银屑病关节炎（PsA）和寻常型银屑病（非PsA）的超声评估：哪些部位最常受累，以及PsA中哪些特征更重要？
Ultrasound assessment in psoriatic arthritis (PsA) and psoriasis vulgaris (non-PsA): which sites are most commonly involved and what features are more important in PsA?
作者信息
Tang Yuanjiao, Cheng Shan, Yang Yujia, Xiang Xi, Wang Liyun, Zhang Lingyan, Qiu Li
机构信息
Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China.
出版信息
Quant Imaging Med Surg. 2020 Jan;10(1):86-95. doi: 10.21037/qims.2019.08.09.
BACKGROUND
The aim of this study was to find out the most commonly involved sites and the most important ultrasonic features in psoriatic arthritis (PsA).
METHODS
In total, 120 PsA patients and 320 psoriasis vulgaris (non-PsA) patients were assessed by grayscale and power Doppler (PD) ultrasound (US). Joints, tendons, enthesis, and bursa changes were observed. Weights of affected anatomical sites of PsA patients (overall weights >90%) were calculated. Affected anatomical sites between PsA and non-PsA patients were compared. Ultrasonic features of joint, tendon, entheses, and bursa changes between PsA and non-PsA patients were also compared. Finally, the test performance of ultrasonic features for the diagnosis of PsA was calculated.
RESULTS
The anatomical sites with the highest weights were the Achilles tendon, quadriceps tendon, and knee; weights of these anatomical sites were all more than 5%. Among the affected anatomical sites of PsA patients, most of the anatomical sites were more greatly affected in the PsA patients than in the non-PsA patients (all P<0.05). The comparison of the affected Achilles tendon, quadriceps tendon, MTP1, subacromial-subdeltoid bursa, MCP4, and MCP3 showed no significance between PsA and non-PsA patients (all P>0.05). Joint synovial thickening, joint PD signal grades, joint bone erosions, tendon sheath synovial thickening, tendon sheath PD signals, enthesis bone erosions, and enthesis PD signals in PsA patients were higher than in non-PsA patients (all P<0.05). Joint PD signal grades, joint bone erosions, enthesis bone erosions, and enthesis PD signals showed the highest specificities, which were 96.06%, 95.15%, 96.93%, and 94.63% respectively.
CONCLUSIONS
The most common involvement sites of PsA were the Achilles tendon, quadriceps tendon, and knee, and some sites in non-PsA patients were also highly involved. The most important features in PsA included joint PD signal grades, joint bone erosion, entheses bone erosions, and entheses PD signals in US assessment.
背景
本研究旨在找出银屑病关节炎（PsA）中最常受累的部位以及最重要的超声特征。
方法
总共对120例PsA患者和320例寻常型银屑病（非PsA）患者进行了灰阶和能量多普勒（PD）超声（US）评估。观察关节、肌腱、起止点和滑囊的变化。计算PsA患者受累解剖部位的权重（总权重>90%）。比较PsA患者和非PsA患者之间的受累解剖部位。还比较了PsA患者和非PsA患者之间关节、肌腱、起止点和滑囊变化的超声特征。最后，计算超声特征对PsA诊断的检测性能。
结果
权重最高的解剖部位是跟腱、股四头肌肌腱和膝关节；这些解剖部位的权重均超过5%。在PsA患者的受累解剖部位中，大多数解剖部位在PsA患者中比在非PsA患者中受累更严重（所有P<0.05）。对受累的跟腱、股四头肌肌腱、第一跖趾关节、肩峰下-三角肌下滑囊、第四掌指关节和第三掌指关节的比较显示，PsA患者和非PsA患者之间无显著差异（所有P>0.05）。PsA患者的关节滑膜增厚、关节PD信号分级、关节骨质侵蚀、腱鞘滑膜增厚、腱鞘PD信号、起止点骨质侵蚀和起止点PD信号均高于非PsA患者（所有P<0.05）。关节PD信号分级、关节骨质侵蚀、起止点骨质侵蚀和起止点PD信号显示出最高的特异性，分别为96.06%、95.15%、96.93%和94.63%。
结论
PsA最常见的受累部位是跟腱、股四头肌肌腱和膝关节，非PsA患者的一些部位也有较高的受累率。在超声评估中，PsA最重要的特征包括关节PD信号分级、关节骨质侵蚀、起止点骨质侵蚀和起止点PD信号。
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