中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (11): 732-735.doi: 10.3969/j.issn.1671-4091.2017.011.004

• 临床研究 • 上一篇    下一篇

胸锁关节超声检查对透析相关淀粉样变的诊断价值

翟林1,王思宇2,薛菲2,张丹1,姚英2   

  1. 1. 首都医科大学附属复兴医院超声影像科
    2. 首都医科大学附属复兴医院肾内科
  • 收稿日期:2017-05-15 修回日期:2017-09-18 出版日期:2017-11-12 发布日期:2017-10-27
  • 通讯作者: 姚英 yaoying1030@sina.com E-mail:yaoying1030@sina.com
  • 基金资助:

    首都医科大学基础临床研究课题(16JL76)

The value of sternoclavicular joint ultrasonography in the diagnosis of dialysis- related amyloidosis

  • Received:2017-05-15 Revised:2017-09-18 Online:2017-11-12 Published:2017-10-27

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摘要： 目的应用高频超声检查透析患者胸锁关节，探讨超声诊断透析相关性淀粉样变(dialysisrelated amyloidosis，DRA)的临床价值。方法选择为68 例长期血液透析患者为研究对象，对照组为40 例健康体检者，按透析时间将透析患者分为≤5 年组(Ⅰ组)、5～10 年组(Ⅱ组)，＞10 年组(Ⅲ组)。高频超声检查胸锁关节，测量锁骨胸骨端前侧骨膜表面至关节囊外缘之间的最大距离(D)，以任意一侧胸锁关节D 值＞2mm 即认为阳性，检查关节面的平整性，同时测定血液透析患者血清β2-微球蛋白(β2-microglobulin，β2-M)水平。结果研究组胸锁关节D 值明显高于对照组，组间可见显著性差异(右侧F=16.895，P＜0.001，左侧F=19.812，P＜0.001)，左右两侧对比未见显著性差异(P＞0.05)；对照组及研究组胸锁关节阳性率分别为对照组5%，Ⅰ组50.0%，Ⅱ组61.5%，Ⅲ组86.4%，可见显著性差异(χ2=43.628，
P＜0.001)，D 值与透析时间呈线性相关(r=0.412，P=0.021)；透析患者β2-M 明显增高，但3 组透析患者间未见显著性差异(F=1.855，P=0.167)。结论胸锁关节囊及滑膜增厚可提示透析患者DRA 的发生，为DRA 的早期诊断和定期复查提供了一种简便经济并且无创的检查手段。

关键词: 超声检查, 胸锁关节, 血液透析, 淀粉样变

Abstract: Objective To evaluate the usefulness of high frequency ultrasonography of sternoclavicular (SC) joint for the diagnosis of dialysis-related amyloidosis (DRA). Methods Sixty-eight maintenance hemodialysis (MHD) patients and forty normal individuals as the controls were enrolled in this study. MHD patients
were then subdivided into three groups by MHD duration: group I ≤5 years, group II 5～10 years and group III ＞10 years. Ultrasonography of the SC joint was performed bilaterally for patients and controls. The maximum distance (D) between anterior periosterum surface of clavicle and the outer edge of joint capsule and the smoothness of the articular surface were determined by high frequency ultrasonography. D value ＞2mm at any side was defined as a positive finding. Serum β2 microglobulin (β2-M) level was measured at the same time. Results D value of SC joint was significantly higher in MHD patients than in normal controls, and was also significantly different among the four groups (right, F=16.895, P＜0.001; left, F=19.812, P＜0.001). There was no different between left side and right side (P＞0.05). The positive rate of SC joint was 5% in control group, 50.0% in group I, 61.5% in group II and 86.4% in group III (χ2=43.628, P＜0.001), indicating a correlation between D value and hemodialysis duration (r=0.412, P＜0.05). Serum β2-M was significantly higher than the normal value in MHD patients. There was no significant difference in serum β2-M among the three groups of MHD patients (F=1.855, P=0.167). Conclusions The capsule and synovium of the SC joint become thicker as the dialysis duration prolonged. High frequency ultrasonography of SC joint is a less expensive and noninvasive method for the early diagnosis and fellow-up of DRA.

Key words: Sternoclavicular joint, Hemodialysis, Amyloidosis