關節超音波於無關節症狀血液透析病人之下肢接骨點評估

Sonographic evaluation of lower-limbs entheses in subclinical patients undergoing hemodialysis

目的：針對臨床無關節症狀之血液透析病人進行關節超音波掃描，以評估下肢接骨點病變之盛行率，並針對異常部位以GUESS評分標準給予評分，進而比較病變分數與臨床相關因子之關係。方法：將48位臨床無關節症狀之血液透析病人，依血液透析時間分成兩組，估兩組之間下肢接骨點病變分數之差異。分析病變分數與年紀、性別、血液透析時間、身體質量指數以及血清生化檢查數值之關聯性。結果：統計發現，血液透析時間不但與下肢接骨點病變總分數（total GUESS）呈現正相關（p<0.001, r = 0.88 ），與enthesophyte病變分數也是如此（p<0.001, r = 0.71），但與年紀、性別、身體質量指數（BMI）以及血清生化檢查如：鈣、磷、鈣與磷乘積、副甲狀腺素、尿酸、膽固醇、三酸甘油酯及發炎指數等數值無關。在無關節症狀之血液透析病人群中，下肢接骨點病變之盛行率為21.8%。結論：下肢接骨點病變可能發生於無關節症狀之血液透析病人身上，而且隨著透析時間的延長，關節病變的嚴重程度增加。對於此病人族群，臨床醫師應廣泛使用關節超音波來及早診斷下肢接骨點之病變。

Objective: To survey the prevalence of entheseal abnormality in the lower limbs in subclinical patients undergoing hemodialysis by musculoskeletal ultrasound (MSUS), rate the severity of abnormalities using the Glasgow Ultrasound Enthesitis Scoring system (GUESS), and correlate the score with other clinical factors. Methods: Forty-eight subclinical patients who had undergone hemodialysis for at least 4 months were divided into 2 groups. The groups were compared for the total GUESS score, thickness score, erosion score, enthesophyte score, and bursitis score. We then assessed the correlations between these scores and the duration of dialysis, sex, age, body mass index (BMI), and levels of serum biomarkers. Results: The duration of hemodialysis was found to be significantly correlated with the total GUESS score (p<0.001, r = 0.88) and enthesophyte score (p<0.001, r = 0.71). No significant correlation was detected between the scores and the following variables: age; sex; BMI; calcium-phosphorus product; and serum levels of calcium, phosphorous, parathormone, uric acid, triglycerides, cholesterol, and C-reactive protein. The prevalence of bilateral lower limb enthesopathy, determined on the basis of grayscale musculoskeletal ultrasound examination, was 21.8%. Conclusion: Hemodialysis patients may develop lower limb enthesopathy, which worsens with increase in the duration of hemodialysis, even in the absence of obvious clinical symptoms or signs. MSUS should be more widely employed by clinicians for the early diagnosis of enthesopathy in subclinical hemodialysis patients.