应用高频超声检查结合E-flow显像初步评价缺乏心血管疾病临床表现的类风湿关节炎患者（RA）指端微循环状态。

选取2012年6月至2013年3月川北医学院附属医院收治的不伴心血管疾病临床表现的RA患者45例（RA组）。选取同期川北医学院附属医院体检的年龄、性别匹配的健康志愿者45名作为健康对照组。所有研究对象均行右手中指末节指端血管高频超声检查并结合E-fIow显像。观察研究对象指端血管分布特征、走行，测量指掌侧固有动脉及甲床动脉收缩期峰值流速（PSV）、舒张末期流速（EDV）、平均血流速度（MV）、阻力指数（RI）及搏动指数（PI），并且计算甲床内血管-甲床像素比。采用独立样本t检验比较RA组患者与健康对照组受检者中指末端动脉血流参数、甲床内血管-甲床像素比。

RA组患者中指末端指掌侧固有动脉及甲床动脉PSV、EDV、MV均低于健康对照组受检者，甲床动脉RI高于健康对照组受检者，但差异均无统计学意义；而RA组患者中指末端指掌侧固有动脉RI、PI及甲床动脉PI均高于健康对照组受检者（0.65±0.08 vs 0.62±0.06，1.16±0.33 vs 1.02±0.18，1.17±0.32 vs 1.01±0.21），且差异均有统计学意义（t=-2.02，P=0.047；t=-2.09，P=0.041；t=-2.06，P=0.043）。RA组患者甲床内的血管-甲床像素比低于健康对照组受检者［（9.82±4.68）% vs （15.56±5.47）%］，且差异有统计学意义（t=3.68，P<0.01）。E-flow显像显示，健康对照组受检者指掌侧固有动脉、甲床动脉及其细小分支能够清晰显示，末节指端血流信号丰富；较多RA组患者末节指端血流显示欠清晰，指掌侧固有动脉、甲床动脉及其细小分支连续性欠佳，血流分布减少，甲床动脉弓显示不完整。

RA患者有效血管床减少，指端微循环血流灌注减少，血流阻力增加，血管系统可出现不同程度的损害。高频超声检查结合E-flow显像可视化直观观察血流走行分布特征及定量评价缺乏心血管疾病临床表现的类风湿关节炎患者存在指端微循环变化。

To preliminarily evaluate the fingertip′s microcirculation in rheumatoid arthritis (RA) patients without clinical manifestations of cardiovascular disease by high frequency ultrasonography and E-flow imaging.

From June 2012 to March 2013, 45 consecutive RA inpatients of affiliated hospital of North Sichuan Medical College without clinical manifestations of cardiovascular disease were enrolled. At the same time, 45 age-and sex-matched healthy volunteers were selected as the health control group. To observe the course and distribution characteristics of the fingertip vessels, peak systolic velocity (PSV), end diastolic velocity (EDV), mean velocity (MV), vascular resistance index (RI) and pulsatility index (PI) of digital palmar propria artery and nail bed arteries were measured. In addition, the ratio of pixels in vessels and nail bed was calculated. The arterial blood flow parameters of middle fingertip and the ratio of pixels in vessels-nail bed in RA group and healthy control group were compared using independent sample t test.

Compared to control group, PSV, EDV and MV of the digital palmar propria artery of middle finger was lower and RI of the nail bed arteries was higher in RA group (P>0.05), but there were no statistical differences between RA and control group. RI and PI of digital palmar propria artery and PI of nail bed arteries in RA group were higher than those of the control group (0.65±0.08 vs 0.62±0.06, 1.16±0.33 vs 1.02±0.18 and 1.17±0.32 vs 1.01±0.21), and the differences were statistically significant (t=-2.02, P=0.047; t=-2.09, P=0.041; t=-2.06, P=0.043). In addition, it was statistically significant between RA and control group (t=3.68, P<0.01) and the ratio of pixels in vessels and nail bed in RA group was lower [(9.82±4.68)% vs (15.56±5.47)%]. In healthy control group, there was rich blood supply of fingertip, moreover, the digital palmar propria artery and nail bed arteries could be displayed clearly and continuously by E-Flow imaging, while the definition and continuity of small vascular flow images in the majority of RA patients were not as good as that in normal controls, and the distribution of blood flow was decreased.

Effective vascular bed and microcirculation perfusion of fingertip reduced and blood flow resistance increased in RA patients. In the end, the vascular system was differently damaged. High frequency ultrasonography combined with E-flow imaging can visually observe vascular distribution characteristics of fingertip and quantitatively evaluate the changes of fingertip′s microcirculation function in RA without clinical manifestations of cardiovascular disease.