无高尿酸血症的急性痛风性关节炎的诊断方法的对比研究

A Comparative Study on the Diagnostic Method for Urate Crystal Deposits in Acute Gout Patients Without Hyperuricemia

目的探讨双源CT和普通X线影像技术在急性痛风性关节炎的诊断准确性的对比研究。方法用双源CT和X线对224例血尿酸在正常范围内的急性关节炎患者进行双源CT和X线等影像学检查,同时,对38例临床排除痛风的急性关节炎患者也进行双源CT和X线检查,评估痛风石的检出率。结果 224例血尿酸不高的患者,通过双源CT发现32例病人的肿痛关节周围有痛风石沉积,检出率为12.4%,而X线仅发现1例有痛风性骨侵蚀,检出率为1.8%,经卡方检验两种检查方法所得结果有统计学差异(χ2=23.861,P<0.001);而无痛风的对照患者,都未查出痛风石。结论在血尿酸正常的急性关节炎患者,双源CT比X线更特异敏感地检测出痛风石。因此,对于血尿酸正常的急性痛风性关节炎患者需要进行双源CT检查,有重要的从而与其他急性关节炎鉴别。

Objective To compare the diagnostic accuracy for detecting monosodium urate crystal deposits between dual-energy CT （DECT） and X-ray radiation. Methods A total of 224 consecutive male patients （mean age of 51 years old） who had normal serum uric acid levels （ 〈 70mg/L） but clinically suspected gout were included in this study. DECT and X-ray radiation of feet, knees and hands were performed in all patients. There were 38 acute arthritis patients who had no gout were also included in the study as control. Results Urate crystals were detected by DECT in nine patients. The relevance ratio of gout was 12.4% （32/ 224）. The relevance ratio was 1.8% （4/224） by X-ray radiation. There was a statistical difference between dual-energy CT （DECT） and X-ray radiation （χ^2 =23.681 ,P 〈0. 001 ）. Urate crystals were not detected in acute non-grout arthritis 0% （0/38）. Conclusion DECT is more specific and sensitive method for the diagnosis of gout than X-ray. It can detect small urate crystal deposits in patients without Hyperuricemia. It might be particularly useful in the cases with ambivalent findings for clinicians.