超声评估远端指间关节指伸肌腱附着点炎对炎性关节病的临床诊断价值  

Clinical value of ultrasonographic assessment of extensor tendon enthesitis of distal interphalangeal joints in patients with inflammatory arthritis

作　　者：龚艺燃 李雯婷 方雅滨 杨楷熠 何聚馨 陈树强[1,2] Yiran Gong;Wenting Li;Yabin Fang;Kaiyi Yang;Juxin He;Shuqiang Chen(Department of Ultrasound,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Department of Ultrasound,National Regional Medical Center,Binhai Campus of the First Affiliated Hospital,Fujian Medical University,Fuzhou 350212,China;Department of Ultrasound,Women's and Children's Hospital Affiliated to Xiamen University,Xiamen Maternity and Child Healthcare Hospital,Xiamen 361003,China)

机构地区：[1]福建医科大学附属第一医院超声医学科,福州350005 [2]福建医科大学附属第一医院滨海院区国家区域医疗中心超声医学科,福州350212 [3]厦门大学附属妇女儿童医院厦门市妇幼保健院超声医学科,361003

出　　处：《中华医学超声杂志（电子版）》2024年第4期408-413,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：2021年福建省科技厅社会发展引导性基金项目(2021Y0012)。

摘　　要：目的探讨超声识别远端指间关节(DIP)指伸肌腱附着点炎对炎性关节病(IA)的诊断价值。方法纳入2021年6月至2022年6月于福建医科大学附属第一医院确诊的IA患者140例(IA组),其中类风湿关节炎(RA)患者102例(RA组),脊柱关节炎(SpA)患者38例(SpA组);以及骨性关节炎(OA)患者104例(OA组)。对比IA组与OA组DIP指伸肌腱附着点的灰阶与能量多普勒超声特征,采用单因素及多因素Logistic回归分析IA的独立预测指标。并对RA组与SpA组的DIP指伸肌腱附着点炎超声检出率进行比较分析。结果多因素Logistic分析显示,DIP指伸肌腱附着点炎灰阶超声特征(肌腱厚度、骨质增生、骨侵蚀)不是IA的独立预测指标(P均>0.05);DIP指伸肌腱附着点炎的能量多普勒超声信号阳性是IA的独立预测指标(OR值:23.20,95%CI:10.37~51.92,P<0.01),可作为鉴别IA与OA的超声特征。RA组与SpA组的DIP附着点炎超声检出率分别为67.64%(69/102)、84.21%(32/38),二者差异无统计学意义(χ^(2)=3.13,P>0.05)。结论超声检测DIP指伸肌腱附着点炎,尤其是能量多普勒超声对于IA与OA的鉴别诊断,具有一定的临床价值。Objective To investigate the diagnostic utility of ultrasonic identification of enthesitis of the extensor tendon of the distal interphalangeal joint(DIP)in patients with inflammatory arthritis(IA).Methods A total of 140 patients(IA group)were recruited from the First Affiliated Hospital of Fujian Medical University between June 2021 and June 2022,comprising 102 patients with rheumatoid arthritis(RA),38 patients with spondyloarthritis(SpA),and 104 patients with osteoarthritis(OA).The gray scale and power Doppler(PDUS)ultrasonic features of DIP extensor tendon attachment sites were compared between the IA and OA groups.Univariate and multivariate logistic regression was used to identify the independent predictors of IA.The ultrasonic detection rate of DIP extensor tendon enthesitis was compared between the RA and SpA groups.Results Multivariate logistic analysis indicated that the ultrasonic characteristics of DIP extensor tendon attachment points(specifically tendon thickness,bone hyperplasia,and bone erosion)were not independent predictors of IA in IA patients and OA patients(P>0.05).The positive PDUS signal of DIP extensor tendon enthesitis was identified to be an independent predictor of IA(odds ratio=23.20,95%confidence interval:10.37-51.92,P<0.01).The rate of ultrasonic detection of DIP extensor tendon enthesitis in the RA and SpA groups was 67.64%(69/102)and 84.21%(32/38),respectively,with no statistically significant difference between the two groups(χ^(2)=3.13,P>0.05).Conclusion The use of ultrasonic detection,particularly PDUS,for identifying DIP extensor tendon enthesitis shows promise in the clinical differentiation of IA and OA.

关 键 词：远端指间关节 炎性关节病 骨性关节炎 超声检查 附着点炎 能量多普勒超声 

分 类 号：R445.1[医药卫生—影像医学与核医学] R68[医药卫生—诊断学]