高频超声评价关节病型银屑病指甲损害及指伸肌腱改变的临床价值  

Application of high frequency ultrasound in evaluating nail damages and extensor tendon changes in patients with articular psoriasis

作　　者：程静 蒋瑶[2] CHENG Jing;JIANG Yao(Department of Ultrasound,Chongqing Southeast Hospital,Chongqing 401336,China)

机构地区：[1]重庆市东南医院超声科,401336 [2]重庆市中医院超声科

出　　处：《临床超声医学杂志》2020年第10期764-767,共4页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨高频超声在评估关节病型银屑病患者指甲损害及指伸肌腱改变中的临床应用价值。方法选取我院确诊的银屑病患者86例,其中关节病型银屑病46例(PsA组),寻常型银屑病40例(Ps组),另选同期无指甲损害的健康体检者30例为对照组。应用高频超声测量各组指甲甲板、甲床、甲基质及指伸肌腱的厚度,Wortsman分类对指甲进行形态学分类,彩色多普勒评估指甲局部炎症情况;应用修正银屑病甲严重指数(mNAPSI)对甲损害进行评分,银屑病面积和严重程度指数(PASI)评估银屑病严重程度。比较各组上述参数的差异,分析超声所测指甲甲板、甲床及甲基质的厚度与临床资料的相关性。结果Ps组患者银屑病严重程度大于PsA组,而PsA组炎症指数高于Ps组患者,差异均有统计学意义(均P<0.05)。PsA组、Ps组甲板、甲床、甲基质、指伸肌腱厚度均较对照组增厚,差异均有统计学意义(均P<0.05)。Ps组患者Wortsman分类以Ⅰ型多见(186个),PsA组以Ⅱ型多见(184个)。CDFI示PsA组和Ps组患者甲床、甲基质以及两组指甲远端指节关节肌腱处血流信号均较对照组明显增强。Ps组和PsA组患者甲板、甲床及甲基质的厚度与mNAPSI指数均呈正相关(r=0.340、0.208、0.517,P=0.024、0.025、0.009);甲板厚度与银屑病的临床病程呈正相关(r=0.305,P=0.018)。结论应用高频超声可以评估银屑病患者指甲结构和形态学改变,反映甲床局部炎症情况,对关节病型银屑病的发生发展具有重要评估价值。Objective To explore the clinical value of high frequency ultrasound in the diagnosis of nail damages and extensor tendon changes in patients with articular psoriasis ultrasound.Methods A total of 86 patients with psoriasis diagnosed in our hospital were analyzed retrospectively,including 46 patients with arthropathy psoriasis(PsA group)and 40 patients with psoriasis vulgaris(Ps group).Thirty healthy subjects without nail damages in the same period were selected as the control group.All patients were examined by physical examination,and the general clinical data were recorded.The thickness of nail deck,nail bed,nail matrix and extensor tendon were measured by high frequency ultrasound.Wortsman classification was used to classify fingernails.Color Doppler ultrasound was used to evaluate the local inflammation of fingernails.The modified psoriasis severity index(mnapsi)was used to score the nail damage.The psoriasis area and severity index were used to evaluate the severity of psoriasis.The correlation between the thickness of nail deck nail bed and methyl substance measured by ultrasound and clinical data was analyzed.Results The severity of psoriasis in Ps group was higher than that in PsA group,but the inflammatory index in PsA group was higher than that in Ps group,there were significant differences(both P<0.05).The thickness of deck,nail bed,methyl substance and extensor tendon in PsA group and Ps group were greater than those in control group.The differences were statistically significant(all P<0.05).TypeⅠof Wortsman classification was common in Ps group(186 nails),while typeⅡwas common in PsA group(184 nails).CDFI showed that the blood flow signals in nail bed,nail matrix and tendon of distal fingernail joint were significantly enhanced in PsA group and Ps group.The thickness of deck nail bed and methyl substance were positively correlated with mnpsi index in PS and PSA groups(r=0.34,0.208,0.517,P=0.024,0.025,0.009);deck thickness was positively correlated with clinical psoriasis(r=0.305,P=0.018).Conclus

关 键 词：超声检查 多普勒 彩色 银屑病 关节病型 甲损害 指伸肌腱 

分 类 号：R445.1[医药卫生—影像医学与核医学] R758.7[医药卫生—诊断学]