| Background:Hemophilia is a hemorrhagic disease with hereditary deficiency of coagulation factors.Joint bleeding is the main clinical manifestation of hemophilia due to the lack of coagulation factors.It is reported that the median age at the time of first joint bleeding was 2.2 years(range:0.2 Mel 5.8 years),and 90%of patients experienced joint bleeding at least once at the age of 4.4.Long-term repeated joint bleeding can cause synovial hyperplasia,hemosiderin deposition,and even destruction of cartilage and bone,resulting in hemophilic arthritis,which is also the main cause of disability in hemophilia patients.Early detection of joint pathological changes,change of treatment strategy and prevention of long-term serious complications are the focus of hemophilia patients.Imaging evaluation can be used to monitor the therapeutic effect of hemophilia and the lesions of joint structure for a long time,which is conducive to a clearer understanding of the changes of the diseaseObjective:By comparing the consistency of ultrasound and magnetic resonance imaging in the detection of hemophilia joint lesions,combined with the 2.1version hemophilia joint health score scale,to explore the feasibility and limitation of ultrasound imaging in the diagnosis of joint lesions,so as to provide basis for clinical diagnosis,treatment and long-term follow-upMethods:The clinical data of 60 patients with hemophilia A registered in Henan Hemophilia diagnosis and treatment Center from March 2018 to June 2019 were collected.60 joints of 60 patients were examined by MRI and ultrasonography,and the joint health was evaluated and scored according to the 2.1version HJHS scale.The results of MRI were scored according to the scoring standard established by the international prophylaxis study group,and the ultrasonic results were scored according to the ultrasonic scoring standard put forward by Melchiorre in 2011.According to the scoring results,the consistency analysis of ultrasound and MRI in the detection of joint lesions,the correlation analysis of joint lesion severity,and the correlation analysis between ultrasound and MRI and HJHS were carried out.The patients were divided into severe group(FVIII<1%)and non-reformed group(F?? 1%)according to the concentration of coagulation factors.According to the results of joint ultrasound scores of the two groups,the differences in joint effusion/hematocele,synovial hyperplasia,hemosiderin deposition,cartilage changes,bone destruction and other aspects of hemophilia patients with different severity were analyzed.According to the difference of age,the patients were divided into two groups:the low age group(4-12 years old)and the high age group(12-18 years old).The annual bleeding times,joint ultrasound score,average daily activity distance and annual absenteeism times were compared to analyze whether there was any difference in daily life between the low age group and the high age group.According to the patient's weight,age,annual bleeding times and ultrasound score,multiple linear regression analysis was conducted to analyze whether body weight,age and annual bleeding times were the risk factors for the severity of joint lesions in hemophiliacs.Results:1.A total of 60 hemophilia patients were included for ultrasonic and MRI examination and joint health assessment,of which the average ultrasonic score was(6.52±3.67),MRI average(7.32±4.26),and HJHS average(9.85±6.17),showing an overall correlation(P<0.05).There was no significant difference between ultrasound and MRI in the detection rate of joint effusion/hemorrhage,synovial hyperplasia,hemosidrin deposition,and cartilage changes(P>0.05).In terms of bone damage,MRI detection was more sensitive than ultrasound detection,and the difference was statistically significant.(? 2=7.502,P=0.006)Ultrasonography and MRI in the assessment of hemophilia joint for joint effusion/bleeding,synovial hyperplasia,cartilage change score has good correlation.(r respectively 0.755,0.833,0.645,P<0.05),ultrasonic score and secondary MRI score in the aspect of hemosiderin deposition correlation(r=0.515,P<0.05),the correlation between ultrasound and MRI on bone damage score was poor.(r=0.357,P=0.005)(r=0.357,P=0.005)2.According to the concentration of coagulation factors,the ultrasonic scores of joint effusion/hemorrhage,synovial hyperplasia,hemosiderin deposition,cartilage changes and bone destruction in the severe group were significantly higher than those in the non-severe group,and the difference was statistically significant.(P<0.05).According to the age of the patients,there was no significant difference in the number of annual bleeding,ultrasonic score and annual absenteeism between the high age group and the low age group(P>0.05).There were more children in the high age group than in the low age group,and the difference was statistically significant.(P<0.05)3.Using multiple linear regression analysis in ultrasonic score and age,weight,correlation between number of bleeding,including ultrasonic score as the dependent variable,age,weight,years bleeding times as the independent variable.There was no significant correlation between ultrasound score and age and body weight(t=0.391,P=0.697;t=0.595,P=0.555),and there was a certain correlation between ultrasonic score and annual bleeding frequency.(t=5.740,P<0.05)Conclusions:1.Ultrasound has a good consistency with MRI in the diagnosis of early lesions of hemophilia joint(effusion/hemorrhage,synovial hyperplasia)and cartilage lesions,and can replace MRI as a routine detection method of hemophilia joint.It has the advantages of simple,rapid,economical and reliable,and is suitable for wide clinical application2.HJHS score has a good correlation with ultrasound and MRI score,and it is not sensitive in the early stage of joint disease,so it can be used as an auxiliary evaluation tool for joint disease3.Severe hemophilia patients with severe joint lesions,younger age patients with rapid progression of joint lesions,serious impact on the quality of daily life,should pay attention to prevention and treatment and regular imaging evaluation. |
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