高频超声早期筛查亚临床银屑病关节炎的临床价值  

Clinical value of high frequency ultrasound in the early screening subclinical psoriatic arthritis

作　　者：龚艺燃 陈树强[1] 何聚馨 李雯婷 孙南英 黄嵘森 Gong Yiran;Chen Shuqiang;He Juxin;Li Wenting;Sun Nanying;Huang Rongsen(Department of Ultrasound,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Department of Ultrasound,Ningde People′s Hospital,Ningde 352000,China;Department of Ultrasound,Quanzhou Children′s Hospital,Quanzhou 362000,China)

机构地区：[1]福建医科大学附属第一医院超声影像科,福州350005 [2]宁德市人民医院超声影像科,宁德352000 [3]泉州市儿童医院超声科,泉州362000

出　　处：《中华超声影像学杂志》2022年第6期532-536,共5页Chinese Journal of Ultrasonography

基　　金：福建省社会发展引导性基金项目(2021Y0012);福建省自然科学基金项目(2017J01289)。

摘　　要：目的探讨附着点炎在银屑病(psoriasis,PsO)中的显著性及高频超声在筛查亚临床银屑病关节炎(psoriatic arthritis,PsA)的价值;设计并探讨附着点炎半定量评分在评估亚临床PsA结构损伤程度及疗效改善中的价值。方法收集2019年1月至2021年3月在福建医科大学附属第一医院就诊的125例PsO患者为PsO组,50例骨性关节炎(osteoarthritis,OA)患者为OA组,同期招募50例健康志愿者为对照组,对比三组被检查者远端指间关节(distal interphalangealjiont,DIP)指伸肌腱附着点炎患病率。设计超声附着点炎半定量评分,探究其与临床评分的相关性。比较银屑病甲同DIP附着点炎的相关性。结果PsO组与OA组及对照组中DIP附着点炎患病率差异有统计学意义(均P<0.001);PsO组治疗前后DIP附着点炎评分差异具有统计学意义(P<0.001);PsO组治疗前后DIP附着点炎评分与银屑病面积和严重性指数评分具有中等强度的相关性(rs=0.538,P<0.001),与银屑病甲严重指数评分具有极强的相关性(rs=0.877,P<0.001);PsO组中有甲病手指同无甲病者附着点炎患病率差异有统计学意义(P<0.001);PsO组中无甲病手指同对照组中无甲病手指的附着点炎患病率差异有统计学意义(P<0.001)。结论附着点炎是PsO的一个显著的特征,本研究设计的附着点炎半定量评分与临床评分有着良好的一致性,可用于评估亚临床PsA结构损伤。此外,DIP附着点病变有可能与银屑病甲是相对独立的过程。Objective To explore the significance of enthesitis in psoriasis(PsO)and the value of high-frequency Doppler ultrasound(HDUS)in screening potential subclinical psoriatic arthritis(PsA)patients through enthesitis;Designing the semi-quantitative score of enthesitis explore the value of semi-quantitative score in evaluating the degree of joint structure damage and improving the curative effect in patients with subclinical PsA.Methods Clinical and sonographic data were collected in 125 PsO patients and 50 osteoarthritis(OA)patients who attended hospital from January 2019 to March 2021,and healthy controls(HC)recruited during the same period.The prevalence of enthesitis of distal interphalangeal joint(DIP)of psoriasis patients,osteoarthritis patients and HC was compared.Meanwhile the semi-quantitative scoring system for ultrasound-guided enthesitis was designed,and the correlation between the severity of enthesitis and clinical score was analyzed.The correlation between psoriasis nail and enthesitis of extensor tendon of DIP finger was also analyzed.Results The significant difference was found in the prevalence of enthesitis of DIP among PsO group,OA group and HC group(all P<0.001);There was a significant difference in the severity of enthesitis of DIP in PsO group before and after treatment(P<0.001);In PsO group,the correlation between the severity of enthesitis of DIP and Psoriasis Area and Severity Index(PASI)score was moderate(rs=0.538,P<0.001),and highly correlated with Nail Psoriasis Severity Index(NAPSI)scores(rs=0.877,P<0.001).There was a significant difference in the incidence of enthesitis between the patients with psoriasis nail and the patients without that(P<0.001).The prevalance of enthesitis of nail disease free fingers was also found significantly different between PsO group and HC group(P<0.001).Conclusions Enthesitis is a prominent characteristic of PsO.And the semi-quantitative scores designed in this research are in satisfied consistence with the clinical scores,and could be used to evaluate subcli

关 键 词：高频超声 附着点炎 亚临床银屑病关节炎 银屑病甲 

分 类 号：R758.63[医药卫生—皮肤病学与性病学] R684.3[医药卫生—临床医学]