【摘要】：目的： 探討超聲檢查在評(píng)估類風(fēng)濕關(guān)節(jié)炎（rheumatoid arthritis，RA）診斷中的應(yīng)用價(jià)值。 方法： 77例臨床疑診RA的患者分別進(jìn)行超聲檢查及臨床方法診斷RA。超聲通過檢測(cè)患側(cè)腕關(guān)節(jié)，第2、3掌指關(guān)節(jié)(metacarpophalangeal joints,MCP)，第2、3近端指間關(guān)節(jié)(proximal interphalangeal joints, PIP），第2、5跖趾關(guān)節(jié)（metatarsophalangeal joints, MTP）等7個(gè)關(guān)節(jié)，觀察滑膜增生、滑膜內(nèi)血流信號(hào)、骨侵蝕及關(guān)節(jié)積液4項(xiàng)指標(biāo)，以4步半定量分級(jí)系統(tǒng)中滑膜病變?yōu)橹鞯牟±曁崾綬A。對(duì)兩種方法進(jìn)行對(duì)比分析。同時(shí)對(duì)這4項(xiàng)指標(biāo)進(jìn)行等級(jí)評(píng)分，評(píng)分總和與同期血清學(xué)指標(biāo)進(jìn)行單因素相關(guān)Pearson分析。 結(jié)果： 超聲提示RA55例，非RA22例，臨床診斷RA53例，非RA24例。超聲提示和臨床診斷兩種方法間的差異無統(tǒng)計(jì)學(xué)意義（P=0.774）�；ぱ髟u(píng)分總和、積液評(píng)分總和與血沉(erythrocyte sedimentationrate，ESR)成正相關(guān)（r值分別是0.739、0.564，P值均=0.000）。 結(jié)論： （1）高頻超聲可較清楚顯示骨質(zhì)破壞、關(guān)節(jié)積液、滑膜增生及增生滑膜內(nèi)血流信號(hào)并進(jìn)行超聲分級(jí)。 （2）超聲同時(shí)應(yīng)用4項(xiàng)指標(biāo)對(duì)類風(fēng)濕關(guān)節(jié)炎進(jìn)行提示的方法同臨床診斷基本吻合，，且其滑膜血流評(píng)分總和及積液評(píng)分總和與血清學(xué)指標(biāo)存在正相關(guān)性，超聲可作為RA的篩查方法，為臨床早期確診提供更多影像學(xué)依據(jù)，值得推廣應(yīng)用。 （3）部分患者超聲提示結(jié)果可以早于實(shí)驗(yàn)室診斷。
[Abstract]:Objective: to evaluate the value of ultrasonography in the diagnosis of rheumatoid arthritis (rheumatoid arthritis,RA). Methods: 77 patients with suspected RA were examined by ultrasound and diagnosed with RA. by clinical methods. Ultrasound was used to detect the synovial hyperplasia and intrasynovial blood flow signal of 7 joints, including wrist joint, metacarpophalangeal joint (metacarpophalangeal joints,MCP), interphalangeal joint (proximal interphalangeal joints, PIP), metatarsophalangeal joint (metatarsophalangeal joints, MTP) and metatarsophalangeal joint (metatarsophalangeal joints, MTP). Four indexes of bone erosion and joint effusion. RA. was revealed by ultrasound in synovial lesions in a four-step semi-quantitative grading system. The two methods are compared and analyzed. At the same time, the four indexes were graded, the sum of the scores and the serological indexes of the same period were analyzed by univariate Pearson. Results: RA55, non-RA22, RA53 and non-RA24 were diagnosed by ultrasonography. There was no significant difference between ultrasound indication and clinical diagnosis (P0. 774). The sum of synovial blood flow score and accumulative fluid score were positively correlated with erythrocyte sedimentationrate,ESR (r = 0. 739 鹵0. 564 P = 0.000). Conclusion: (1) High-frequency ultrasound can clearly display the blood flow signal in synovial membrane of bone destruction, joint effusion, synovial hyperplasia and hyperplasia. (2) the methods of indicating rheumatoid arthritis with four indexes of ultrasound were in good agreement with clinical diagnosis, and the sum of synovial blood flow score and accumulated fluid score were positively correlated with the serological indexes. Ultrasound can be used as a screening method for RA and provide more imaging evidence for clinical early diagnosis. (3) the ultrasonic findings of some patients can be diagnosed earlier than the laboratory diagnosis.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R593.22

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