Significance Of Energy Doppler Ultrasound And Serum TNF-? And HA In Knee Osteoarthritis

Osteoarthritis?OA?is a joint disease that occurs in the elderly.The chronic joint swelling and pain and limited activity are the main clinical manifestations.According to the affected parts,it is often divided into hip osteoarthritis,knee osteoarthritis and hand osteoarthritis.Over the past that it is a degenerative joint disease,but recently more and more literature reported as an inflammatory joint disease,a large number of studies confirm that joint synovitis,joint effusion and inflammatory factors are related to Osteoarthritic disease and Progress.Energy Doppler ultrasound has an important role in the imaging examination of osteoarthritis according to its advantages of no radiation,reproducibility,low cost,good sensitivity to articular cartilage and surrounding soft tissue lesions.Objective:To investigate the characteristics of knee osteoarthritis?KOA?ander energy Doppler ultrasound?blood flow signal,synovial thickness,cartilage injury,joint effusion,meniscus injury?,and the clinical significance of serological index HA,TNF-?in KOA.And the relationship between energy Doppler ultrasound parameters,serological parameters and clinical indexes of KOA.To further understand the clinical value of power Doppler ultrasound in KOA.Methods:A total of 291 KOA patients from our hospital from December 2016 to May2018 were collected,including 80 males and 211 females with an average age of 56?51,65?.The patients with rheumatoid arthritis?RA?which knee joints involved were recruited as control group.The serum concentrations of TNF-?and HA were detected by ELISA kit,include sixty-five KOA patients and twenty-five healthy peoples.The data that conform to the normal distribution are expressed by ???±S,and others are represented by M(P₂₅,P₇₅).The t test,the rank test and chi-square test were used between two groups,and ANOVA or K-W test was used to compare the data between the multiple groups,Spearman correlation analysis was used for correlation analysis.Results:?1?There was no difference in age and sex between KOA group and RA group?Z=-8.415,P<0.001?,but there was significant difference in the duration of disease between the two groups?P<0.05?,KOA group was shorter than RA group.The incidence of female was higher than male,KOA?72.51%?RA?81.94%?,respectively.?2?The number of synovial blood flow signals detected by power Doppler ultrasound in KOA group?96 cases 19.63%?was significantly lower than that in RA group?62 cases47.69%?.Comparing KOA group with RA group without distinguishing the level of synovial blood flow??²=286.6,P<0.001?;in addition to joint effusion,Synovial thickening,cartilage thinning,osteophyte formation,popliteal cyst and meniscus protrusion were statistically significant?Z=-3.674,P<0.001;Z=-5.027,P<0.001;?²=24.455,P<0.001;?²=4.484,P=0.04;?²=32.332,P<0.001?,synovial thickening,popliteal cysts is more common in RA,Osteophyte,cartilage thinning and meniscus injury is more common in osteoarthritis.?3?in KOA group,there was no significant difference in ESR and Hs-CRP in different synovial blood flow signal levels?P>0.05?.?4?In KOA,Hs-CRP of synovial blood flow signal grade group was lower than that in RA group with the same grade synovial blood flow signal,the difference was statistically significant?Z=-9.812,P<0.001,Z=-5.867,P<0.001,t=-0.308,P=0.005,t=-4.527,P<0.001?.ESR of synovial blood flow signal grade 0,grade ? and ? in KOA group were lower than those in RA group with the same level of blood flow signal,the difference was statistically significant?Z=-8.414,P=0.000;Z=-4.991,P=0.000;t=-3.428,P=0.003?.?5?the levels of serum TNF-?and HA in the synovial blood flow signal group were significantly higher than those in the synovial no blood flow signal group?F=1.049,F=1.137,all P<0.05?,and compared with the normal control group,the serum TNF-?and HA levels in the synovial blood flow signal group were more higher?F=1.324,F=1.559,all P<0.05?;The levels of TNF-?and HA in the synovial membrane without blood flow signal group were significantly higher than those in the normal control group?F=5.212,F=5.686,all P<0.05?.?6?in KOA group,the degree of synovial effusion and synovial thickening were significantly different in different synovial blood flow signal levels?H=39.111,P<0.001?,Synovial blood flow signal grade 0 and synovial blood flow signal grade ?,synovial blood flow signal grade 0 and synovial blood flow signal ? grade,synovial blood flow signal grade 0 and synovial blood flow signal grade ?,There was significant difference in the amount of joint effusion?P<0.001,P=0.007,P=0.041?,and there was a positive correlation between joint effusion and the signal level of synovial blood flow?r_s=0.277,P<0.001?.?7?Popliteal cysts in KOA group were different among synovial blood flow signal grade 0,grade ?,grade ? and grade ???²=33.455,P=0.000?.The incidence of popliteal cysts was different between synovial blood flow signal grade 0 and synovial blood flow signal grade I,synovial blood flow signal grade 0 and synovial blood flow signal ? grade,synovial blood flow signal grade 0 and synovial blood flow signal grade ??P=0.001,P=0.000,P=0.038,P=0.034?;and in meniscus injury was only significantly different between the synovial blood flow signal grade 0 and synovial blood flow signal grade I?P<0.001?.?8?Osteophyte and cartilage was no statistical significance in synovial blood flow signal level of KOA?P>0.05?,but in the same synovial blood flow signal level group,The cartilage in KOA group was thicker than that in RA group except for synovial blood flow signal grade ?,The difference was statistically significant?Z=-2.185,P=0.029;t=2.309,P=0.023;t=2.886,P=0.008?.?9?WOMAC score and LEQUENSE index were different among synovial blood flow signal groups in KOA,which were different from those of synovial blood flow signal grade 0 and synovial blood flow signal grade ? and ? in KOA group.The difference was statistically significant?all P<0.05?,and positively correlated with the degree of synovial blood flow signal?r_s=0.352,r_s=0.424,all P<0.05?.The US-1 score was different in different synovial blood flow signal levels of KOA patients.the results suggested that the synovial blood flow signal grade 0 was different from that of synovial blood flow signal ?,? and ?.The difference was statistically significant?all P<0.001?,and positively correlated with the degree of synovial blood flow signal?r_s=0.59,P<0.05?.?10?the levels of TNF-?and HA were negatively correlated with WOMAC score?r=0.222,r=0.258,all P<0.05?.Conclusions:Eenergy Doppler ultrasonography can contribute to detect the KOA synovitis.Synovitis is not rare in KOA patients,and which is associated with disease activity.However,Serum TNF-?and HA are not sensitive to synovitis in patients with knee osteoarthritis,KOA and RA cannot be differentiated by Eenergy Doppler ultrasonography.