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Vloga standardizirane ultrazvočne preiskave pri ugotavljanju zgodnje hemofilične artropatije
ID Plut, Domen (Author), ID Salapura, Vladka (Mentor) More about this mentor... This link opens in a new window, ID Preložnik Zupan, Irena (Comentor)

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Abstract
Izhodišče Ponavljajoče krvavitve v sklep prizadenejo okoli 90% bolnikov s hudo hemofilijo in vodijo v kronično okvaro sklepov z invalidnostjo. Slikovna diagnostika omogoča zaznavo tudi klinično nemih sprememb hemofilične artropatije in lahko vpliva na potek profilaktičnega zdravljenja. Slikanje z magnetno resonanco (MR) predstavlja zlati standard za natančno oceno sklepnih sprememb, vendar pri rednem sledenju bolnikov s hemofilijo ni enostavno izvedljivo. Laboratorijski kazalci pri oceni prisotnosti oziroma stopnje izraženosti hemofilične artropatije niso zanesljivi. Uvedba nove standardizirane ultrazvočne metode za zaznavo zgodnjih sprememb hemofilične artropatije (HEAD-US) je odprla nove možnosti za uporabo ultrazvoka (UZ) pri obravnavi teh bolnikov. Protokol omogoča hitro oceno šestih najpogosteje prizadetih sklepov hkrati. Cilj naše prospektivne raziskave je bil ugotoviti diagnostično točnost HEAD-US za zaznavanje in oceno stopnje prizadetosti sklepov pri hemofilični artropatiji v primerjavi z MR. Hkrati smo v raziskavi preverjali tudi diagnostično točnost trenutno uporabljenih metod ocenjevanja prizadetosti sklepov v praksi rednega sledenja bolnikov s hemofilijo, torej bolnikove subjektivne presoje prizadetosti sklepov in kliničnega pregleda. Ocenjevali smo tudi, kako se vrednosti nekaterih laboratorijskih kazalcev ujemajo s stopnjo izraženosti bolezni pri MR. Preverjali smo serumske vrednosti prekurzorja vitamina D (25-OH vitamin D3), kazalca zaloge železa feritina, kazalca kostne resorpcije C-terminalnega telopeptida kolagena tipa I (CTX), kazalca kostne tvorbe N-terminalnega propeptida prokolagena tipa I (PINP) in proteina hrustančnega matriksa (COMP). Hipoteze H1: Ocena hemofilične artropatije opravljena s standardizirano ultrazvočno preiskavo (HEAD-US) je primerljiva z ugotovitvami pri magnetno resonančni preiskavi. H2: UZ preiskava je natančnejša metoda za prepoznavo zgodnje hemofilične artropatije od kliničnega pregleda in subjektivne ocene prizadetosti sklepov. H3: Obstaja povezava med serumskimi vrednosti markerjev kostnega remodeliranja (CTX in PINP) in proteina hrustančnega matriksa (COMP) ter hemofilično artropatijo. Bolniki in metode V raziskavo smo vključili 30 bolnikov s hudo obliko hemofilije. Starost bolnikov je bila med 16-49 let. Pri vseh preiskovancih smo v istem dnevu opravili preglede komolcev, gležnjev in kolen (skupaj 168 sklepov) z UZ po HEAD-US protokolu, klinično po protokolu HJHS 2.1 (angl. Hemophilia Joint Health Score) in z MR slikanjem ovrednotenim z IPSG (angl. International Prophylaxis Study Group) lestvico. Isti dan smo odvzeli kri za preverbo serumskih vrednosti vitamina D, feritina, markerjev kostnega remodeliranja (CTX in PINP) ter proteina hrustančnega matriksa (COMP). Preiskovanci so izpolnili vprašalnik o subjektivni oceni prizadetosti sklepov. Ocena primerljivosti metod z MR je bila določena s Pearsonovim koeficientom korelacije. Rezultati Rezultati so pokazali visoko stopnjo ujemanja med UZ in MR (r=0.92). Stopnja ujemanja z MR pri UZ je precej višja, kot je bilo ugotovljeno za oceno kliničnega pregleda (r=0.62) in subjektivno oceno preiskovanca (r=0,66). Stopnja ujemanja med UZ in MR preiskavo je bila zelo visoka za ocenjevanje komolčnih in kolenskih sklepov (r≈0.95) ter le nekoliko nižja za oceno gleženjskih sklepov (r≈0.85). Analiza rezultatov laboratorijskih preiskav ni prikazala ujemanja med prisotnostjo oziroma stopnjo izraženosti hemofilične artropatije in nobenim izmed pregledovanih laboratorijskih kazalcev. Zaključek HEAD-US protokol je hitra, zanesljiva in točna metoda za zaznavo in oceno stopnje prizadetosti sklepov pri hemofilični artropatiji v primerjavi z MR slikanjem. Diagnostična točnost HEAD-US preiskave je precej višja kot diagnostična točnost trenutno uporabljenih metod ocenjevanja sklepov v redni klinični praksi spremljanja bolnikov s hudo hemofilijo, zato jo lahko uporabimo pri rednem spremljanju in pri odločitvah glede prilagajanja profilaktične terapije. Preiskovani laboratorijski kazalci niso zanesljiv kazalec prisotnosti ali stopnje izraženosti hemofilične artropatije.

Language:Slovenian
Keywords:Ultrazvok, HEAD-US, hemofilija, hemofilična artropatija, magnetna resonanca
Work type:Doctoral dissertation
Organization:MF - Faculty of Medicine
Year:2019
PID:20.500.12556/RUL-116966 This link opens in a new window
COBISS.SI-ID:6702764 This link opens in a new window
Publication date in RUL:18.06.2020
Views:1040
Downloads:182
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Secondary language

Language:English
Title:The role of standardized ultrasound examination in detection of early haemophilic arthropathy
Abstract:
Background Repeated haemarthroses affect approximately 90% of patients with severe haemophilia and lead to progressive arthropathy, which is the main cause of morbidity in these patients. Diagnostic imaging can detect even subclinical arthropathy changes and can impact prophylactic treatment. Magnetic resonance imagining (MRI) is generally the gold standard tool for precise evaluation of joints, but it is not easily feasible in regular follow-up of patients with haemophilia. The development of the standardized ultrasound (US) protocol for detection of early changes in haemophilic arthropathy (HEAD-US) opened new perspectives in the use of US in management of these patients. The HEAD-US protocol enables quick evaluation of the six mostly affected joints in a single study. The aim of this prospective study was to determine the diagnostic accuracy of the HEAD-US protocol for the detection and quantification of haemophilic arthropathy in comparison to the MRI. We additionally intended to assess how HEAD-US holds up in comparison to currently used tools for regular joint status evaluation in clinical practice: clinical examination and patient's subjective grading of disease expression. We also evaluated correlation of some of the laboratory markers with MR imaging (vitamin D, ferritin, C-terminal telopeptide of type I collagen (CTX), N-terminal propeptide of type I procollagen (PINP), and cartilage oligomeric matrix protein (COMP)). Hypotheses H1: Evaluation of hemophilic arthropathy changes by the standardized US examination (HEAD-US) provides comparable results to the results of MRI. H2: Ultrasound is a more accurate method for the detection and evaluation of early hemophilic arthropathy changes in comparison to the clinical evaluation and patient’s subjective grading. H3: Results of laboratory analysis of s-CTX, s-PINP and s-COMP correlate with the results of imaging diagnostics for the presence or expression of hemophilic arthropathy. Patients and methods The study included 30 patients with severe haemophilia. Patient age ranged from 16 to 49 years. We evaluated their elbows, ankles and knees (overall 168 joints) by US using the HEAD-US protocol, clinically by Haemophilia Joint Health Score (HJHS) 2.1 and by MRI using the International Prophylaxis Study Group (IPSG) MRI score. Patients also filled subjective grade questionnaire and had blood taken for laboratory analysis. The correlation between the methods was determined using the Pearson's correlation coefficient. Results The results show that the overall HEAD-US score correlates very highly with the overall IPSG MRI score (r=0.92). The correlation is very high for the evaluation of the elbows and knees (r≈0.95), and only slightly lower for the ankles (r≈0.85). Analysis of laboratory results showed no correlation between the laboratory values and the presence or expression of haemophilic arthropathy. Conclusions HEAD-US protocol proved to be a quick, reliable and accurate method for the detection and quantification of haemophilic arthropathy in comparison to MRI. Diagnostic accuracy of HEAD-US is considerably higher than the diagnostic accuracy of currently used methods of joint evaluation in clinical practice of management patients with severe haemophilia. Therefore, it can be confidently and safely included into the protocol of regular follow-up of these patients and to modify their prophylactic treatment regimen. Investigated laboratory parameters show no correlation with the presence or expression of haemophilic arthropathy.

Keywords:Ultrasound, HEAD-US, haemophilia, haemophilic arthropathy, magnetic resonance imaging

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