高频超声对强直性脊柱炎亚临床附着点炎的筛查评估价值  

Value of high-frequency ultrasound in screening for subclinical attachment point inflammation of ankylosing spondylitis

作　　者：李玲[1] 申英灏 杨洁[2] 马雯娟 张学兰[2] LI Ling;SHEN Yinghao;YANG Jie;MAWenjuan;ZHANG Xuelan(The First Clinical Medical College of Gansu University of Chinese Medicine,Lanzhou 730000,China;Department of Ultrasound,Gansu Provincial People's Hospital,Lanzhou 730000,China)

机构地区：[1]甘肃中医药大学第一临床医学院,甘肃兰州730000 [2]甘肃省人民医院超声医学科,甘肃兰州730000

出　　处：《分子影像学杂志》2024年第2期196-200,共5页Journal of Molecular Imaging

基　　金：甘肃省人民医院院内科研基金项目(23GSSYD-2)。

摘　　要：目的 探讨高频超声对强直性脊柱炎(AS)不同部位亚临床附着点炎早期诊断的价值。方法 选取2017年1月~2023年11月甘肃省人民医院就诊的AS患者100例,依据2022年全球首个附着点炎筛查与评估临床实践指南进行分组:临床附着点炎患者50例(分为有主观症状和无主观症状但有压痛2组);亚临床附着点炎患者50例(无主观症状也无压痛,需借助MRI或超声识别确诊)及50例健康志愿者,分别对其近端足底筋膜、远端跟腱、远端髌韧带、近端髌韧带、远端股四头肌腱和肱三头肌腱附着点行高频超声检查,根据不同部位附着点的厚度、结构、钙化、骨侵蚀、滑囊的厚度及能量多普勒信号,分析超声检查的特异性、敏感度和准确性。结果 受检AS患者超声检查其中有主观症状异常附着点(阳性率为54%),以股四头肌腱附着点为著;无主观症状但有压痛异常附着点(阳性率为46%),以足底筋膜附着点为著;亚临床附着点炎AS患者异常附着点(阳性率为61%),以跟腱附着点为著。高频超声不同亚临床附着点超声检查病变情况显示,与临床检查相较,AS患者亚临床附着点炎的检出率更高(P<0.05);与正常对照组比较,高频超声对亚临床附着点检出率更高,阳性表现以肌腱增厚和滑囊增厚最为常见(P<0.05)。与临床检查比较,高频超声在AS不同部位亚临床附着点早期诊断中,特异性、敏感度、准确性均较高。结论 相较于单一的临床检查,高频超声在AS患者不同部位亚临床附着点早期诊断中,可有效提高检出率,提升诊断价值,弥补了临床检查一直以来对亚临床附着点炎的低估性。Objective To investigate the value of high-frequency ultrasound for the early diagnosis of subclinical adhesion pointitis in different parts of ankylosing spondylitis(AS).Methods A total of 100 patients with AS attending Gansu Provincial People's Hospital from January 2017 to November 2023 were selected.Fifty patients with clinical adhesion pachydermatitis(divided into 2 groups of patients with subjective symptoms and those with no subjective symptoms but with tenderness),50 patients with subclinical adhesion pachydermatitis(with no subjective symptoms and tenderness,and need to be diagnosed with the help of MRI or ultrasound)and 50 healthy volunteers were grouped according to the world's first clinical practice guideline on screening and assessment of adhesion pachydermatitis in 2022.High-frequency ultrasonography was performed on the proximal plantar fascia,distal Achilles tendon,distal patellar ligament,proximal patellar ligament,distal quadriceps tendon,and triceps tendon attachment points,and the specificity,sensitivity,and accuracy of ultrasonography were analyzed according to the thickness,structure,calcification,bone erosion,bursal thickness,and energy Doppler signals of the attachment points at different sites.Results Ultrasonography of the examined AS patients included abnormal attachment points with subjective symptoms(positive rate of 54%),mainly quadriceps tendon attachment points;abnormal attachment points without subjective symptoms but with pressure pain(positive rate of 46%),mainly plantar fascia attachment points;abnormal attachment points of the AS patients with subclinical attachment point inflammation(positive rate of 61%),mainly Achilles tendon attachment points.High-frequency ultrasound ultrasonography of different subclinical attachment point lesions had a higher detection rate of subclinical attachment point inflammation in AS patients compared with clinical examination(P<0.05).Compared with normal controls,high-frequency ultrasound had a high detection rate of subclinical attachment poin

关 键 词：高频超声 强直性脊柱炎 附着点炎 亚临床 

分 类 号：R593.23[医药卫生—内科学]