类风湿关节炎腕关节超声在中医不同寒热证候间的表现特征  

Manifestation characteristics of wrist ultrasound between cold and heat syndrome of rheumatoid arthritis patients

作　　者：陶庆文[1] 徐愿[1] 孔维萍[1] 许森 王建明[1] 张楠[1] 王琬茹[3] 阎小萍[1] 

机构地区：[1]中日友好医院中医风湿病科,北京100029 [2]北京市朝阳区中医院内科,北京100020 [3]北京中医药大学研究生院,北京100029

出　　处：《中华中医药杂志》2015年第8期2752-2755,共4页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：北京中医药科技项目(No.JJ2011-89);中日友好医院院级青年基金课题(No.2013-QN-03)~~

摘　　要：目的:以腕关节为例,探索关节超声各项参数在类风湿关节炎(RA)不同寒热证候间的表现差异。方法:81例RA患者,根据寒热证候辨证分为寒证组和热证组,分别观察腕关节超声的关节腔积液、能量多普勒(PD)信号、腱鞘炎、骨侵蚀等参数,比较腕关节超声表现在RA寒热证候间的差异性。结果:RA关节超声的关节腔积液、PD、腱鞘炎和骨侵蚀的阳性率在寒证组分别为56.76%、29.73%、54.05%、43.24%,热证组分别为95.45%、90.91%、72.72%、63.64%;寒热证候间比较,关节积液和PD在寒证组和热证组的构成比均有显著差异(P<0.01);受试者工作特征曲线(ROC)结果显示,关节积液和PD判断RA热证差异具有统计学意义(P<0.01),当双腕关节积液>1.5时,判断RA热证的敏感性为86.3%,特异性为62.2%;当双腕PD>1.5分时,判断RA热证的敏感性为80.8%,特异性为93.3%。结论:RA腕关节超声的关节积液和PD参数在不同寒热证候间表现有显著差异性,双腕关节积液或PD积分超过1.5分可提示属于RA热证。Objective： To explore the difference in various parameters of joint ultrasound between cold and heat syndromes of rheumatoid arthritis （RA） patients based on the example of wrist ultrasound. Methods： 81 RA patients were divided into cold syndrome group and heat syndrome group according to the differentiation of cold and heat syndromes. The wrist ultrasound parameters as arthroedema, power doppler （PD）, tenosynovitis, bone erosion and so on were observed respectively in order to compare the difference in wrist ultrasound between cold and heat syndromes of RA. Results： The positive rate of arthroedema, PD, tenosynovitis and bone erosion of patients in cold syndrome group was 56.76%, 29.73%, 54.05% and 43.24% respectively, and which of patients in heat group was 95.45%, 90.91%, 72.72% and 63.64% respectively. The difference in constitution ratio of arthroedema and PD between cold and heat syndrome groups was significant （P〈0.01）, and the difference in constitution ratio of tenosynovitis and bone erosion between the two groups was not significant. The results of receiver operating characteristic curve （ROC） showed that there was a statistical significance of arthroedema and PD in the diagnosis of heat syndrome of RA （P〈0.01）; when the arthroedema in double wrist joints was greater than 1.5, its sensibility and specificity in the diagnosis of heat syndrome of RA was 86.3% and 62.2% respectively; when PD of double wrist joints was greater than 1.5, its sensibility and specificity in the diagnosis of heat syndrome of RA was 80.8% and 93.3% respectively. Conclusion： There is significant difference＇in parameters as arthroedema and PD showed by wrist ultrasonic between cold and heat syndromes of RA patients. The integration of arthroedema and PD in double wrist joints over 1.5 points could prompt that the syndrome of RA belonged to heat.

关 键 词：类风湿关节炎 关节超声 腕关节 关节积液 能量多普勒 

分 类 号：R259[医药卫生—中西医结合]