宝石能谱CT检测不同痛风患者足踝关节尿酸盐沉积的临床价值

Diagnostic value of uric acid quantification in feet and ankles in gout patients using gemstone spectral imaging computerized tomography technology

目的掌握宝石能谱(gemstone spectral imaging,GSI)CT技术检测尿酸盐沉积的方法,探讨该方法对痛风患者足踝部尿酸盐沉积定量的临床价值。方法选择2013年8月-2016年4月解放军总医院海南分院风湿免疫科门诊及住院的89例患者,35例痛风石痛风患者(A组),36例无症状高尿酸血症患者(B组),18例其他类型关节炎患者(对照组C组)。对其双侧第一跖趾关节和双侧外踝旁软组织行GSI-CT扫描,分别测量尿酸盐[羟基磷灰石(hydroxyapatite,HAP)]、羟基磷灰石-尿酸盐的基物质浓度。结果三组的第一跖趾关节和外踝旁软组织尿酸盐-羟基磷灰石浓度均存在统计学差异(P均<0.05):第一跖趾关节,A组为(1 186.32±23.86)mg/cm^3>B组为(1 157.71±19.35)mg/cm^3>C组为(1 123.62±10.51)mg/cm^3;外踝,A组(1 162.71±30.12)mg/cm^3<B组(1 139.32±11.57)mg/cm^3<C组(1 123.0±9.07)mg/cm^3。结论 GSI-CT发现痛风石痛风患者的足踝部尿酸盐沉积程度较无症状高尿酸血症患者重。

Objective To investigate the diagnostic value of gemstone spectral imaging （GSI） CT technology in detecting uric acid quantification in gout patients＇ feet and ankles. Methods From August 2013 to April 2016, a total of 89 patients in the department of rheumatology in Hainan Branch of Chinese PLA General Hospital were enrolled in this study and underwent CT scans with GSI mode. These patients were divided into three groups： 35 gout patients with clinically detectable tophus in group A, 36 patients with asymptomatic hyperuricemia in group B, and lg patients with other arthropathies in group C as controls. Two locations including soft tissues beside bilateral first metatarsophalangeal joints （FMTPJs） and bilateral exteral malleoli were selected for quantitative analysis of uric acid and hydroxyapatite （HAP）. Results There were significant differences in uric acid （HAP） concentration of three groups in soft tissues beside FMTPJs [A： （1 186.32 ± 23.86）mg/cm3 〉 B： （1 157.71 ± 19.35）mg/cm3 〉 C： （1 123.62 ± 10.51）mg/cm3, P 〈 0.05] and soft tissues beside maUeoli [A： （1 162.71 ± 30.12） mg/cm3 〈 B： （1 139.32 ± 11.57） mg/cm3 〈 C： （1 123.0 ± 9.07） mg/cm3, P 〈 0.05], respectively. Conclusion The uric acid deposits in feet and ankles of patients with tophaceous gout is more serious than that in the same locations of those patients with hyperuricemia examined by GSI-CT technology.