本文選題：高頻肌肉骨骼超聲 + 類(lèi)風(fēng)濕性疾病　； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:類(lèi)風(fēng)濕性關(guān)節(jié)炎(rheumatoid arthritis,RA)是以慢性關(guān)節(jié)炎為主要臨床表現(xiàn)的多種因素共同引起的自身免疫病。隨著RA病程中免疫反應(yīng)反復(fù)發(fā)作,常伴有以漸進(jìn)性關(guān)節(jié)功能異常損害為主要表現(xiàn)的關(guān)節(jié)病理改變。迄今為止,對(duì)RA病因發(fā)生至今尚存在不少的疑問(wèn)與不解之處;建立一種能早期診斷RA患者關(guān)節(jié)功能異常及關(guān)節(jié)損害的技術(shù)與方法,是研究RA的發(fā)生、診斷與治療亟待解決的問(wèn)題。高頻肌肉骨骼超聲,簡(jiǎn)稱高頻肌骨超聲(Musculoskeletal ultrasound,MSUS)檢測(cè)可應(yīng)用于關(guān)節(jié)病變?cè)\斷的研究,為RA患者發(fā)病機(jī)制的研究探索,以及診斷和治療提供了一種特有評(píng)價(jià)手段,特別是高頻超聲能準(zhǔn)確獲得關(guān)節(jié)病變相應(yīng)的相關(guān)數(shù)據(jù),客觀地應(yīng)用于評(píng)價(jià)RA局部病變的發(fā)生、發(fā)展與轉(zhuǎn)歸,以及進(jìn)一步的診斷與治療評(píng)價(jià)。本研究旨在探討高頻超聲在評(píng)價(jià)類(lèi)風(fēng)濕性關(guān)節(jié)炎局部病變中診斷與治療的應(yīng)用價(jià)值。方法:以美國(guó)風(fēng)濕病協(xié)會(huì)(American Rheumatism Association,ACR)1987年修訂的RA診斷為標(biāo)準(zhǔn),隨機(jī)選取2014年1月~2014年12月在鄭州大學(xué)第二附屬醫(yī)院接受診斷和治療的RA患者64例。參照國(guó)際超聲標(biāo)準(zhǔn),切面留取患者雙膝關(guān)節(jié)、雙踝關(guān)節(jié)、雙腕關(guān)節(jié)超聲圖像;采用8~12MHz頻率的線陣探頭進(jìn)行采圖,檢測(cè)使用相同的多普勒預(yù)設(shè)定參數(shù),多切面觀察病變關(guān)節(jié)滑囊有無(wú)積液,測(cè)量滑膜厚度,評(píng)估滑膜內(nèi)血流信號(hào)灌注分級(jí),分析臨床表現(xiàn)與超聲表現(xiàn)的相關(guān)性,每項(xiàng)數(shù)據(jù)重復(fù)測(cè)量3次取得的平均值為最終測(cè)量值。對(duì)64例患者進(jìn)行了12周的標(biāo)準(zhǔn)療程治療,每例均于入院當(dāng)天及治療后28天測(cè)定紅細(xì)胞沉降率(erythrocyte sedimentation rate,ESR)和C-反應(yīng)蛋白(C-reactive protein,CRP)。選取同一時(shí)期入鄭州大學(xué)第二附屬醫(yī)院體檢的健康志愿者30例為對(duì)照組,無(wú)關(guān)節(jié)腫痛及損傷病史,超聲檢查方法及參數(shù)同治療組。結(jié)果:1.治療前64例RA患者中,膝關(guān)節(jié)病變56例、腕關(guān)節(jié)病變28例,踝關(guān)節(jié)病變30例;與健康組對(duì)比,病變關(guān)節(jié)均有明顯的滑膜增厚,滑囊積液及增厚滑膜內(nèi)血流信號(hào)增多的超聲圖像特征;2.64例RA患者治療后病變關(guān)節(jié),膝關(guān)節(jié)、踝關(guān)節(jié)、腕關(guān)節(jié)的最大滑囊積液深度、滑膜厚度、彩色多普勒血流量等超聲圖像的特征數(shù)據(jù),與治療前相比均有顯著好轉(zhuǎn),差異有統(tǒng)計(jì)學(xué)意義(分別P0.05);3.比較研究結(jié)果還發(fā)現(xiàn),膝關(guān)節(jié)、腕關(guān)節(jié)、踝關(guān)節(jié)滑膜厚度、CDFI及臨床表現(xiàn)均與病程有明顯的正相關(guān)性改變,有統(tǒng)計(jì)學(xué)意義(分別P0.05)。結(jié)論:1.高頻超聲可早期發(fā)現(xiàn)RA患者的滑膜改變,在臨床診斷中具有重要的應(yīng)用價(jià)值;2.在RA的治療前后對(duì)比評(píng)價(jià)中,高頻超聲具有一定優(yōu)勢(shì),既能準(zhǔn)確反映出治療前后病變關(guān)節(jié)滑囊積液量、滑膜厚度、滑膜血流量灌注的變化情況,又能及時(shí)的評(píng)估其療效和病情反復(fù)情況,具有很好的臨床應(yīng)用前景。
[Abstract]:Objective: rheumatoid arthritis (RA) is an autoimmune disease caused by chronic arthritis. With the repeated attack of immune response in the course of RA, the pathological changes of joint are often accompanied by progressive abnormal joint function. So far, there are still many questions and puzzles about the etiology of RA. To establish a technique and method for early diagnosis of joint dysfunction and joint damage in patients with RA is to study the occurrence of RA. Diagnosis and treatment are urgent problems. High frequency musculoskeletal ultrasound (MSUSS) can be used in the diagnosis of joint diseases, which provides a special evaluation method for the pathogenesis, diagnosis and treatment of RA. In particular, high-frequency ultrasound can accurately obtain the relevant data of joint lesions, and can be used objectively to evaluate the occurrence, development and outcome of RA local lesions, as well as the further diagnosis and treatment evaluation. The purpose of this study was to evaluate the value of high-frequency ultrasound in the diagnosis and treatment of local lesions of rheumatoid arthritis. Methods: 64 RA patients who were diagnosed and treated in the second affiliated Hospital of Zhengzhou University from January 2014 to December 2014 were randomly selected according to the criteria of American Rheumatism Association (ACR) revised in 1987. Referring to the international ultrasound standard, the ultrasound images of the knee joint, ankle joint and wrist joint of the patient were left on the section plane. The images were taken using a linear array probe with 8~12MHz frequency, and the same Doppler pre-set parameters were detected. The synovial thickness was measured, the perfusion grade of blood flow signal in synovium was evaluated, and the correlation between clinical manifestation and ultrasonic manifestation was analyzed. The average value of 3 times repeated measurement of each data was the final measurement value. 64 patients were treated with standard course of treatment for 12 weeks. Erythrocyte sedimentation rate (sedimentation) and C-reactive protein (C-reactive protein) were measured on the day of admission and 28 days after treatment. Thirty healthy volunteers who entered the second affiliated Hospital of Zhengzhou University in the same period were selected as control group. There was no history of joint swelling and pain, ultrasonic examination method and parameters were the same as those in the treatment group. The result is 1: 1. In 64 patients with RA before treatment, 56 cases had knee joint disease, 28 cases had wrist joint disease, 30 cases had ankle joint disease, compared with the healthy group, the pathological joint had obvious synovial thickening. Ultrasonographic features of increased blood flow signal in synovial thickening and synovial fluid accumulation in synovial thickening. 2.The maximum depth of synovial fluid accumulation and synovial thickness of the diseased joint, knee joint, ankle joint and wrist joint after treatment in 64 patients with RA. The characteristic data of color Doppler blood flow and other ultrasound images were significantly improved compared with those before treatment, and the difference was statistically significant (P0.05 / 3, respectively). The results also showed that CDFI and clinical manifestations of knee joint wrist joint and ankle synovial thickness were significantly correlated with the course of disease (P 0.05). Conclusion 1. High frequency ultrasound can detect synovial changes in RA patients early and has important value in clinical diagnosis. In the comparative evaluation of RA before and after treatment, high frequency ultrasound has some advantages, which can accurately reflect the changes of synovial fluid, synovial thickness and synovial blood flow perfusion before and after treatment. It can evaluate its curative effect and repeated condition in time, so it has a good prospect of clinical application.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R445.1;R593.22

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