肌肉骨骼超声对痛风性关节炎的诊断意义

The diagnostic value of musculoskeletal ultrasound in gouty arthritis

目的探讨痛风性关节炎（GA）在肌肉骨骼超声中的特殊表现及超声对其的诊断意义。方法收集就诊于解放军总医院行肌肉骨骼超声检查的GA患者及其他关节炎（非GA）患者184个关节。通过灰阶超声监测相应关节的滑膜增生、腱鞘炎、软组织肿胀、骨面、滑囊及骨化情况，采用能量多普勒测量滑膜上血流情况以评价炎症程度。结果GA患者更易出现痛风石（10个关节）、平行线（101个关节）、滑膜上高回声点（10个关节）或韧带内高回声（8个关节），与非GA者相比（0、13、2、0个关节），差异有统计学意义（P值均〈0．05）；腱鞘炎和骨侵蚀更易见于非GA者，与GA者相比，差异有统计学意义（P值均〈0．05）。出现痛风石、平行线、高回声点或韧带内高回声中的任意一项或一项以上诊断GA的特异性为92．4％，敏感性为60．3％，ROCAUC为0．764（P〈0．05）。结论超声影像出现关节内痛风石、平行线、高回声点或韧带内高回声对GA具有诊断意义。肌肉骨骼超声是一种有效的GA诊断工具。

Objective To observe the characteristic features of museuloskeletal ultrasound （MSUS） in gouty arthritis （GA） and to assess its value in GA diagnosis. Methods Patients with GA and non-GA who underwent MSUS examination in Chinese PLA General Hospital were enrolled in this study. The synovitis, tenosynovitis, soft tissue swelling, bone erosion, bursitis and ossification were measured by greyscale ultrasound, and the synovial vascularity was measured by power Doppler ultrasound to evaluate the degree of inflammation. Results The ultrasound images of GA were intended to have specific features like tophus, hyperechoic deposition on the surface of the articular hyaline cartilage （ double contour sign ） , hyperechoic deposition in the synovium appearing as bright stippled loci, and bright strap in tendons with a significant difference when compared with non-GA group （ P 〈 0.05 ）. The percentage of tenosynovitis and bone erosion in non-GA group was higher than that in the GA group with a significant difference （P 〈 0. 05 ）. Tophus, double contour sign, bright stippled loci or bright stippled foci in tendons together suggested gout with a specificity of 92. 4% and a sensitivity of 60.3% , the AUC of ROC was 0.764 （ P 〈 0. 05 ）. Conclusion Tophus, double contour sign, bright loci and bright strap detected by MSUS are of diagnostic value on GA and MSUS may he a promising tool in diagnosing GA.