CAJ | 학술논문

目的评价高频超声检测类风湿关节炎(RA)膝滑膜炎的效能.方法 95例活动期RA患者行高频彩色多普勒超声检测膝滑膜炎声像,其中51例评价膝病理滑膜炎指标,应用Spearman秩相关分析及受试者工作特征曲线(ROC)等分析临床、病理与高频超声滑膜炎指标的相关性.结果超声滑膜厚度、彩色多普勒滑膜血流信号分别与病理滑膜炎积分、衬里层增生程度、衬里下层炎症浸润程度呈正相关(滑膜厚度:r值分别为0.438,0.424,0.368,血流信号:r值分别为0.357,0.377,0.347；P均＜0.05).比较病理轻、重度滑膜炎患者的临床滑膜炎指标,差异无统计学意义(均P＞0.05),而重度滑膜炎患者超声滑膜厚度[4.5(2.3～5.0) mm]及血流信号[1.0(1.0～2.0)]显著高于轻度滑膜炎患者[分别为2.4(2.0～2.8)mm,1.0(0～1.0),P=0.001,0.036].超声滑膜厚度≥3.9 mm时诊断重度滑膜炎的特异性为96.7％,敏感性为61.9％.结论 RA关节高频超声滑膜炎声像与滑膜炎病理表现相关并有助于判断病理滑膜炎的严重程度.
목적 평개고빈초성검측류풍습관절염(RA)슬활막염적효능.방법 95례활동기RA환자행고빈채색다보륵초성검측슬활막염성상,기중51례평개슬병리활막염지표,응용Spearman질상관분석급수시자공작특정곡선(ROC)등분석림상、병리여고빈초성활막염지표적상관성.결과 초성활막후도、채색다보륵활막혈류신호분별여병리활막염적분、츤리층증생정도、츤리하층염증침윤정도정정상관(활막후도:r치분별위0.438,0.424,0.368,혈류신호:r치분별위0.357,0.377,0.347；P균＜0.05).비교병리경、중도활막염환자적림상활막염지표,차이무통계학의의(균P＞0.05),이중도활막염환자초성활막후도[4.5(2.3～5.0) mm]급혈류신호[1.0(1.0～2.0)]현저고우경도활막염환자[분별위2.4(2.0～2.8)mm,1.0(0～1.0),P=0.001,0.036].초성활막후도≥3.9 mm시진단중도활막염적특이성위96.7％,민감성위61.9％.결론 RA관절고빈초성활막염성상여활막염병리표현상관병유조우판단병리활막염적엄중정도.
Objectives To examine the validity of high-frequency Doppler ultrasound in identifying knees synovitis in patients with rheumatoid arthritis (RA).Methods Ninety-five consecutive patients with active RA were examined with high-frequency Doppler ultrasound to examine synovitis signals in knees.Synovial tissue samples of 51 patients were obtained by closed needle biopsy from knees after ultrasound examination.Serial synovial tissue sections were stained with H&E and immunohistochemical staining,and the histopathological synovitis scores were evaluated.The relationship among clinical, histopathological and ultrasound synovitis indexes was analyzed by Spearman's rank order correlation test and receiver operating characteristic curve analysis.Results Among 95 RA patients,the median thickness of synovial membrane in ultrasound was 2.8 mm,the median depth of effusion was 2.7 mm; Doppler signals of synovial blood flow were detected in 82％(78/95 ) of patients and the median semiquantitive grading of synovial blood flow was 1.0.The thickness of synovial membrane and synovial blood flow at Doppler ultrasound correlated positively with histological synovitis score,hyperplasia of the lining layer,and inflammatory infiltration in sublining area (the thickness of synovial membrane:r=0.438,0.424,0.368,respectively; synovial blood flow:r=0.357,0.377,0.347,respectively; all P＜0.05).Although there was no significant difference in clinical synovitis indexes between patients with histologically low-grade and high-grade synovitis,the thickness of synovial membrane and synovial blood flow in ultrasound in patients with histologically high-grade synovitis was significantly higher than those with low-grade synovitis (P=0.001,0.036,respectively).When the thickness of synovial membrane in ultrasound was ≥ 3.9 mm,the specificity of diagnosing the high-grade synovitis was 96.7％ and the sensitivity was 61.9％.Conclusion Synovitis signals at high-frequency Doppler ultrasound correlate with histopathological synovitis,and it might be helpful in evaluating the severity of histopathological synovitis.