CAJ | 학술논문

目的应用高频彩色多普勒超声检查早期类风湿关节炎(RA)患者的跖趾关节,调查跖趾关节滑膜炎在早期RA中的发病率及病变特点,并与临床检查结果相比较.方法对连续57例病史＜1年的RA患者在入院当天进行跖趾关节体格检查,记录关节有无肿胀、触痛,前足挤压试验阳性情况.同日进行跖趾关节的超声检查,记录关节积液、滑膜增生、滑膜血流情况.以超声检查结果作为金标准,对跖趾关节的体格检查及超声检查结果进行一对一比较.结果 29例患者主诉有足趾痛和(或)行走时前脚掌疼痛症状(占50.9％).体格检查发现85个跖趾关节肿/痛阳性(阳性率14.9％),45只足前足挤压试验阳性(阳性率39.5％).对照组超声检查未发现有跖趾关节滑膜炎.RA组中有45例患者(占78.9％)超声检查发现87只足至少1个跖趾关节有滑膜炎.全部570个跖趾关节中共287个发现有滑膜炎(阳性率50.4％),以第2跖趾关节滑膜炎阳性率最高,其次为第3跖趾关节.23个关节增生的滑膜内可检测到血流信号(占有滑膜增生关节的9.8％).查体肿/痛关节阳性诊断跖趾关节滑膜炎与超声检查诊断滑膜炎的Kappa值为0.134,二者一致性较低.以超声检查结果为金标准,关节肿/痛、挤压试验检测跖趾关节滑膜炎的敏感性、特异性、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为0.22、0.92、0.73、0.54、2.66、0.85和0.51、0.96、0.98、0.38、13.66、0.51.结论跖趾关节是早期RA较易累及的关节,临床检查虽有较高的特异性,但不够敏感,超声在检测跖趾关节滑膜炎中有较高的应用价值.
목적 응용고빈채색다보륵초성검사조기류풍습관절염(RA)환자적척지관절,조사척지관절활막염재조기RA중적발병솔급병변특점,병여림상검사결과상비교.방법 대련속57례병사＜1년적RA환자재입원당천진행척지관절체격검사,기록관절유무종창、촉통,전족제압시험양성정황.동일진행척지관절적초성검사,기록관절적액、활막증생、활막혈류정황.이초성검사결과작위금표준,대척지관절적체격검사급초성검사결과진행일대일비교.결과 29례환자주소유족지통화(혹)행주시전각장동통증상(점50.9％).체격검사발현85개척지관절종/통양성(양성솔14.9％),45지족전족제압시험양성(양성솔39.5％).대조조초성검사미발현유척지관절활막염.RA조중유45례환자(점78.9％)초성검사발현87지족지소1개척지관절유활막염.전부570개척지관절중공287개발현유활막염(양성솔50.4％),이제2척지관절활막염양성솔최고,기차위제3척지관절.23개관절증생적활막내가검측도혈류신호(점유활막증생관절적9.8％).사체종/통관절양성진단척지관절활막염여초성검사진단활막염적Kappa치위0.134,이자일치성교저.이초성검사결과위금표준,관절종/통、제압시험검측척지관절활막염적민감성、특이성、양성예측치、음성예측치、양성사연비、음성사연비분별위0.22、0.92、0.73、0.54、2.66、0.85화0.51、0.96、0.98、0.38、13.66、0.51.결론 척지관절시조기RA교역루급적관절,림상검사수유교고적특이성,단불구민감,초성재검측척지관절활막염중유교고적응용개치.
Objective Use the high frequency color Doppler ultrasound to check the metatarsophalangeal joints of the patients with early rheumatoid arthritis (RA),in order to investigate the prevalence of US pathologic abnormalities in the metatarsophalangeal joints synovitis in early RA and to compare them with the clinical examination results.Methods 57 consecutive patients with RA ( disease duration ＜ 1 year) received clinical examination of metatarsophalangeal joints( presence or absence of swelling and/or tenderness,forefoot squeezing test results) in the day of admission.Ultrasonography of MTPs was performed searching for joint effusion,synovial hypertrophy and power doppler,graded from 0 ～ 3 on a semi-quantitative scale on the same day.A joint-by-joint comparisons of clinical examination and ultrasound were made using the latter as the gold standard.Results 29 patients complained of toe pain and/or forefoot pain when walking( 50.9％ ).85 metatarsophalangeal joints were swelling and/or tenderness positive( 14.9％ ) and 45 feet had positive forefoot squeezing test(39.5％ ).Ultrasound examination of the control group did not find the MTP synovitis.45 patients in RA group(78.9％ )were found at least one metatarsophalangeal joint had synovitis in 87 feet by ultrasound examination.287 MTPs had Synovitis of all 570 MTPs(50.4％ ),Synovitis was present most frequently in the 2nd MTP joint,followed by the 3rd MTP.PD signal was found in 23 joints with synovial proliferation ( 9.8％ ).The kappa coefficient between clinical examination and ultrasound in the detection of MTP synovitis was 0.134,showing very poor agreement.With ultrasound as the gold standard,the sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio of joint swelling and/or tenderness for the detection of MTP synovitis were 0.22,0.92,0.73,0.54,2.66 and 0.85,respectively,while the corresponding values for forefoot squeezing test were 0.51,0.96,0.98,0.38,13.66 and 0.51.Conclusions Metatarsophalangeal joints are easily involved in early RA.Clinical examination has high specificity and positive predictive values,but sensitivity and negative predictive values was low.Evaluation of MTPs by US may be of major clinical importance in RA.