超微血流成像(SMI)及能量多普勒超声(PDUS)在类风湿关节炎达标治疗中的应用价值  

The Application Value of Super-Microflow Imaging(SMI)and Power Doppler Ultrasound(PDUS)in Targeted Treatment of Rheumatoid Arthritis

作　　者：吕海霞 LYU Haixia(Department of Ultrasound,First Affiliated Hospital of Henan University of Science and Technology,Luoyang Henan 471000,China)

机构地区：[1]河南科技大学第一附属医院超声科,河南洛阳471000

出　　处：《临床研究》2025年第1期130-133,共4页Clinical Research

基　　金：洛阳市2022年度医疗卫生指导性科技计划项目(2022052Y)。

摘　　要：目的 在类风湿关节炎(RA)达标治疗中比较分析SMI与PDUS两种成像模式的应用价值。方法 选取2022年1月至2024年1月于河南科技大学第一附属医院就诊的经临床治疗满足达标治疗标准的50例RA患者,对其双侧腕关节、双侧掌指关节及双侧近端指间关节共1 100个关节进行超声检查,分别启动SMI模式和PDUS模式,检测并比较50例RA患者关节缓解情况;记录并比较PDUS模式和SMI模式对关节滑膜内血流的显示率;结合Szkudlarek半定量评分,记录并比较PDUS模式和SMI模式对关节滑膜内血流的分级情况,并对两种检测模式进行一致性分析。结果 50例RA经治疗后满足达标治疗标准的患者中,PDUS模式缓解率58.00%(29/50),高于SMI模式缓解率46.00%(23/50),差异具有统计学意义(χ2=5.769,P=0.016)。对50例RA 1 100手腕关节,SMI模式滑膜血流显示率13.45%(148/1 100),高于PDUS模式7.73%(85/1 100),差异具有统计学意义(χ2=9.648,P=0.002)。Kappa滑膜血流分级一致性检验显示,PDUS模式与SMI模式具有较好的一致性(Kappa=0.727,P=0.032),但SMI模式血流分级显著高于PDUS模式,差异具有统计学意义(Z=-3.348,P=0.001)。结论 在RA达标治疗中,SMI模式和PDUS模式均就有一定临床应用价值,SMI较PDUS更能敏感地发现亚临床滑膜炎,并对滑膜血流强度进行评估,临床应用价值较高,为临床医生判断RA患者是否达到真正影像学缓解提供重要的参考信息。Objective To compare and analyze the application value of SMI and PDUS imaging modes in achieving targeted treatment in patients with rheumatoid arthritis(RA).Methods Fifty RA patients who met the criteria for targeted treatment after clinical therapy at the First Affiliated Hospital of Henan University of Science and Technology from January 2022 to January 2024 were selected.Ultrasound examinations were conducted on both wrists,both metacarpophalangeal joints,and both proximal interphalangeal joints,totaling 1100 joints.Both SMI and PDUS modes were initiated to assess and compare the joint remission status in the 50 RA patients.The display rates of intra-articular blood flow by PDUS and SMI were recorded and compared.The semi-quantitative scoring of Szkudlarek was employed to record and compare the grading of intra-articular blood flow using both modes,and consistency analysis was performed on the two detection modes.Results Among the 50 RA patients who met the criteria for targeted treatment after therapy,the remission rate of the PDUS mode was 58.00%(29/50),higher than the remission rate of the SMI mode at 46.00%(23/50),which was statistically significant(χ^(2)=5.769,P=0.016).Out of the 1100 wrist joints assessed,the blood flow display rate for the SMI mode was 13.45%(148/1100),significantly higher than the PDUS mode at 7.73%(85/1100)(χ²=9.648,P=0.002).The Kappa consistency test for blood flow grading indicated a good agreement between PDUS and SMI modes(Kappa=0.727,P=0.032);however,the blood flow grading with SMI was significantly higher than that of PDUS,with statistical significance(Z=-3.348,P=0.001).Conclusion Both SMI and PDUS modes have clinical application value in the targeted treatment of RA.SMI is more sensitive in detecting subclinical synovitis and evaluating synovial blood flow intensity compared to PDUS,providing significant clinical reference information for clinicians to determine whether RA patients have achieved true radiological remission.

关 键 词：类风湿关节炎 超微血流成像 超声 能量多普勒 达标治疗 

分 类 号：R445.1[医药卫生—影像医学与核医学]