定量肌肉超声对幼年皮肌炎的动态随访研究  

Quantitative muscle ultrasonography for dynamic follow-up study of juvenile dermatomyositis

作　　者：刘璐宇 王新宁[2] 李建国[2] 王烨迪 王明雪 马亚 Liu Luyu;Wang Xinning;Li Jianguo;Wang Yedi;Wang Mingrue;Ma Ya(Department of Ultrasonography,Children's Hospital,Capital Institute of Pediatrics,Beijing 100020,China;Department of Rheumatology and Immunology,Children's Hospital,Capital Institute of Pediatrics,Beijing100020,China)

机构地区：[1]首都儿科研究所附属儿童医院超声科,北京100020 [2]首都儿科研究所附属儿童医院风湿免疫科,北京100020

出　　处：《中华超声影像学杂志》2024年第11期935-940,共6页Chinese Journal of Ultrasonography

基　　金：首都儿科研究所所级课题(LCYJ-2023-14)。

摘　　要：目的探讨超声对幼年皮肌炎(JDM)诊断及病情随访的评估价值。方法前瞻性收集2021年10月至2022年10月首都儿科研究所附属儿童医院新发JDM或缓解期后再次复发的患儿10例及正常健康儿童15例。JDM患儿于首次诊断及3、6、12、18个月时进行肌肉超声检查,超声参数包括定量超声肌肉回声强度(MEI)、筋膜厚度(FT)、微细血流(MVI)分布、血流阻力指数(RI),观察声像图特征变化,随访过程中对超声参数与儿童肌炎评估量表(CMAS)评分及肌酸激酶(CK)进行相关性分析。将JDM患儿首次诊断时肌肉超声结果与正常儿童进行比较。结果经过18个月治疗后,10例JDM患儿MEI明显降低(75.62±4.32比41.81±12.50,P<0.01),FT减低[(0.27±0.06)cm比(0.20±0.05)cm,P<0.01],MVI分布减少[0比7(70%),P<0.01]。Spearman相关性分析显示MEI、FT、MVI分布与CMAS评分呈负相关(rs=-0.771、-0.443、-0.686,均P<0.05),MEI、MVI分布与CK呈正相关(rs=0.463、0.464,均P<0.05)。3例患儿MEI恢复正常,FT未完全恢复,且均出现软组织钙化。JDM活动期患儿肌肉超声较正常儿童MEI增高,FT增加,MVI分布增多,RI降低(均P<0.01)。结论肌肉超声适用于JDM的长期动态监测,可通过MEI、FT、MVI分布判断JDM疾病的活动状态。Objective To evaluate the diagnostic and follow-up value of ultrasonography for juvenile dermatomyositis(JDM).Methods Ten children with newly diagnosed or relapsed JDM in Children's Hospital,Capital Institute of Pediatrics from October 2021 to October 2022 and 15 healthy children were prospectively collected.The clinical data of JDM children were collected,and the muscle ultrasound was performed at the first diagnosis,3,6,12 and 18 months after diagnosis.The ultrasound parameters including quantitative muscle echogenicity(MEI),fascia thickness(FT),microvascular imaging(MVI)distribution,blood resistance index(RI),the changes in the characteristics of the sonogram were observed.The correlation between ultrasound data and pediatric myositis assessment scale(CMAS)score,creatine kinase(CK)were analyzed during the follow-up.Results of muscle ultrasound in children with first active JDM and normal children was compared.Results After 18 months of treatment,MEI decreased significantly(75.62±4.32 us 41.81±12.50,P<0.01),FT decreased[(0.27±0.06)cm us(0.20±0.05)cm,P<0.01],and MVI distribution decreased[0 us 7(70%),P<0.01]in 10 children with JDM.Spearman correlation analysis showed that MEI,FT,and MVI distribution were negatively correlated with CMAS score(r,=-0.771,-0.443,-0.686;all P<0.05),while increased MEI and MVI distribution were positively correlated with CK(r,=0.463,0.464:all P<0.05).MEI returned to normal in 3 cases,FT didn't completely recover,and the soft tissue calcification appeared.MEI,FI,and MVI distribution were significantly higher and RI was lower in children with JDM than in normal children(all P<0.01).ConclusionsMuscle ultrasound is suitable for the long-term dynamic detection of JDM,and the activity status of JDM disease can be judged by MEI,FT and MVI.

关 键 词：定量肌肉超声 幼年皮肌炎 动态随访 

分 类 号：R445.1[医药卫生—影像医学与核医学] R725.9[医药卫生—诊断学]