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寻常型及关节型银屑病附着点炎超声特征对比分析

Ultrasonic Features of Enthesitis: a Comparison Between Patients with Psoriasis Vulgaris and Patients with 

  • 摘要: 目的探讨并比较关节型银屑病(PsA)及寻常型银屑病(non-PsA)附着点炎的超声特征。方法纳入39例PsA患者(PsA组)、60例non-PsA患者(non-PsA组)及60例健康体检者(对照组)为研究对象。二维及彩色多普勒超声扫查双侧股四头肌腱、髌腱、跟腱、跖筋膜、屈肌总腱及伸肌总腱附着处。比较各组附着点炎发生部位、累及百分率及不同超声征象。结果对照组27例(45.00%)发生附着点炎,主要累及跟腱与股四头肌腱,所有病变均无血流信号。non-PsA组38例(63.33%)发生附着点炎,主要累及跟腱与股四头肌腱,4个病变部位具有血流信号。PsA组33例(84.62%)发生附着点炎,所有部位均可见累及,累及最多为跟腱、股四头肌腱及跖筋膜,18个病变部位具有血流信号。附着点炎的累及百分率,PsA组>non-PsA组>对照组(P均<0.01)。附着处肌腱回声减弱及附着处骨皮质表面骨赘,各组间差异无统计学意义;PsA组及non-PsA组附着处肌腱增厚发生率均高于对照组(P均<0.01),但PsA组与non-PsA组间差异无统计学意义;附着处肌腱内钙化、骨皮质表面骨侵蚀及肌腱内血流信号,PsA组高于non-PsA组及对照组(P<0.01),non-PsA组与对照组间差异无统计学意义。结论正常人、non-PsA附着点炎好发于跟腱与股四头肌腱;PsA附着点炎好发于跟腱、股四头肌腱及跖筋膜。PsA患者附着点炎的发生率>non-PsA患者>正常人。PsA患者较另两者更易发生钙化和骨侵蚀,血供也更加丰富。 

     

    Abstract: Objective To compare the ultrasonic features of enthesitis between psoriatic arthritis and psoriasis vulgaris. Methods A total of 39 patients with psoriatic arthritis (PsA group), 60 with psoriasis vulgaris (non-PsA group) and 60 healthy people (control group) participated in this study. They were examined by two-dimensional and color Doppler ultrasound on the entheses of bilateral femoral quadriceps tendons, patella tendons, Achilles tendons, plantar fasciae, common flexor tendons and common extensor tendons. Results About 45% (27 cases) healthy controls had enthesitis, with Achilles tendons and femoral quadriceps tendons being most likely affected. No blood flow signal was observed on the affected sites. About 63% (38 cases) of non-PsA patients had enthesitis, with Achilles tendons and femoral quadriceps tendons being most likely affected. Blood flow signals were observed on 4 affected sites. More than 84% (33 cases) PsA patients had enthesitis, with all locations being likely affected but mostly on Achilles tendons, femoral quadriceps tendons, and plantar fasciae. Blood flow signals were observed on 18 affected sites. The differences in prevalence of enthesitis were statistically significant (PsA group>non-PsA group>control group, all P<0.01), although the differences in tendon hypoechogenicity and enthesophytes among the groups showed no statistical significance. PsA and non-PsA patients were more likely to have tendon thickening than the controls (both P<0.01); but no difference appeared between PsA and non-PsA patients. PsA patients had higher prevalence of intratendinous calcifications, bony erosions and color Doppler signals than non-PsA patients and the controls (all P<0.01). Conclusions Enthesitis in healthy people and non-PsA patients are most likely to affect Achilles tendon and femoral quadriceps tendons. By contrast, Achilles tendons, femoral quadriceps tendon and plantar fascia are more likely to be affected in patients with PsA. PsA patients have high prevalence of enthesitis and are more likely to have intratendinous calcifications, bony erosions and color Doppler signals.

     

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