本文關鍵詞： 脊柱關節(jié)炎 彩色多普勒超聲 附著點炎 類風濕關節(jié)炎　出處：《石河子大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:了解脊柱關節(jié)炎(SpA)患者肌腱附著點炎的發(fā)生率、超聲表現(xiàn)特點,探討超聲在SpA中的診斷價值。方法:收集2015年12月至2016年12月新疆自治區(qū)人民醫(yī)院門診及住院SpA患者80例為觀察組,收集同期類風濕關節(jié)炎(RA)患者50例(RA組),健康志愿者50例(HC組)為對照組,通過二維彩色多普勒超聲分別對三組研究對象上肢2個肌腱附著點(肱二頭肌長頭腱,岡上肌肌腱)及下肢5個肌腱附著點(股四頭肌肌腱止點、髕腱起點、髕腱止點、跟腱、跖底筋膜)進行超聲檢查及超聲評分,對相關數(shù)據(jù)進行統(tǒng)計學分析。結(jié)果:(1)80例SpA患者共1112處附著點(2人拒絕行上肢檢查),超聲檢查發(fā)現(xiàn)118處異常,臨床檢查發(fā)現(xiàn)29處異常,二者差異有統(tǒng)計學意義(P0.01)。(2)SpA患者包括AS組50例,非AS組30例(未分化脊柱關節(jié)炎12例、銀屑病關節(jié)炎15例、反應性關節(jié)炎3例),AS組696處附著點,超聲發(fā)現(xiàn)76處異常,非AS組416處附著點超聲發(fā)現(xiàn)42處異常,二者差異無統(tǒng)計學意義(P0.05)。(3)SpA組患者1112處附著點118處(10.61%)異常,RA組患者700處附著點29處(4.1%)異常,HC組700處附著點8處(1.14%)異常,SpA組與RA組及HC組差異均有統(tǒng)計學意義(P0.05);在下肢附著點檢查中,SpA組發(fā)現(xiàn)滑囊炎46處(38.98%),骨侵蝕31處(27.84%),肌腱增厚16處(13.56%),是最常見的表現(xiàn)形式,RA組和HC組滑囊炎分別為3處和2處,HC組骨侵蝕1處,兩對照組均未發(fā)現(xiàn)肌腱增厚,SpA組與RA組、HC組差異均有統(tǒng)計學意義(P0.05);SpA組患者跟腱、髕腱止點、髕腱起點、股四頭肌肌腱止點,肱二頭肌長頭腱異常率分別為(65.25%,15.25,0.85%,0.85%,17.80%);(4)超聲GUESS評分與患者BASDAI、背痛VAS、晨僵時間、血沉、CRP等疾病活動性指標并無明顯相關性(P0.05),與外周關節(jié)有一定相關性(P0.05);(5)應用Logistic對超聲評分進行回歸分析,結(jié)果顯示:對SpA診斷有預測作用的是跟腱評分和滑囊炎評分(P0.05)。結(jié)論:超聲可以發(fā)現(xiàn)SpA患者肌腱附著點異常;跟腱和髕腱止點最常被累及,表現(xiàn)形式以滑囊炎、骨侵蝕、肌腱增厚最常見。跟腱評分和滑囊炎評分在SpA診斷預測中有重要意義。
[Abstract]:Objective: To investigate the spinal arthritis (SpA) patients with tendon enthesitis incidence, ultrasound features, explore the value of ultrasonography in diagnosis of SpA. Methods: from December 2015 to December 2016, the Xinjiang Autonomous Region People's hospital out-patient and hospitalization in patients with SpA 80 cases in observation group were collected in the same period of rheumatoid arthritis (RA) in 50 cases (RA group) and 50 healthy volunteers (group HC) as control group, using two-dimensional color Doppler ultrasound respectively in three groups of subjects 2 upper limb tendon attachment point (tendon of long head of biceps supraspinatus tendon) and lower limb 5 tendon attached point (unit four biceps tendon, patellar tendon starting point, patellar tendon, Achilles tendon, plantar fascia) by ultrasound and ultrasound score, statistical analysis of related data. Results: (1) 80 cases of SpA patients with a total of 1112 attachment points (2 refused to upper limb examination), ultrasound examination found 118 abnormal clinical examination found 29 寮傚父,浜岃，

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