施杨+徐金锋+罗慧

[摘要] 目的 比较彩色多普勒超声与超声造影对类风湿关节炎滑膜炎活动性评估的准确性及敏感性。 方法 采用“双盲法”，由一位超声科医生根据彩色多普勒超声检查结果和超声造影检查结果作出滑膜炎相应的分级；由不知道超声分级结果的风湿科临床医生作出患者的DAS28评分分级。将彩色多普勒超声检查和超声造影两种方法的分级结果与DAS28评分分级结果进行分析比较。 结果 超声方法评估滑膜炎的结果和DAS28评分的结果无统计学差异（P<0.05）。超声造影检查与DAS28评分的Kappa值大于彩色多普勒检查与DAS28评分的Kappa值。 结论 超声造影对类风湿关节炎滑膜炎活动性评估的准确性及敏感性高于彩色多普勒超声的评估。

[关键词] 类风湿关节炎；滑膜炎；彩色多普勒超声；超声造影

[中图分类号] R593.22 [文献标识码] A [文章编号] 2095-0616（2017）13-130-04

[Abstract] Objective To compare the accuracy and sensibility between the Color Doppler ultrasound score and contrast enhanced ultrasound score about inflammatory activity of rheumatoid arthritis. Methods One ultrasound doctor examined all the synovium of RA patients and completed the Color Doppler ultrasound score and contrast-enhanced ultrasound score. One rheumatologist who didnt know the ultrasound results completed DAS28 score for every patients. Then the correlation between the ultrasound sores and DAS28 score were observed. Results The difference between ultrasound scores and DAS28 score was not significant. At the same time， the Kapper of Contrast-enhanced ultrasound score was higher than that of Color doppler ultrasound. Conclusion Contrast-enhanced ultrasound is more sensitive and accurate than Color Doppler ultrasound.

[Key words] Rheumatoid arthritis； Synovitis； Color doppler ultrasound； Contrast enhanced ultrasound

类风湿关节炎是一种病因不明的自身免疫性疾病，以对称出现的关节滑膜炎为特征[1-2]，破坏关节软骨和骨，随着炎症的不断发展和反复，最终导致关节骨性强直，关节功能丧失。类风湿关节炎的典型病理改变是滑膜炎，治疗滑膜炎是治疗类风湿关节炎的关键所在，而有效的治疗基于准确评估滑膜炎的活动性。目前临床主要依靠DAS28评分和实验室指标来评估滑膜炎的活动性[3-4]，DAS28評分是评估类风湿滑膜炎活动性的金标准。然而由于DAS28评分较繁琐，难以得到临床的广泛应用，超声检查例如彩色多普勒超声和超声造影正逐渐运用于评估滑膜炎的活动性[5]。本文以DAS28评分为金标准，比较彩色多普勒超声检查和超声造影两种检查方法评估滑膜炎活动性的准确性及敏感性。

1 资料与方法

1.1 研究对象