痛风患者发生关节超声下尿酸盐沉积的危险因素分析

Risk factors of urate deposition on ultrasound in patients with gout

目的探讨痛风患者发生关节超声下尿酸盐沉积的危险因素。 方法收集2015年2月至2017年2月于北京大学第一医院就诊同时行双侧膝、踝和第一跖趾关节超声检查的痛风患者的临床资料和超声检查结果。依据超声下是否存在双轨征或痛风石对患者进行分组比较。采用t检验、χ2检验及Logisitic回归进行数据分析。 结果126例痛风患者入组本研究。其中50例（39.7%）患者存在双轨征，48例（38.1%）患者存在痛风石。双轨征阳性组患者的平均血尿酸水平显著高于双轨征阴性组[（602±79）μmol/L与（538±101）μmol/L，t=3.998，P=0.044]；双轨征阳性组患者高尿酸血症病程明显高于双轨征阴性组[（186±87）个月与（130±77）个月，t=3.330，P=0.002）]。超声发现痛风石组患者的高尿酸血症病程明显长于未发现痛风石组患者[（175±102）个月与（138±96）个月，t=2.003，P=0.045]。血尿酸水平、高尿酸血症病程是痛风患者出现超声下双轨征阳性的独立危险因素[OR=1.006，95%置信区间（CI）（1.002，1.011）；OR=1.028，95%CI（1.013，1.042）]。高尿酸血症病程是痛风患者超声发现痛风石的独立危险因素[OR=1.004，95%CI（1.000，1.007）]。受试者工作特征曲线（ROC）分析显示：高尿酸血症病程超过94个月，平均血尿酸水平高于505.5 μmol/L的患者，关节部位更容易出现超声下双轨征；而高尿酸血症病程超过137个月时，关节出现痛风石的可能性增加。 结论超声下出现双轨征和痛风石患者的高尿酸血症病程更长，双轨征阳性与患者的平均血尿酸水平升高相关，高尿酸血症病程是痛风患者发生尿酸盐沉积的独立危险因素。

ObjectiveTo explore the risk factors of urate deposition on ultrasound in patients with gout. MethodsAll the gout patients who visited our center between February 2015 and February 2017 and underwent ultrasound examination of bilateral knees, ankles and first metatarsophalangeal joints （MTP1） were enrolled. Subgroup analysis was done depending on whether double contour sign （DCS） or tophus was found on ultrasound. Main statistical analysis methods were t test, chi-square test and logistic regression model. ResultsOne hundred and twenty-six patients were included. DCS was found in 50（39.7%） patients and tophus was found in 48（38.1%） patients. The serum uric acid （SU） level of the DCS positive group was signi-ficantly higher than the DCS negative group [（602±79） μmol/L vs （538±101） μmol/L, t=3.998, P=0.044]. The hyperuicemia duration of the two groups were （186±87） months and （130±77） months, which was significantly different （t=3.330, P=0.002）. The hyperuicemia duration of the tophus positive group was significantly higher than tophus negative group [（175±102） months vs （138±96） months, t=2.003, P=0.045]. The SU level and hyperuicemia duration were independent risk factors of positive DCS in gout patients [OR=1.006, 95%CI（1.002, 1.011）; OR=1.028, 95%CI（1.013, 1.042）]. The hyperuicemia duration was independent risk factor of positive tophus in gout patients [OR=1.004, 95%CI （1.000, 1.007）]. Receiver operating characteristic curve （ROC） curve showed gout patient whose hyperuricemia duration was longer than 94months and SU level was higher than 505.5 μmol/L were more likely to have positive DCS in joints; meanwhile, patient whose hyperuricemia duration was longer than 137 months were more likely to have positive tophus in joints. ConclusionGout patients who have positive DCS and tophus on ultrasound have longer hyperuicemia duration. Positive DCS is also related with patients＇ higher serum levels. The hyperuicemia duration is an independent risk factor of urate deposition on ultrasound in patients with gout.