临床及超声检查对色素沉着绒毛结节性滑膜炎及活跃期类风湿性关节炎的诊断价值  

The study of differential diagnostic value between pigmented villonodular synovitis and rheumatoid arthritis in active age with clinic and ultrasound

作　　者：张凌燕[1] 包晓丹[2] 唐远姣[1] 冷钱英 向茜[1] 邱逦[1] 

机构地区：[1]四川大学华西医院超声科,成都610041 [2]川北医学院医学影像学系影像技术专科,南充637000

出　　处：《中华医学超声杂志（电子版）》2015年第1期31-34,共4页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家自然科学基金资助项目(81271585)

摘　　要：目的研究临床及超声检查对色素沉着绒毛结节性滑膜炎(PVNS)与活跃期类风湿性关节炎(RA)的鉴别诊断价值。方法 2010年至2014年在四川大学华西医院行超声检查并滑膜切除术后病理结果证实为PVNS患者16例;并选取2014年于四川大学华西医院就诊确诊为类风湿性关节炎,并且经临床医师疾病活动性评分(DAS28)评级为炎症活跃期患者16例。回顾性分析患者临床和超声检查特征。结果 PVNS与炎症活跃期RA患者年龄(T=185)、疼痛评分(T=136)、外伤史(P=0.029)、功能受限情况(P=0.001)、累及关节类型(P=0.000)和数目(P=0.000)、积液内的光点回声(P=0.001)、邻近肌腱受累(P=0.001)、Adler血流分级(P=0.009),差异有统计学意义。PVNS患者年龄较小、多有外伤史;活跃期RA患者疼痛评分较高,且多有功能受限。超声特征:PVNS患者多累及大关节、单关节、积液内多有细密光点回声;RA患者多累及大小关节、多关节、常累及邻近肌腱、Ⅲ级血流比更高。2组患者性别、有无积液和滑膜的厚度比较,差异无统计学意义(P>0.05)。结论年龄、疼痛评分、外伤史和功能受限、累及关节类型和数目、积液内强回声、邻近肌腱受累和Adler血流分级有助于PVNS及炎症活跃期RA的鉴别诊断。Objective To explore the value of differential diagnosis between pigmented villonodular synovitis （PVNS） and rheumatoid arthritis （RA） in active stage with clinic and ultrasound. Methods We analyzed retrospectively the characters of clinic and ultrasound of sixteen patients with PVNS and sixteen patients with rheumatoid arthritis inactive stage. Results In aspects of patient＇s age （T=185）, pain scores （T=136） history of trauma （P=0.029）, functionally uncompensated conditions （P=0.001） type （P=0.000） and sum （P=0.000） of involved joints, bright spot-echoes in hydrops （P=0.001） tendons nearby involved （P=0.001） and the Adler＇s grade of Doppler ultrasound blood flow （P=0.009）, the differences between PVNS and RA in active stage had statistical significance （P 〈0.05）. Clinic characters： patients with PVNS were younger, often had a history of trauma. But patients with RA in active stage had a higher pain score and functionally uncompensated condition. Ultrasound characters： big and single joints were often involved in patients with PVNS, and tiny bright spot echoes could be detected in hydrops. Instead, big and small, multiple joints, tendons nearby were often involved in patients with RA, who had a higher ratio of grade III Doppler ultrasound blood flow. And in aspects of sex, the presence of hydrops and synovium thickness, the differences between the two had no statistical significance （P 〉 0.05）. Conclusion The clinical characters including Patient＇s age, pain scores, history of trauma, functionally uncompensated conditions, and the characters of ultrasound including type and sum of involved joints, bright spot echoes in hydrops, tendons nearby involved and the Adler＇s grade of Doppler ultrasound blood flow, are helpful for the differential diagnosis of PVNS and RA in active stage.

关 键 词：病理学 临床 超声检查 滑膜炎 色素绒毛结节性 关节炎 类风湿 

分 类 号：R445.1[医药卫生—影像医学与核医学] R593.22[医药卫生—诊断学] R686.7[医药卫生—临床医学]