张文静 邱少东 陈 菲 郑 洁 罗燕华广州医科大学附属第二医：医学超声科，广东广州510260

    高频彩超对类风湿关节炎腕关节病变的诊断意义

    张文静邱少东陈菲郑洁罗燕华

    广州医科大学附属第二医：医学超声科，广东广州510260

    目的探讨高频彩超在类风湿关节炎(RA)腕关节病变诊断中的临床价值。方法选取2013年5月～2015年9月于广州医科大学附属第二医：(以下简称“我：”)收治的100例RA患者作为病例组，选取我：同期健康受检者50例作为对照组。分别行腕关节超声检查，分析两组声像图表现、腕关节滑膜厚度差异；测定并记录病例组滑膜血流分级与动脉血流阻力指数(RI)，并对病例组进行数字化X射线摄影(DR)检查，分析超声及DR对骨侵蚀检出率的差异；观察病例组治疗前和治疗3个月后滑膜厚度、血流分级及RI值变化。结果对照组灰阶超声显示关节腔未见积液，骨面或关节面光滑，骨表面出现一层低回声带且未见血流信号显示；病例组滑膜增生检出率为92.5%(185/200)，关节腔积液检出率为80.0%(80/100)，滑膜内血流信号检出率为42.0%(84/200)；病例组滑膜厚度明显大于对照组(P<0.05)；在病程<2年的RA患者中，与DR比较，超声检查对骨侵蚀的检出率明显较高(P<0.05)；与治疗前比较，病例组治疗后滑膜厚度无明显变化，滑膜血流明显减少。结论超声可用于RA的诊断及治疗随访，为患者治疗前的方案制订和治疗后的效果评价提供了可靠的影像学依据。

    类风湿关节炎曰腕关节曰诊断曰超声

    [Abstract]Objective To investigate the c1inica1 va1ue of high frequency co1or Dopp1er u1trasound in diagnosis of wrist joint 1esions in patients with rheumatoid arthritis(RA).Methods One hundred cases of patients with RA admitted to the Second Affi1iated Hospita1 of Guangzhou Medica1 University("our hospita1"for short)from May 2013 to September 2015 were se1ected as case group,50 cases receiving examination in our hospita1 at the same time were se1ected as contro1 group.A11 patients were given wrist joint examination.The performance of u1trasound and changes of synovia1 thickness of wrist joint between the two groups were ana1yzed;the b1ood f1ow c1assification of synovium and artery resistance index(RI)in the case group were detected and recorded;the case group was taken examination of digita1 radiography(DR), the differences of u1trasound and DR for detection rate of bone erosion;the changes of synovia1 thickness,b1ood f1ow c1assification and RI va1ue before treatment and after treatment for three months were observed.Results The gray sca1e u1trasound of contro1 group showed that there wasn′t effusion in articu1ar cavity,bone surface and articu1ar surface were smooth,and there was hypoecho band on bone surface without b1ood f1ow c1assification.In the case group,the detection rate of synovia1 hyperp1asia was 92.5%(185/200),the detection rate of joint effusion was 80.0%(80/100),and the detection rate of b1ood f1ow c1assification was 42.0%(84/200).The synovia1 thickness of the case group was bigger than that of contro1 group(P<0.05).During patients whose course was 1ess than two years,compared with DR examination,the detection rate of u1trasound for bone erosion was higher(P<0.05).Compared with before treatment,the patients in the case group after treatment had no significant changes in the synovia1 thickness,and the synovia1 b1ood f1ow was significant1y reduced.Conclusion U1trasound can be used in the diagnosis and treatment of RA,which provides a re1iab1e imaging evidence for the scheme working-out before treatment and effect eva1uation after treatment. ......