較結(jié)果： 3.1高分辨力超聲檢查滑膜厚度比較： RA組滑膜厚度均較對照組明顯增厚，兩者比較差異有統(tǒng)計學(xué)意義（P0.01）。 3.2高分辨力超聲和MRI檢查結(jié)果比較:20例RA患者滑膜厚度、關(guān)節(jié)腔積液、骨損壞兩種影像學(xué)檢查陽性率比較，差異均無統(tǒng)計學(xué)意義（P0.05）。 結(jié)論：1．高分辨力超聲可以檢出類風(fēng)濕性關(guān)節(jié)炎關(guān)節(jié)滑膜增厚及關(guān)節(jié)積液，可做為超聲診斷類風(fēng)濕性關(guān)節(jié)炎手指小關(guān)節(jié)病變的重要指標(biāo)。 2．彩色多普勒血流顯像檢測滑膜內(nèi)血流信號分布情況是判斷類風(fēng)濕性關(guān)節(jié)炎滑膜炎癥程度及炎癥活動性的重要指標(biāo)。 3．高分辨力超聲檢出關(guān)節(jié)軟骨和軟骨下骨骨質(zhì)的侵蝕情況是判斷類風(fēng)濕性關(guān)節(jié)炎手指小關(guān)節(jié)病變程度的重要參考。
[Abstract]:Objective : To investigate the diagnostic value of high resolution ultrasound in the diagnosis of small joint lesions of finger joints of rheumatoid arthritis ( RA ) .

Materials and Methods : The diagnostic criteria of rheumatoid arthritis ( ARA , 1987 ) , which was revised in 1987 by American College of Rheumatology , were selected for the study of rheumatoid arthritis patients hospitalized in Dalian Central Hospital .

Results : 1 . Ultrasonic examination results of small finger joint lesions :

1.1 synovial thickening : Among the 40 cases , 358 synovial thickening were detected , accounting for 49.72 % ( 40 / 40 ) of total patients and 49.72 % ( 358 / 720 ) of the total number of joints , 58.50 % ( 234 / 400 ) and 38.75 % ( 124 / 320 ) respectively .

1.2 Joint cavity effusion : There were 29 cases of articular cavity effusion in 29 cases , accounting for 72.50 % ( 29 / 40 ) of total number of patients and 43.06 % ( 310 / 720 ) of the total number of joints . The detection rate of MCP and PIP was 46.00 % ( 184 / 400 ) and 39.38 % ( 126 / 320 ) , respectively .

1.3 In RA group , 17 cases 85 joints were positive blood flow signals , accounting for 42.50 % ( 17 / 40 ) and 11.81 % ( 85 / 720 ) , MCP and PIP were 16.50 % ( 66 / 400 ) and 5.94 % ( 19 / 320 ) , respectively .

1.4 Bone damage : There were 11 cases of 79 lesions , which accounted for 27.50 % ( 11 / 40 ) of the total number of patients and 10.97 % ( 79 / 720 ) of the total number of joints . The detection rate of MCP and PIP was 14.00 % ( 56 / 400 ) and 7.19 % ( 23 / 320 ) , respectively .

2 . MRI findings of small finger joint lesions :

2.1 The thickness of synovial membrane : 14 cases were found to be thickened , accounting for 70.00 % ( 14 / 20 ) of the total number of patients and 66.94 % ( 241 / 360 ) of the total number of joints .

2.2 Joint cavity effusion : There were 12 cases of 167 joints with joint cavity effusion , accounting for 60.00 % ( 12 / 20 ) of total number of patients and 46.39 % ( 167 / 360 ) of total number of joints .

2.3 Bone damage : 8 cases of 65 lesions were detected with cartilage and bone erosion , accounting for 40.00 % ( 8 / 20 ) of the total number of patients and 18.06 % ( 65 / 360 ) of the total number of joints .

3 . Comparison Results :

3.1 Compared with the control group , the thickness of synovial membrane in RA group was significantly increased compared with the control group ( P0.01 ) .

3.2 The results of high resolution ultrasonography and MRI showed that 20 patients with RA had no statistical significance ( P0.05 ) .

Conclusion : 1 . High - resolution ultrasound can detect synovial thickening and joint effusion of rheumatoid arthritis joint synovial membrane , and can be used as an important index for the diagnosis of small joint disease of finger joint of rheumatoid arthritis .

2 . The distribution of blood flow signal in synovial fluid by color Doppler flow imaging is an important index to judge the degree of rheumatoid arthritis and the activity of inflammation .

3 . The high - resolution ultrasonography is an important reference for the determination of the degree of small joint lesion of the finger facet of rheumatoid arthritis .

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.1;R593.22

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 李萍;王正濱;牛曉燕;;彩色多普勒超聲診斷類風(fēng)濕性關(guān)節(jié)炎手腕關(guān)節(jié)病變[J];中國醫(yī)學(xué)影像技術(shù);2008年10期

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