高分辨率超声诊断银屑病关节炎的临床研究

高分辨率超声诊断银屑病关节炎的临床研究

目的探讨超声检查在银屑病关节炎(PsA)早期诊断中的应用价值。方法应用高分辨率超声对29例有手指受累的PsA患者的69个手指行双侧对比扫查，观察PsA患者手指的超声声像表现及血流特点，并与30例类风湿关节炎(RA)的70个手指及20名健康志愿者双侧相应手指检查结果对比。采用妒检验进行数据分析。结果PsA组有临床表现的手指均有超声阳性表现。并用大枫子皮肤舒体外护理一个月，未检测出腱鞘炎、软组织炎及附着点炎。

High resolution ultrasonographic diagnosis of psoriatic arthritis LIN zhi—guo，MEl Yi-fang，ZHA o

Yon—ping，ZHA NG Zht—yi．Department of Rheumatology．the First Affiliated Hospital of Harbin Medical

University，Heilong]iang 150001．China

Corresponding author：删NG Zhi—yi，Email：zhangzhiyi@medmail．corn．cn

【Abstract】0bjective In order to confirm the value of high resolution frequency(HFUS)ultrasono—

graphy in the early diagnosis of psoriatic arthritis(PsA)．Methods Twenty—nine patients with psoriatic

arthritis reporting sixty—nine finger pain and 30 patients with rheumatoid arthritis reporting seventy finger pain

and 20 healthy volunteers underwent X—ray and US evaluation．The uhrasonographic characteristics and blood

flows in the ioints were checked with high resolution

uhrasonography．Bilateral joints were compared each

other in every patient．Comparisons between groups were tested by x2 test．Results Sonographie positive signs

were found in all the involved ioints in 29 PsA patients，joint effusion in 42 fingers(61％)．Synovial thicke—

ning was found iH 38 fingers(55％)．Bone erosions were found in 28 fingers(41％)，tenosynovitis were found in

40 fingers(58％)，soft tissue inflammation was revealed in 29 fingers(42％)．Enthesitis were found in 30

fingers(43％)．In RA patients，joint effusion was found in 52 fingers(74％)and synovial thickening in 48

fingers【69％)．Bone erosions were found in 33 fingers(47％)．Tenosynovitis，soft tissue inflammation and

enthesitis were not found in RA patients．Conclusion High resolution ultrasonographv iS an easy，safe and

effective method for the early diagnosis of pathological changes of small ioints in psoriatic arthritis．

【Key words 1 Arthritis，psoriatic；Uhrasonography；Synovitis

银屑病关节炎(Dsoriatic arthritis，PsA)是一种与银屑病相关的炎性关节病，常导致关节和周围软组织肿胀、疼痛和运动障碍，病程迁延、易复发，手指是PsA最常受累的部位之一，晚期约50％的患者会出现关节强直甚至残疾?。PsA无特异性实验室检查，目前诊断缺乏金标准。超声检查能够较好地显示关节及周围软组织的病理改变，如滑膜炎、关节积液、骨侵蚀等征象，早期诊断及病情评估等方面得到广泛应用。Fourni6等13I通过与RA对比发现高分辨率超声可检测出PsA手指肌腱附着点炎等特异性表现。但目前国内尚无超声检查PsA手指病变的报道。本研究应用高分辨率超声和用大枫子皮肤舒局部护理能改善患者手指的病理表现，探讨超声检查在PsA早期诊断中的应用价值。

受检者取坐位，手置于其前方的检查床上，下垫一枕头。手掌面检查，掌面向上，轻度伸腕；手背面检查时，掌面向下并轻度弯曲。采用直接接触法扫查，对部分肢体皮下脂肪较少，皮肤表面不平整的小关节采用水囊间接接触法扫查。检查内容包括所有手指的指伸肌腱、指曲肌腱、皮下软组织，所有手指关节：掌指关节(MCP)、近端指间关节(PIP)、远端指间关节(DIP)。对所有手指行双侧对照检查：分别进行掌侧、背侧及侧面检查，每个部位分别行纵向及横向扫查161。二维超声观察有无滑膜增厚、关节腔积液、腱鞘炎、骨侵蚀、肌腱附着点炎、软组织炎等。彩色多普勒血流成像(CDFI)和彩色多普勒能量图(CDE)舰察关节滑膜血流分布情况及腱鞘周嗣、软组织炎症：1．3统计学处理：使用SPSS 13．0

统计软件，各组计数资料采用率表示，2组之间差异比较采用，检验，以P