超微血流成像在类风湿关节炎滑膜血流评估中的应用  

Ultramicroangiography for evaluation of synovial blood flow in rheumatoid arthritis patients

作　　者：李雪兰 杨萌 赵辰阳 王铭 张睿 齐振红 李建初 姜玉新[1] Li Xuelan;Yang Meng;Zhao Chenyang;Wang Ming;Zhang Rui;Qi Zhenhong;Li Jianchu;Jiang Yuxin(Department of Ultrasound,Peking Union Medical College Hospital,CAMS&PUMC,Beijing 100730,China)

机构地区：[1]中国医学科学院、北京协和医学院、北京协和医院超声医学科,北京100730

出　　处：《中华医学超声杂志（电子版）》2023年第2期232-237,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家自然科学基金面上项目(61971447);北京市自然科学基金杰出青年基金(JQ18023);国际科技合作计划(2015DFA30440);中国医学科学院临床与转化医学研究基金项目(2020-12M-C&T-B035)。

摘　　要：目的探索超微血流成像(UMA)对类风湿性关节炎(RA)手关节滑膜内增生血管评估的临床应用价值以及UMA显示骨侵蚀缺损处穿支血流征象(UMA-sign)的临床意义。方法对2020年5月至2021年4月北京协和医院29例RA患者腕关节、第2-3掌指关节及第2-3近端指间关节行能量多普勒超声(PDUS)和UMA检查,记录滑膜血流显示率及其半定量评分,采用Wilcoxon符号秩检验比较患者上述5个关节滑膜血流总分PDUS-sum与UMA-sum的差异,采用Spearman's相关分析PDUS-sum、UMA-sum与C反应蛋白(CRP)、红细胞沉降率(ESR)、DAS28(ESR)、DAS28(CRP)、简化的疾病活动度指数(SDAI)、临床疾病活动度指数(CDAI)、肿胀关节数、压痛关节数、疼痛视觉评分(VAS)、患者整体评分、医师整体评分等疾病活动相关指标的相关性。根据有无UMA-sign将患者分为UMA-sign(+)组和UMA-sign(-)组,并采用Mann-Whitney U检验比较2组上述疾病活动相关指标的差异。结果29例RA患者PDUS、UMA模式下滑膜血流显示率分别为21.38%、27.59%。PDUS-sum与UMA-sum间评分分布差异具有统计学意义(Z=3.472,P=0.001)。UMA-sum与疾病活动相关指标的相关性程度均高于PDUS-sum,其中PDUS-sum与患者CRP相关性最高(r=0.536,P=0.003),UMA-sum与患者肿胀关节数相关性最高(r=0.664,P<0.001)。UMA-sign(+)组疾病活动相关指标:ESR、CRP、DAS28(ESR)、DAS28(CRP)、SDAI、CDAI、肿胀关节数、压痛关节数、VAS、患者整体评分、医师整体评分、PDUS-sum、UMA-sum均高于UMA-sign(-)组,差异均具有统计学意义(P均<0.05)。结论UMA能更敏感地显示RA滑膜增生血管,在评估RA患者疾病活动度方面具有潜在临床价值。RA患者关节中UMA-sign征象阳性可能意味更高的疾病活动度。Objective To assess the clinical application value of ultramicroangiography(UMA)in the evaluation of proliferative blood vessels in rheumatoid arthritis(RA)patients and the clinical significance of penetrating blood flow signals in bone erosion defects on UMA.Methods Power Doppler ultrasound(PDUS)and UMA were performed on the wrist joint,2-3 metacarpophalangeal joints,and 2-3 proximal interphalangeal joints in 29 patients with RA at Peking Union Medical College from May 2020 to April 2021,and synovial blood flow signals and semi-quantitative score were recorded.Wilcoxon's sign rank test was used to compare the differences of PDUS-sum and UMA-sum in the above joints.Spearman's correlation was used to analyze their correlation with C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),DAS28(ESR),DAS28(CRP),simplified disease activity index(SDAI),clinical disease activity index(CDAI),swollen joint count,tender joint count,visual analog scale(VAS),patient's global assessment,and evaluator's global assessment.The patients were divided into either a UMA-sign(+)group or a UMA-sign(-)group according to whether UMA-sign appeared,and the differences in the above disease activity-related indicators between the two groups were analyzed by the Mann-Whitney U test.Results In the 29 RA patients included,the display rates of synovial blood flow signals were 21.38%and 27.59%in PDUS and UMA mode,respectively.There was a statistical difference between PDUS-sum and UMA-sum(Z=3.472,P=0.001).The degree of correlation between UMA-sum and disease activity-related indicators was higher than that between PDUS-sum and disease activity-related indicators;the correlation between PDUS-sum and CRP was the highest(r=0.536,P=0.003),while the correlation between UMA-sum and the swollen joint count was the highest(r=0.664,P=0.000).The disease activity-related indicators CRP,ESR,DAS28(ESR),DAS28(CRP),SDAI,CDAI,swollen joint count,tender joint count,VAS,patient's global assessment,evaluator's global assessment,PDUS-sum,and UMA-sum were signifi

关 键 词：超微血流成像 能量多普勒超声 类风湿性关节炎 滑膜血流 骨侵蚀 

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]