CAJ | 학술논문

目的探讨高频彩色多普勒超声在早期类风湿关节炎(RA)患者外周关节病变检测中的应用价值.方法对连续30例病史＜1年的RA患者在入院当天行肘、腕、膝、踝、掌指、近端指间、跖趾关节的体格检查及超声检查,记录有无关节肿胀和(或)压痛、超声显示的关节积液、滑膜增生、滑膜血流、肌腱病变、骨侵蚀情况.采用独立样本t检验和Kappa检验.结果 RA组1140个外周关节中471个有关节积液和(或)滑膜增生(阳性率41.3％).其中404个关节检测到关节积液(35.4％)；359个关节滑膜增生(31.5％)；128个关节增生的滑膜内可见血流信号(占病变关节的35.7％)；腕、踝、第2～5掌指关节共360个关节中90个关节有周围肌腱病变(25％)；27个关节检测到骨侵蚀(阳性率2.4％).在外周关节中最易受累的是腕关节,无论积液阳性率、滑膜增生率、骨侵蚀率及关节内血流阳性率均最高.其他易于出现滑膜炎的关节依次是膝、踝、肘、跖趾、掌指、近端指间关节.在除腕关节以外的小关节中,跖趾关节滑膜炎阳性率最高.掌指关节、近端指间关节、跖趾关节中最易出现滑膜炎的部位分别是第二掌指关节、第三近端指间关节和第二跖趾关节.体格检查肿/痛阳性关节总数为370个(32.5％).查体关节肿/痛阳性与超声检查所显示的关节积液/滑膜增生之间有显著相关性,Kappa一致性检验值0.21,提示二者一致性较低.结论高频彩色多普勒超声是检测RA患者外周关节病变的一个有效手段,有助于提高RA的早期诊断率及全面评估疾病活动度.
목적 탐토고빈채색다보륵초성재조기류풍습관절염(RA)환자외주관절병변검측중적응용개치.방법 대련속30례병사＜1년적RA환자재입원당천행주、완、슬、과、장지、근단지간、척지관절적체격검사급초성검사,기록유무관절종창화(혹)압통、초성현시적관절적액、활막증생、활막혈류、기건병변、골침식정황.채용독립양본t검험화Kappa검험.결과 RA조1140개외주관절중471개유관절적액화(혹)활막증생(양성솔41.3％).기중404개관절검측도관절적액(35.4％)；359개관절활막증생(31.5％)；128개관절증생적활막내가견혈류신호(점병변관절적35.7％)；완、과、제2～5장지관절공360개관절중90개관절유주위기건병변(25％)；27개관절검측도골침식(양성솔2.4％).재외주관절중최역수루적시완관절,무론적액양성솔、활막증생솔、골침식솔급관절내혈류양성솔균최고.기타역우출현활막염적관절의차시슬、과、주、척지、장지、근단지간관절.재제완관절이외적소관절중,척지관절활막염양성솔최고.장지관절、근단지간관절、척지관절중최역출현활막염적부위분별시제이장지관절、제삼근단지간관절화제이척지관절.체격검사종/통양성관절총수위370개(32.5％).사체관절종/통양성여초성검사소현시적관절적액/활막증생지간유현저상관성,Kappa일치성검험치0.21,제시이자일치성교저.결론 고빈채색다보륵초성시검측RA환자외주관절병변적일개유효수단,유조우제고RA적조기진단솔급전면평고질병활동도.
Objective To evaluate the value of high-frequency color Doppler ultrasound in the examination of pathological changes in the peripheral joints of patients with early rheumatoid arthritis (RA).Methods Peripheral joints of 30 consecutive patients with early rheumatoid arthritis (disease duration ＜1year) and 15 healthy volunteers were assessed with ultrasound searching for joint effusion,synovial hypertrophy,tendon lesion and bone erosions.The joints examined including bilateral elbows,wrists,knees,ankles,metacarpophalangeal joints (MCP),proximal interphalangeal joints (PIP) and metatar-sophalangeal joints (MTP).Data were analyzed with t-test and kappa test.Results Joint effusion and/or synovial hypertrophy were found in 471 joints (41.3％).Four hundred and four (35.4％) joints had joint effusion,359(31.5％) had synovial hypertrophy.Power Doppler signals were found in 128 (35.7％) joints with synovial hypertrophy.Periarticular tendon lesions were found in 90(25％) joints of all wrists,ankles and the 2nd to 5th metacarpophalangeal joints.Bone erosions were detected in 27 (2.4％) joints.The most likely involved joint in all peripheral jints was wrist which had the highest positive rate of effusion,synovial hypertrophy,bone erosion and power Doppler signals in the synovial membrane.Other joints which were easily involved with synovitis were knee,ankle,elbow,MTP,MCP and PIP.The positive rate of synovitis was highest in the MTP of all small joints exception the wrist.Synovitis present most frequently in the 2nd MCP of all MCPs,the 3rd PIP of all PIPs and the 2nd MTP of all MTPs.The kappa coefficient between clinical examination and ultrasound in the detection of peripheral joints synovitis was 0.21,showing very poor agreement.Conclusion High-frequency color Doppler ultrasound exa.mination is an effective method in assessing the pathological changes of peripheral joints of patients with early rheumatoid arthritis.It may improve the early diagnosis of RA and useful in assessing disease activity comprehensively.