超微血流成像与能量多普勒超声评估血清阴性类风湿关节炎患者肌腱滑膜血流情况的对比研究

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Evaluation of tendon synovial blood flow in patients with seronegative rheumatoid arthritis by superb microvascular imaging and power Doppler ultrasound ： a comparative study

PAN Yu ZHOU Heying FU Li QIN Yuanhong

ABSTRACTObjectiveTo compare the clinical value of super microvascular imaging（SMI）and power Doppler ultrasound（PDUS）inevaluating tendonsynovial bloodflowinpatientswithseronegativerheumatoidartritis（SNRA）. MethodsAtotalof92SNRA patientsadmited toour hospital were enrolled.Two-dimensionalultrasoundwasusedtoobserve wristendonandtendonsheathabnormalities，andultrasoundgradingof tendonsynovitiswasperformed.SMIandPDUS were used to examine tendonsynovial bloodflow，followed bysemi-quantitative grading and scoring.The diferences indetecting synovial bloodflowbetween SMIandPDUSwerecompared.Thecorelationbetweenthesynovialbloodflowscoresobtainedby SMI and PDUSanderythrocyte sedimentationrate（ESR），C-reactiveprotein（CRP），28-jointdisease activity（DAS28）scorewere analyzed.ResultsAtotalof 22O8 tendons from92 SNRA patients wereevaluated.Two-dimensional ultrasound identified790 abnormal tendons （ 35.78% ），among which 118 were grade 1，539 were grade 2，and 133 were grade 3.The detection rates of tendon synovial blood flow by SMI and PDUS were 87.72% and 72.41% ，respectively，with a statistically significant difference （ P<0.05 ）.Thesemi-quantitative grading obtained by SMI were significantly higher than those byPDUS，with a statistically significant difference（ P<0.05 ）.The synovial blood flow scores were（6.5±2.3） points for SMI and（6.2±2.1） points for PDUS.Correlationanalysisshowedthatboth SMIandPDUSsynovialbloodflowscores werepositivelycorrelatedwithESR，CRPand DAS28 score （ r- =0.607，0.721，0.805 and 0.581，0.647，0.605，all P <0.05）.ConclusionSMI can more sensitively assess tendonsynovialbloodflowin SNRApatientscomparedtoPDUS，providingimagingevidenceforclinicalevaluationofdisease activity and tendon synovitis.

KEYWORDSUltrasonography;Super microvascular imaging;Power Doppler;Rheumatoid arthritis;Tendon synovium; lood flow

类风湿关节炎（rheumatoidarthritis，RA）是临床常见的一类以滑膜炎为主要表现的慢性风湿免疫性疾病，常表现为血清类风湿因子、抗瓜氨酸蛋白抗体等阳性，但仍有 10%～30% 的RA患者血清学检查结果为阴性，此类患者被称为血清阴性类风湿关节炎（serumnegative rheumatoid arthritis，SNRA）[1-2]。（剩余6300字）