【摘要】 目的：初探肌骨灰阶超声联合超声造影检查辅助诊断横纹肌溶解症的临床价值。方法：74例临床疑似横纹肌溶解症患者依据有无横纹肌溶解症将患者分为两组。采用灰阶超声联合超声造影完成检查，总结分析图像特征，采用Mann-Whitney U检验以及卡方检验进行组间比较确定存在显著差异的影响因素，影响因素间采用Logistic单因素回归分析模型，分析超声图像特征与诊断性能之间的相关性。结果：74例疑似患者中，依据肌酸激酶及核磁共振检查结果，明确诊断有横纹肌溶解症患者63例。灰阶超声联合超声造影诊断横纹肌溶解症58例，灵敏度为90.5%，特异度为90.9%，其中灰阶超声检查受损区域肌肉边界及纹理的不清晰、肌纤维结构紊乱，呈“云雾状”或“磨玻璃样”回声增高，超声造影患部肌肉动脉期呈现快速高增强，逐渐向四周呈“滴水波纹”扩散的现象为诊断横纹肌溶解症的超声典型声像图特征均为疾病的影响因素（P<0.05），快速高增强与横纹肌溶解症具有强相关（rs=0.734,P<0.01），为独立影响因素，具有相对较高的诊断性能。结论：灰阶超声联合超声造影检查简便快捷、实时准确，可操作性及推广性强，在横纹肌溶解症诊断中，适合基层医院或患者受核磁检查条件限制的情况下开展使用。更多还原

【Abstract】 Objective: To explore the clinical value of musculoskeletal gray-scale ultrasound combined with contrast-enhanced ultrasound in auxiliary diagnosis of rhabdomyolysis. Methods: Seventy-four patients with clinically suspected rhabdomyolysis were included and divided into two groups according to the presence or absence of rhabdomyolysis. Gray scale ultrasound combined with contrast-enhanced ultrasound was used to complete the examination, and image features were summarized and analyzed. Mann-Whitney U test and Chi-square test were used to compare the influential factors with significant differences between groups. Logistic univariate regression analysis model was used to analyze the correlation between ultrasonic image features and diagnostic performance. Results: Seventy-four suspected patients, 63 were diagnosed as having rhabdomyolysis based on creatine kinase and MRI. The sensitivity and specificity of gray scale ultrasound combined with contrast-enhanced ultrasound in diagnosis of rhabdomyolysis were 90.5% and 90.9% in 58 cases. Gray-scale ultrasound examination showed unclear muscle boundaries and texture, muscle fiber structure disorder in the damaged area, like “cloud” or “ground glass” increased echo, and, the muscular arterial phase of the affected part showed rapid and high enhancement after CEUS,gradually spreading around like a “drip ripple”. These phenomena are typical ultrasonographic features in the diagnosis of rhabdomyolysis and all of them were influencing factors of disease(P<0.05). Rapid hyperenhancement was strongly correlated with rhabdomyolysis(rs=0.734, P<0.01), which was an independent factor and had relatively high diagnostic performance. Conclusion: Gray-scale ultrasound combined with CEUS is simple, fast, real-time and accurate, and has strong operability and popularization. In the diagnosis of rhabdomyolysis, it is suitable for primary hospitals or patients restricted by the conditions of MR examination.更多还原