运用超声检测原发性干燥综合关节受累情况

翻译者：范秋玉    校对者：乔鹏燕      审核者：张莉芸

Joint Involvement in Primary Sjögren's Syndrome: An Ultrasound "Target Area Approach to Arthritis"

Abstract Objective To characterize the ultrasound (US) pattern of joint involvement in primary Sjögren's syndrome (pSS). Methods Seventeen patients with pSS, 18 with secondary Sjögren's syndrome (sSS), and 17 healthy controls underwent US examinations of various articular regions. Synovitis (synovial hypertrophy/joint effusion), power Doppler (PD) signals, and erosions were assessed. Results In patients with pSS, synovitis was found in the metacarpophalangeal joints (MCP, 76%), wrists (76%), and knees (76%), while the proximal interphalangeal joints, elbows, and ankles were mostly unscathed. Intra-articular PD signals were occasionally detected in wrists (12%), elbows (6%), and knees (6%). Erosions were evident in the wrists of three (18%) patients with pSS, one of these also having anti-cyclic citrullinated peptide (anti-CCP) antibodies. While US synovitis does not discriminate between sSS and pSS, demonstration of bone erosions in the 2nd MCP joints showed 28.8% sensitivity and 100% specificity for diagnosing sSS; in comparison, these figures were 72.2 and 94.1% for circulating anti-CCP antibodies. Conclusions In pSS, the pattern of joint involvement by US is polyarticular, bilateral, and symmetrical. Synovitis is the US sign most commonly found in patients with pSS, especially in MCP joints, wrists, and knees, and bone erosions also may occur.

【摘要】目的 通过超声检查发现原发性干燥综合征患者受累关节的特点。方法 运用超声分别对17例原发性干燥综合征、18例继发性干燥综合征和17例健康者（对照组）各关节区进行检测，并对关节滑膜炎和关节侵蚀度进行评估。结果 原发性干燥综合征患者中掌指关节、双腕关节和双膝关节滑膜炎发生率均占76%，双腕关节、双肘关节、双膝关节的滑膜炎发生率较低，分别占12%，6%，6%，而近端指间关节、双肘关节、双踝关节较少有受累。原发性干燥综合征患者中有3例被证实有关节侵蚀（占18%），其中1例患者抗CCP抗体阳性。虽然超声不能区别原发性干燥综合征和继发干燥综合征的关节滑膜炎表现，但是通过检测发现区分继发性干燥综合征患者第2掌指关节有无侵蚀的敏感性达28.8%，特异性达100%。相比之下，抗CCP抗体的检测敏感性达72.2%，特异性达94.1%。结论 通过超声检测发现原发性干燥综合征患者中受累关节的特点是对称性多关节炎，滑膜炎在原发性干燥综合征患者中非常常见，尤其是掌指关节、双腕关节和双膝关节，且关节侵蚀也可能发生。