CAJ | 학술논문

目的观察血友病性膝关节病的超声特征.方法对68例血友病患者(血友病A59例、血友病B9例)的135个膝关节行超声探查并评分,分析血友病患者膝关节超声评分与出血次数、年龄及血友病关节健康评分的相关性.结果全部68例患者均为男性,中位年龄20(3～48)岁.关节积液、纤维隔膜、滑膜增厚、伴血管增生的滑膜增厚、含铁血黄素沉积的检出率分别为39.2％(53/135)、3.0％(4/135)、77.0％(104/135)、49.6％(67/135)、37.8％(51/135),软骨改变、骨侵蚀、骨重建、骨赘形成检出率分别为63.7％(86/135)、48.1％(65/135)、3.0％(4/135)、13.3％(18/135).全部135个膝关节超声评分平均数为5.21[95％CI(4.50～5.93)].随着关节出血次数增加,超声评分明显增加(F=49.926,P＜0.01).轻、中间、重型血友病患者膝关节超声评分差异无统计学意义(F=0.90,P=0.914).≤6、7～18、＞18岁年龄组膝关节超声评分别为0.63[95％CI(0.15～1.10)]、2.88[95％CI(1.90～3.85)]、7.83[95％CI(7.07～8.60)],组间比较差异均有统计学意义(P＜0.01).超声评分与血友病关节健康评分呈正相关(r=0.745,P＜0.01).结论血友病性膝关节病常见超声异常依次为滑膜增厚、软骨改变、骨侵蚀、关节积液、含铁血黄素沉积.超声是评估血友病性关节病简便、有效、安全的检查方法.
목적 관찰혈우병성슬관절병적초성특정.방법 대68례혈우병환자(혈우병A59례、혈우병B9례)적135개슬관절행초성탐사병평분,분석혈우병환자슬관절초성평분여출혈차수、년령급혈우병관절건강평분적상관성.결과 전부68례환자균위남성,중위년령20(3～48)세.관절적액、섬유격막、활막증후、반혈관증생적활막증후、함철혈황소침적적검출솔분별위39.2％(53/135)、3.0％(4/135)、77.0％(104/135)、49.6％(67/135)、37.8％(51/135),연골개변、골침식、골중건、골췌형성검출솔분별위63.7％(86/135)、48.1％(65/135)、3.0％(4/135)、13.3％(18/135).전부135개슬관절초성평분평균수위5.21[95％CI(4.50～5.93)].수착관절출혈차수증가,초성평분명현증가(F=49.926,P＜0.01).경、중간、중형혈우병환자슬관절초성평분차이무통계학의의(F=0.90,P=0.914).≤6、7～18、＞18세년령조슬관절초성평분별위0.63[95％CI(0.15～1.10)]、2.88[95％CI(1.90～3.85)]、7.83[95％CI(7.07～8.60)],조간비교차이균유통계학의의(P＜0.01).초성평분여혈우병관절건강평분정정상관(r=0.745,P＜0.01).결론 혈우병성슬관절병상견초성이상의차위활막증후、연골개변、골침식、관절적액、함철혈황소침적.초성시평고혈우병성관절병간편、유효、안전적검사방법.
Objective To investigate the characteristics of ultrasonography in haemophilic arthropathy in knee joints.Methods The knee joints (n=135) of 68 patients with haemophilia A (n=59) or haemophilia B (n=9) were consecutively evaluated with ultrasonography and scored according to MELCHIORRE ultrasound score.The correlations between ultrasound score and the number of knee joint bleeding episodes,age,and World Federation Haemophilic orthopedic (WFHO) score were studied.Results 68 male patients with median age 20 (3-48) years old were enrolled in this study.The prevalences of hydrops articuli,fibrotic septa,synovial hypertrophy,synovial hypertrophy with angiogenesis,haemosiderin deposition were 39.2％ (53/135),3.0％ (4/135),77.0％ (104/135),49.6％ (67/ 135),37.8％ (51/135),respectively; and the prevalences of cartilage damage,bone erosion,bone remodeling,osteophytes were 63.7％ (86/135),48.1％ (65/135),3.0％ (4/135),13.3％ (18/135) respectively.The average ultrasound score was 5.21 [95％ CI (4.50-5.93)].The ultrasound score of knees joints according to age 0-6,7-18 and ＞18 years old groups were 0.63[95％ CI (0.15-1.10)],2.88[95％ CI (1.90-3.85)],7.83 [95％ CI (7.07-8.60)],respectively; and the difference among groups was statistically significant (P＜0.01).The significant difference of ultrasound score was not found among moderate,mild and severe haemophilia (F=0.90,P=0.914).A significant positive correlation between ultrasound and WFHO scores was demonstrated (r=0.745,P＜0.01).The ultrasound score increased significantly with the increase of number of knee bleed Episodes (F=49.926,P＜0.01).Conclusion The main characteristics of ultrasonography of haemophilic arthropathy in knee joints were identified as followings:synovial hypertrophy,cartilage damage,bone erosion,hydrops articuli,and haemosiderin deposition.Ultrasonography was a fast,effective,safe,and available inspection method in assessment of haemophilic anhropathy.