超声诊断透析相关性淀粉样变  

Ultrasound examination for the diagnosis of dialysis related amyloidosis

作　　者：杨燕[1] 林跃萍[2] 周华[1] 梁敏[2] 崔志文[1] 

机构地区：[1]第一军医大学南方医院超声科,广州510515 [2]第一军医大学南方医院肾内科,广州510515

出　　处：《中华超声影像学杂志》2000年第4期240-242,共3页Chinese Journal of Ultrasonography

摘　　要：目的　研究透析相关性淀粉样变 (DRA)的声像图特点 ,评价超声技术对DRA的诊断价值。方法　采用高分辨力超声诊断仪检查肩关节 ,检测对象包括 10例正常人、6例肾功能正常的骨关节病患者和 77例慢性肾功能衰竭患者。测定肩袖 (RC)的最大厚度并观察关节周围有无增强回声 (EP)。结果　①正常人肩关节RC均 <0 .8cm ,无EP ;透析患者肩关节声像图改变的特点是RC厚度增宽 ,在RC与肌腱间出现EP ,以及骨关节面欠平滑 ;② 9例经组织病理学证实DRA的患者中 7例RC >0 .8cm和 (或 )EP阳性 ,16例非DRA者无 1例阳性 ,以RC >0 .8cm和 (或 )EP阳性诊断DRA的敏感性为 77.8% ,特异性为 10 0 % ;③RC和EP的阳性率随透析龄的延长而提高 ;④ 3 6例无症状透析患者中 13例RC >0 .8cm和 (或 )EP阳性 ,其中 11例为单纯EP阳性者 ,单纯EP阳性的无症状率高于RC(P <0 .0 1) ;⑤ 68例双侧肩关节比较 ,显示右侧RC的阳性率高于左侧 (P <0 .0 5 )。结论　透析患者DRA的发病率随透析龄延长而升高 ,并且右肩较左肩更易累及 ,早期DRA患者可无临床症状 ,超声主要表现为EP阳性。超声诊断DRA有较高的敏感性和很高的特异性 ,是一种适于早期发现、定期复查DRA的非创伤性手段。Objective To evaluate the value of high resolution ultrasound diagnosing on the dialysis related amyloidosis(DRA).Methods The shoulders of 77 patients in hemodialysis and 16 persons with normal renal function were studied by high resolution ultrasound.Results Two ultrasonographic findings were selectively observed in the dialysis patients:rotator cuffs(RC)>0.8 cm in the thickness and echogenic pads(EP) between muscle tendon and the RC.The sensitivity and specificity of ultrasonographic diagnosis on DRA were 77.8% and 100%,respectively.The incidence of DRA was positively correlative with dialysis duration,and the frequency of RC>0.8 cm was higher in right shouler than left.Conclusions High resolution ultrasound is a relatively sensitive and highly specific non invasive mothod to the diagnosis of DRA.

关 键 词：超声检查 淀粉样变 肩关节 诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学]