Nghiên cứu đặc điểm siêu âm Doppler năng lượng khớp cổ tay bệnh nhân viêm khớp dạng thấp

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  • TRNG I HC Y H NINGHIN CU C IM SIU M DOPPLER NNG LNG KHP C TAY BNH NHNVIM KHP DNG THP L NGC QULUN VN THC S Y HCNgi hng dn khoa hc:Ts. Nguyn Vn Hng

  • T VN VKDT l bnh t min, tin trin, khp c tay (70%)Tn thng c bn l vim MHD, mng vim Pannusnh gi mc hot ng bnh c ngha quan trng trong qun l iu tr VKDTTng sinh mch l c trng ca qu trnh vim, c th pht hin trn PDUSsiu m s lng khp nht nh c gi tr nh siu m ton b khp

    Trn Ngc n (2004), Bnh vim khp dng thp, Bi ging bnh hc ni khoa tp II, Trng i hc Y H Ni, NXB Y hc: 259 - 263 Shumacher HR(1993), Rheumatoid arthritis, Primer on the Rheumatic Disease, 10th Edition, arthitis Foundation: 86-89

  • MC TIUnh gi vai tr siu m doppler nng lng khp c tay trong vic o lng mc hot ng bnh VKDT 1. M t c im siu m doppler nng lng khp c tay bnh nhn VKDT

  • TNG QUANVKDT chim 1% dn s th gii; Vit Nam khong 0,5%, Khong 20% bnh khp phi nhp vin. N > namNguyn nhn: Yu t nhim khun, yu t gia nh HLA DR4c im tn thng: Cc khp nh, nh, i xng, cng khp bui sngI CNG BNH VIM KHP DNG THPTrn Ngc n (2004), Bnh vim khp dng thp, Bi ging bnh hc ni khoa tp II, Trng i hc Y H Ni, NXB Y hc: 259 - 263 Shumacher HR(1993), Rheumatoid arthritis, Primer on the Rheumatic Disease, 10th Edition, arthitis Foundation: 86-89

  • TNG QUANC CH BNH SINH VIM KHP DNG THP

  • TNG QUANTRIU CHNG BNH VIM KHP DNG THP Lm sng: Sng, au khp, i xng, cng khp, Ngoi khp: Ht di da, thiu mu, tn thng gn, dy chng, ni tngCn lm sng: Bilan vim (+), RF v anti CCP (+), XQ: bo mn, ni soi: Tng sinh hnh lng MHD, siu m: Vim MHD, tng sinh mch MHDCHN ON XC NH VIM KHP DNG THPACR 1987: 4/7 tiu chun, thi gian > 6 tunACR/EULAR 2010CHN ON MC HOT NG BNHDAS28-CRP; SDAI; CDAIIU TR VIM KHP DNG THPiu tr triu chng, DMARDs, tc nhn sinh hc, phng php khc

  • TNG QUANGII PHU KHP C TAY

  • TNG QUANSiu m 2D: S phn hi ca sng mSiu m doppler: chnh lch sng pht v sng phn hiDoppler lin tc: khng cho bit t su tn hiuDoppler xungDoppler mu: ph thuc gcDoppler nng lng: pht hin cc dng chy nh, vn tc chmI CNG V SIU M Nguyn Phc Bo Qun (2002), Nguyn l siu m, Siu m bng tng qut, Trng i hc Y Hu. NXB Y hc: 1-44Kane D, Grassi W, Sturrock R and Balint (2004), A brief history of musculoskeletal ultrasound: From bats and ships to babies and hips, Reumatology 2004; 43: 931-933Backhaus, M., et al., (2002) Technique and diagnostic value of musculoskeletal ultrasonography in rheumatology. Part 6: ultrasonography of the wrist/hand. Z Rheumatol. 61(6): p. 674-87.

  • TNG QUANTn thng gn (vim gn, thoi ho, t gn)Khoang khp: trn dch khp, dy MHD, u sn MHDTn thng sn khp: mt trong sut, gim nt ng vin sn, lot, trt sn, gim b dy sn, calci hoTn thng c: vim, p xe, sarcomaTn thng xng, mng xng, bo mn xng, gai xngCc dch khu tr: kn khoeo, kn MHD, phn bit c u mch, d dng mch, u phn mmCc dy thn kinh ngoi viTn thng da v phn mm di danh hng cc can thip: sinh thit, chc ht dch, tim ni khp..NG DNG SIU M TRONG C XNG KHPGrassi, W. and C. Cervini, (1998) Ultrasonography in rheumatology: an evolving technique. Ann Rheum Dis. 57(5): p. 268-71. Phm Minh Thng (2012), siu m tng qut, NXB i Hc Hu, Hu.

  • TNG QUANNG DNG SIU M TRONG C XNG KHPGrassi, W. and C. Cervini, (1998) Ultrasonography in rheumatology: an evolving technique. Ann Rheum Dis. 57(5): p. 268-71.

  • TNG QUAN1978 Cooperber nh gi tnh trng vim MHD v trn dch khp gi so snh vi lm sng trc v sau tim yttrium-90 dng tim1988 Flaviis ln u tin dng SA m t tn thng bo mn xngBo mn xng: SA nhy gp 7 ln XQ pht hin tn thng smScheel v cng s cng b SA c nhy (90%) v c hiu cao (88%) tng t gi tr ca MRI 2010, Spchez v CS, nghin cu 40 lt khm bnh BN VKDT pht hin 2 trng hp vim MHD di lm sngNG DNG SIU M KHP TRONG VKDTCooperberg PL, Tsang I, Truelove L, Knickerbocker WJ (1978), Gray scale ultrasound in the evaluation of rheumatoid arthritis of the knee, Radiology 1978; 126: 75963De Flaviis L, Scaglione P, Nessi R, Ventura R, Calori G (1988). Ultrasonography of the hand in rheumatoid arthritis, Acta Radiol 1988; 29: 45760 Scheel AK, Hermann KGA, Kahler E, Pasewaldt D, Fritz J, Hamm B, Brunner E, Muller GA, Burmester GR, Backhaus M (2005), A nouvel ultrasonograhic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis, Arthritis Rheum,2005 Mar; 52(3): 681-6 Mihaela Sprchez, Daniela Fodor, Nicolae Miu. Medical Ultrasonography 2010, Vol. 12, no. 2, 97-103j

  • TNG QUANNm 2003, Riben v CS nghin cu SA 233 khp (c tay, bn ngn v ngn gn II-IV) TD trc v sau 6 tun iu tr khng TNF-: ch s vim MHD v ch s MHD cng dn thay i c ngha trc v sau T; c mi lin quan cht ch vi DASNm 2008, Naredo v CS nghin cu 160 BN VKDT, PDUS 6 khp (MCP II-IV) so snh vi 44 khp trc v sau 6 thng T tc nhn sinh hc thy: PDUS 6 khp = PDUS 44 khp c mi tng quan cht ch vi DAS 28Nm 2011, Hammer v CS, 28 BN VKDT, PDUS 7 khp, 12, 28, 44 v 78 khp, TD sau 1 nm T adalimumab thy: PDUS 7 khp c hiu qu tng t 12, 28, 44 v 78 khp2009, Ellegaard v CS, 109 khp c tay 109 bn VKDT, CF c mi tng quan tuyn tnh vi ESR, CRP, SJC, DAS28Ribbens, C., et al., (2003). Rheumatoid hand joint synovitis: gray-scale and power Doppler US quantifications following anti-tumor necrosis factor-alpha treatment: pilot study. Radiology. 229(2): p. 562-9.Naredo, E., et al., (2008). Validity, reproducibility, and responsiveness of a twelve-joint simplified power doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis. Arthritis Rheum. 59(4): p. 515-22.Hammer, H.B. and T.K. Kvien, (2011). Comparisons of 7- to 78-joint ultrasonography scores: all different joint combinations show equal response to adalimumab treatment in patients with rheumatoid arthritis. Arthritis Res Ther. 13(3): p. R78. NG DNG SIU M KHP TRONG VKDT

  • TNG QUANNm 2006, Nguyn Th Ngc Lan v L Th Liu, siu m 2D khp c tay, n = 76 bnh nhn VKDT, SA rt c gi tr pht hin bo mn xng, trn dch khp v dy MHD Nm 2012, Nguyn Vnh Ngc v Li Thu DngSiu m doppler 132 khp gi, n = 68 bnh nhn VKDTPDUS rt c gi tr trong nh gi mc tng sinh mch MHDC mi lin quan vi thang im VAS. NG DNG SIU M KHP TRONG VKDT

  • I TNG V PHNG PHP NGHIN CUa im: Khoa C Xng Khp BVBMThi gian: T thng 2 n thng 8 nm 2013Tiu chun la chn bnh nhnBN c chn on VKDT theo ACR 1987C vim khp c tay trn lm sng hoc khngTui > 16Khng dng glucocorticoid liu cao 1 thng trc nghin cung tham gia nghin cuTiu chun loi tr bnh nhnbnh nhn khng cc tiu chun la chn

    I TNG NGHIN CU

  • I TNG V PHNG PHP NGHIN CUThit k nghin cu: M t ct ngang c phn tchC mu v chn mu: Chn c mu thun tinX l s liu: SPSS 16.0 v Microsoft Excel 2003Ni dung nghin cuBnh nhn chn on VKDT theo ACR 1987, tiu chunKhm lm sng: nh gi s khp sng, s khp au, thang im VAS, mc vim khp c tay trn LSXt nghim: CRP, tc mu lng, RF, anti-CCP,XQTnh mc hot ng bnh theo DAS 28 CRP, SDAI, CDAISiu m khp c tay M t cc tn thng pht hin trn SA, nh gi mi lin quan vi cc pht hin ti ch v cc yu t nh gi mc hot ng bnh ton thn

    PHNG PHP NGHIN CU

  • I TNG V PHNG PHP NGHIN CUNH GI MC HOT NG BNH

  • I TNG V PHNG PHP NGHIN CUDAS 28 CRP = 0,56TJC + 0,28SJC + 0,7ln(CRP) + 0,014(pt global VAS)DAS 28 CRP: > 5,1 --> bnh hot ng mnh DAS 28 CRP: 3,2 5,1 --> bnh hot ng va DAS 28 CRP: 2,6 3,2 --> bnh hot ng nh DAS 28 CRP: < 2,6--> bnh khng hot ng SDAI = s khp sng + s khp au + CRP (mg/dl) + Pt VAS + Phy VASSDAI: > 26--> bnh hot ng mnhSDAI: 11,1 26 --> bnh hot ng vaSDAI: 3,3 11--> bnh hot ng nhSDAI: < 3,3--> bnh khng hot ngCDAI = s khp au + s khp sng + PhyVAS + PtVASCDAI: > 22--> bnh hot ng mnhCDAI: 10,1 22 --> bnh hot ng vaCDAI: 2,8 10--> bnh hot ng nhCDAI: < 2,8--> bnh khng hot ng

    NH GI MC HOT NG BNHAM Van Gestel at al. Arthritis Rheum. 1998; 41(10): 1845-50Smolen Js at al. Rheumatology (oxford). 2003; 42: 244-57D Aletaha at al. Arthritis Res Ther. 2005; 7: R796-R806

  • I TNG V PHNG PHP NGHIN CUNgi siu m: Bs chuyn khoa C Xng - KhpDng c: My siu m Medison Accuvix V10.0 (HQ), u d Liner 10 MHz, Gel siu m Bnh nhn: Bn tay c nh trn mt phng cngCc lp ct: Dc ngang, mode 2D mode PDUSCc thng s nh gi:Mode 2D: trn dch, bo mn xng, vim MHDMode doppler: tng sinh mch theo thang im bn nh lng

    SIU M KHP C TAYBackhaus, M., et al. (2002), Technique and diagnostic value of musculoskeletal ultrasonography in rheumatology. Part 6: ultrasonography of the wrist/hand. Z Rheumatol. 61(6): p. 674-87.FL. VREJU, M. CIUREA, ANCA ROU1, ANCA MUETESCU, D. GRECU, PAULINA CIUREA (2010). Power Doppler sonography, a non-invasive method of assessment of the synovial inflammation in patients with early rheumatoid arthritis, Rom J Morphol Embryol 2011, 52(2):637643

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  • S NGHIN CUBNH NHN VKDT THEO ACR 1987Lm sngSA khp c tayGi tr PDUS khp c tay trong nh gi mc hot ng bnhTin hnh m tXt nghim, XQ

  • KT QU V BN LUN83 Bnh nhn tiu chun, n/nam = 5.6/1C IM CHUNG L Th Liu, 2006, tui: 54.7 12.8; thi gian bnh: 55.7 66.5; SJC: 13.6 2.5; TJC: 18.6 2.8. Vreju, 2011, thi gian bnh: 7.8 2.4 thng.

  • KT QU V BN LUNVIM KHP C TAY TRN LM SNG (n = 166 khp)Ozgocmen, S., et al., Evaluation of metacarpophalangeal joint synovitis in rheumatoid arthritis by power Doppler technique: relationship between synovial vascularization and periarticular bone mineral density. Joint Bone Spine, 2004. 71(5): p. 384-8.

    Vim khpnT l %C6841Khng9859Tng166100

  • KT QU V BN LUNC IM SIU M 2D KHP C TAY (n = 166 khp)L Th Liu, 2006: vim MHD 100%; bo mn xng: 22.4%Scheel v CS, 2006: 118 khp bn ngn v ngn gn t ngn II - V 16 BN VKDT: bo mn xng 9%Scheel, A.K., et al., (2006). Prospective 7 year follow up imaging study comparing radiography, ultrasonography, and magnetic resonance imaging in rheumatoid arthritis finger joints. Ann Rheum Dis. 65(5): p. 595-600.Liu, L.T., (2006) Nghin cu cc giai on tin trin ca bnh vim khp dng thp qua lm sng v siu m khp c tay, i Hc Y H Ni.

  • KT QU V BN LUNSIU M DOPPLER NNG LNG KHP C TAY166 k