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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (6): 1096-1100. doi: 10.19723/j.issn.1671-167X.2025.06.012

• 论著 • 上一篇    下一篇

超微血流成像评估与膝骨关节炎临床症状的关联研究

王翠萍1, 陈哲2,*(), 程永静2   

  1. 1. 北京医院超声科，北京 100730
    2. 北京医院风湿免疫科，国家老年医学中心，中国医学科学院老年医学研究院，北京 100730
  • 收稿日期:2025-08-13 出版日期:2025-12-18 发布日期:2025-10-21
  • 通讯作者: 陈哲
  • 基金资助:
    中央高水平医院临床科研业务费(BJ-2022-134); 中央高水平医院临床科研业务费(BJ-2023-189)

Correlation study of superb microvascular imaging on knee osteoarthritis

Cuiping WANG1, Zhe CHEN2,*(), Yongjing CHENG2   

  1. 1. Department of Sonography, Beijing Hospital; Beijing 100730, China
    2. Department of Rheumatology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Beijing 100730, China
  • Received:2025-08-13 Online:2025-12-18 Published:2025-10-21
  • Contact: Zhe CHEN
  • Supported by:
    the National High Level Hospital Clinical Research Funding(BJ-2022-134); the National High Level Hospital Clinical Research Funding(BJ-2023-189)

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摘要：

目的: 探讨超微血流成像(superb microvascular imaging，SMI)血流分级、超声半定量评分与原发性膝骨关节炎(knee osteoarthritis，KOA)患者临床症状严重程度之间的相关性。方法: 对47例原发性KOA患者的94个膝关节进行超声半定量评分及滑膜SMI分级，同时记录西安大略和麦克马斯特大学骨关节炎指数(the Western Ontario and McMaster Universities osteoarthritis index，WOMAC)、视觉模拟量表(visual analog scale，VAS)评分及血清学指标C反应蛋白(C-reactive protein，CRP)和红细胞沉降率(erythrocyte sedimentation rate，ESR)，分析患者临床评分与KOA超声参数的相关性。结果: SMI滑膜血流检测强度等级明显高于传统的用于评估滑膜血流的能量多普勒(power Doppler, PD)(14.9% vs. 9.6%，Z=-2.531, P=0.011)。WOMAC僵硬度与滑膜炎、关节软骨损伤、SMI评分升高呈正相关，WOMAC功能与骨赘严重程度、滑膜增厚、SMI评分升高呈正相关，WOMAC总分与滑膜炎、滑膜增厚、关节软骨损伤、骨赘严重程度的评分呈正相关(均P < 0.05)。非参数Bootstrap分析(B=2 000次重抽样)显示，SMI血流分级、年龄和体重指数(body mass index，BMI)与WOMAC疼痛、僵硬度、功能评分及总分均无统计学意义的关联(均P>0.05，95%CI均包含0)。结论: SMI对滑膜微血流的检出敏感性显著优于PD，SMI在低级别炎症中可以弥补PD的不足，但SMI对低血流的高敏感性与临床症状严重程度无关，且与WOMAC疼痛评分无显著相关性。

关键词: 超微血流成像, 超声半定量评分, 膝骨关节炎

Abstract:

Objective: To investigate the correlation between superb microvascular imaging (SMI) blood flow grading, ultrasound semi-quantitative scores, and clinical symptom severity in patients with primary knee osteoarthritis (KOA). Methods: A total of 94 knees from 47 patients with primary KOA were evaluated. Ultrasound semi-quantitative scoring and synovial SMI grading were performed for each knee joint. Clinical assessments included the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), visual analog scale (VAS) for pain, and serum biomarkers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Correlations between clinical scores and ultrasound parameters were analyzed. Results: SMI demonstrated a significantly higher synovial blood flow detection rate than power Doppler (PD) (14.9% vs. 9.6%, Z=-2.531, P=0.011). WOMAC stiffness scores showed positive correlations with synovitis, articular cartilage damage, and elevated SMI scores (all P < 0.05). WOMAC function scores were positively correlated with osteophyte severity, synovial thickening, and elevated SMI scores (all P < 0.05). The total WOMAC scores were positively associated with synovitis, synovial thickening, articular cartilage damage, and osteophyte severity (all P < 0.05). However, non-parametric Bootstrap analysis (B=2 000 replicates) revealed no independent associations between SMI blood flow grading, age, or body mass index (BMI) and WOMAC pain, stiffness, function, or total scores (all P>0.05, 95%CI contained zero). Conclusion: The SMI technique demonstrates significantly higher sensitivity than PD in detecting intensity grade of synovial microvascular flow. While SMI compensates for the limitations of PD in identifying low-grade inflammation, its high sensitivity to low- velocity blood flow did not correlate with symptom severity or WOMAC pain scores. These findings suggest that SMI serves as a valuable tool for visualizing microvascular activity in subclinical synovitis, but its role as a direct indicator of clinical symptom severity in KOA remains limited. Further studies with larger sample sizes are warranted to validate its clinical utility.

Key words: Superb microvascular imaging, Ultrasound semi-quantitative scoring, Knee osteoarthritis

中图分类号: 

  • R684.3

表1

膝骨关节炎患者一般临床资料"

Parameter Value
Age/years, $\bar x \pm s$ (range) 62.7±7.1 (47-74)
Height/cm, $\bar x \pm s$ (range) 163.9±7.1 (150-180)
Weight/kg, $\bar x \pm s$ (range) 66.7±10.7 (45-90)
BMI/(kg/m2), $\bar x \pm s$ (range) 41.1±5.8 (27.8-51.2)
Disease duration/years, M (P25, P75) (range) 4.0 (0.5, 7.5) (0.25-20.00)*
WOMAC pain score, $\bar x \pm s$ (range) 10.6±3.3 (6-20)
WOMAC stiffness score, M (P25, P75) (range) 4 (2, 6) (2-10)*
WOMAC fuction score, $\bar x \pm s$ (range) 37.8±12.0 (21-70)
WOMAC total score, $\bar x \pm s$ (range) 52.7±16.6 (29-98)
VAS score, $\bar x \pm s$ (range) 5.4±1.3 (3.9-8.3)
CRP/(mg/L), M (P25, P75) (range) 1.0 (0.5, 3.7) (0.2-57.9)*
ESR/(mm/h), $\bar x \pm s$ (range) 11.9±8.1 (0-34)

表2

滑膜血流PD与SMI分级对比"

Items SMI 0 SMI 1 SMI 2 SMI 3 Total
PD 0 80 5 0 0 85
PD 1 0 6 1 1 8
PD 2 0 0 1 0 1
PD 3 0 0 0 0 0
Total 80 11 2 1 94

表3

WOMAC评分与超声半定量评分、SMI血流分级的相关性分析"

Parameter Synovitis Synovial thickening Joint effusion PD
r P r P r P r P
WOMAC pain score 0.091 0.650 0.185 0.355 0.241 0.226 -0.241 0.226
WOMAC stiffness score 0.058 0.001** 0.153 0.448 -0.179 0.371 0.179 0.371
WOMAC function score 0.349 0.074 0.518 0.006** -0.038 0.851 0.038 0.851
WOMAC total score 0.385 0.047* 0.446 0.020* 0.025 0.901 -0.025 0.901
Parameter SMI Articular cartilage Meniscal extrusion Osteophyte
r P r P r P r P
WOMAC pain score -0.016 0.909 0.389 0.023* 0.332 0.091 0.390 0.023*
WOMAC stiffness score 0.375 0.005** 0.430 0.025* 0.101 0.617 0.217 0.277
WOMAC function score 0.331 0.015* 0.340 0.083 0.144 0.472 0.437 0.023*
WOMAC total score 0.267 0.051 0.401 0.038* 0.183 0.361 0.427 0.026*
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