本文選題：強(qiáng)直性脊柱炎 + 骶髂關(guān)節(jié)　； 參考：《昆明醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的 通過使用彩色多普勒超聲(color Doppler ultrasound, CDUS)觀察強(qiáng)直性脊柱炎(ankylosing spondylitis, AS)患者以及健康志愿者的骶髂關(guān)節(jié)和肌腱端的二維超聲圖像及血流,探討CDUS對評估AS患者骶髂關(guān)節(jié)炎及肌腱端病的價值。并通過對活動期AS患者及其治療后穩(wěn)定期觀察其上述指標(biāo),探討CDUS對評估AS炎癥活動性的價值。 方法 1.使用彩色多普勒超聲,對86例AS患者以及30例健康志愿者的雙側(cè)骶髂關(guān)節(jié)和周圍韌帶、肌腱端,雙下肢股四頭肌腱附著端、髕韌帶髕骨附著端,髕韌帶脛骨附著端、跟腱附著端、足底筋膜附著端等部位進(jìn)行彩色多普勒超聲檢查。經(jīng)統(tǒng)計學(xué)分析兩組觀察指標(biāo)間的差異,探討CDUS診斷骶髂關(guān)節(jié)炎和肌腱端病的價值。 2.選取30例活動期AS患者,經(jīng)風(fēng)濕免疫科規(guī)范治療后,病情達(dá)到穩(wěn)定,使用CDUS重復(fù)檢查骶髂關(guān)節(jié)及肌腱端,觀察指標(biāo)與治療前完全相同,對比治療前后聲像圖變化,經(jīng)統(tǒng)計學(xué)分析,探討以上指標(biāo)評估AS活動性的價值。 結(jié)果 1.AS組與健康對照組骶髂關(guān)節(jié)及周圍韌帶、肌腱附著端異常情況比較(P0.05),差異有統(tǒng)計學(xué)意義。 2.AS組與健康對照組骶髂關(guān)節(jié)血流豐富程度及血流RI差異有統(tǒng)計學(xué)意義(P0.05),根據(jù)ROC曲線可知,曲線下最大面積為0.916(P0.01),以RI=0.695為最佳臨界點,其診斷AS的靈敏度為90.9%,特異度為81.3%。 3.AS組與健康對照組下肢肌腱端的彩色超聲檢查中,發(fā)現(xiàn)AS組肌腱端增厚高于其它異常表現(xiàn)；AS組中滑膜炎以股四頭肌腱發(fā)現(xiàn)率高,增厚、回聲改變、鈣化、骨侵蝕及骨贅、血流異常以跟腱發(fā)現(xiàn)率高。各組肌腱端異常與健康對照組比較,差異有統(tǒng)計學(xué)意義(P0.05)。 4.活動期AS患者治療前后骶髂關(guān)節(jié)血流豐富程度及血流RI差異有統(tǒng)計學(xué)意義(P0.05)。根據(jù)ROC曲線可知,曲線下最大面積為0.898(P0.01),以RI=0.71為最佳臨界點,其診斷AS活動期的靈敏度為81.5%,特異度為89.3%。5.活動期AS患者治療前后下肢各肌腱端厚度、滑膜厚度及滑囊積液、回聲改變、血流情況比較差異有統(tǒng)計學(xué)意義(P0.05),鈣化、骨侵蝕及骨贅情況比較差異無統(tǒng)計學(xué)意義(P0.05)。 結(jié)論 1.AS組骶髂關(guān)節(jié)血流顯示率較高,血流豐富程度較高,血流RI多數(shù)呈低阻,健康對照組血流顯示率較低,血流豐富程度較低,血流RI多數(shù)呈高阻。血流豐富程度及血流RI值可以作為輔助診斷AS患者骶髂關(guān)節(jié)炎的指標(biāo)。 2.彩色多普勒超聲能清晰顯示AS患者肌腱端病的多種病理改變,如肌腱端增厚、滑膜炎癥(包括滑膜增生、滑膜血管翳的形成和滑囊積液)、肌腱端回聲改變、鈣化、骨侵蝕及骨贅改變、血流等,在AS的早期階段就可以發(fā)現(xiàn)肌腱端炎,為臨床診斷提供客觀依據(jù)。 3.活動期AS組治療前后對比,骶髂關(guān)節(jié)血流豐富程度及血流RI、肌腱端厚度、滑膜厚度及滑囊積液、回聲改變、血流等指標(biāo)治療前后有明顯變化,彩超可以較敏感的評估AS病情活動性及監(jiān)測療效。 4.彩色多普勒超聲診斷AS患者肌腱端病敏感性高,對骶髂關(guān)節(jié)炎有一定輔助診斷價值,可以評估疾病活動性及監(jiān)測患者療效。是輔助AS患者早期診斷、鑒別診斷及評估療效的有效影像學(xué)檢查方法,值得在臨床工作中推廣應(yīng)用。
[Abstract]:objective
Color Doppler ultrasound (CDUS) was used to observe the two dimensional ultrasound images and blood flow of the sacroiliac joint and tendon end of the ankylosing spondylitis (ankylosing spondylitis, AS) and the healthy volunteers. The value of CDUS to evaluate the sacroiliitis and tendon end disease of the patients in AS was evaluated and the AS patients in the active phase of AS were used. After treatment, the above indexes were observed and the value of CDUS in evaluating the activity of AS was evaluated.
Method
1. color Doppler ultrasound was used in 86 cases of AS patients and 30 healthy volunteers with bilateral sacroiliac and peripheral ligaments, tendon end, double leg femoral four tendon attachment end, patellar tendon attachment end, patellar tendon attachment end, Achilles tendon attachment end, plantar fascia attachment end and other parts were examined by color Doppler ultrasound. The differences between the two groups were analyzed, and the value of CDUS in diagnosing sacroiliac arthritis and tendons disease was discussed.
2. to select 30 patients with active AS, after the standard treatment of the rheumatology department, the condition was stable, the sacroiliac joint and the tendon end were repeated by CDUS. The observation index was the same as before the treatment. The changes of the sound image before and after the treatment were compared, and the value of the above indexes to evaluate the activity of AS was evaluated by statistical analysis.
Result
There was a significant difference between the 1.AS group and the healthy control group (P0.05).
There was a significant difference in the blood flow and blood flow RI between the 2.AS group and the healthy control group (P0.05). According to the ROC curve, the maximum area under the curve was 0.916 (P0.01), and RI=0.695 was the best critical point. The sensitivity of the diagnosis of AS was 90.9% and the specificity was 81.3%..
In group 3.AS and the color ultrasound examination of the tendon end of the lower limbs of the healthy control group, it was found that the thickening of the tendon end of the AS group was higher than that of the other abnormal manifestations. In group AS, the rate of detection of the four tendon of the femoral head was high, thickening, echo change, calcification, bone erosion and osteophyte, and the abnormal blood flow was found in the Achilles tendon. The abnormal tendon end of each group was compared with the healthy control group, the difference was compared with the healthy control group. There was a statistical significance (P0.05).
There was a significant difference in the blood flow and blood flow RI of the sacroiliac joint before and after the treatment of the 4. active AS patients (P0.05). According to the ROC curve, the maximum area under the curve was 0.898 (P0.01), and RI=0.71 was the best critical point. The sensitivity of the diagnosis of AS activity was 81.5%, and the specificity was the lower extremity tendons of the AS patients in 89.3%.5. active stage before and after treatment. There was a significant difference in the thickness of the end, the thickness of the synovial membrane and the effusion of the capsule, the echo change and the blood flow (P0.05). There was no significant difference in calcification, bone erosion and osteophyte (P0.05).
conclusion
In group 1.AS, the blood flow of sacroiliac joint was high, blood flow was rich, blood flow RI was low, blood flow was low, blood flow was low, blood flow was low, and most of blood flow RI was high. Blood flow and blood flow RI could be used as a marker for diagnosis of sacroilitis in AS patients.
2. color Doppler ultrasound can clearly show a variety of pathological changes of the AS patients with tendon end disease, such as the thickening of the tendon end, synovial inflammation (including synovial hyperplasia, formation of synovial pannus and synovial fluid), the change of the echo of the tendon, calcification, bone erosion and osteophyte change, blood flow, and so on. In the early stage of AS, the clinical diagnosis can be found. Provide an objective basis.
3. active AS group before and after treatment, the blood flow of sacroiliac joint and blood flow RI, the thickness of the tendon, the thickness of the synovial membrane and the fluid, the echo change, the blood flow and so on. The color Doppler ultrasound can be more sensitive to evaluate the activity of AS and monitor the curative effect.
4. color Doppler ultrasound diagnosis of AS patients with high sensibility of tendon end disease is of great value for the diagnosis of sacroilitis. It can evaluate the activity of the disease and monitor the curative effect of the patients. It is an effective imaging examination method to assist the early diagnosis of AS patients, to differentiate the diagnosis and to evaluate the curative effect. It is worth popularizing and applying in the clinical work.

【學(xué)位授予單位】：昆明醫(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;R593.23

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