双能量CT与高频超声诊断痛风性关节炎63例的临床分析

Clinical Analysis of 320 Slice CT and Highfrequency Ultrasound in the Diagnosis of Gouty Arthritis in 63 Cases

目的探讨双能量CT与高频超声诊断痛风性关节炎63例的临床价值。方法选取2013年05月至2015年06月间于我院风湿免疫科就诊63例关节炎患者为研究对象,分别对患者进行高频超声和320排CT检查,观察比较两种方法对GA诊断的敏感度、特异度、假阴性率、假阳性率、阳性预测值、阴性预测值,同时对两种方法检查GA一致性进行分析。结果高频超声和320排CT诊断GA的灵敏度、特异度、假阳性率、假阴性率、阳性预测值、阴性预测值分别为73.91%vs86.96%、82.35%vs88.24%、17.65%vs 11.76%、26.09%vs13.04%、91.89%vs 95.24%、53.85%vs71.43%,两种方法比较差异具有统计学意义(P<0.05)。两种方法诊断GA与临床诊断标准对比绘制ROC曲线比较,高频超声ROC曲线面积为0.79,320排CT ROC曲线面积为0.92,差异具有统计学意义(P<0.05)。两种方法检出尿酸结晶、骨质缺损、关节积液的Kappa值分别为0.578、0.892、0.824(P均<0.05)。结论双能量CT与高频超声对于GA的诊断均有较高的敏感性及特异性,双能量CT在检测尿酸盐结晶较高频超声具有更高灵敏度且能够更好的显示骨质破坏情况及尿酸盐沉积情况。

Objective To investigate the clinical value of 320 slice CT and high-frequency ultrasound in the diagnosis of gouty arthritis（GA） in 63 cases. Methods A total of 63 arthritic patients treated in department of rheumatology in our hospital between May 2013 to June 2015 were selected for the study and were given high-frequency ultrasound and 320 slice CT respectively. The sensitivity, specificity, false negative rate, false positive rate, positive predictive value and negative predictive value of the two methods in the diagnosis of GA were compared, and the consistency of the two methods in the diagnosis of GA was analyzed. Results There were statistically significant differences between high-frequency ultrasound and 320 slice CT in the sensitivity, specificity, false positive rate, false negative rate, positive predictive value and negative predictive value in the diagnosis of GA（73.91% VS 86.96%, 82.35% VS 88.24%, 17.65% VS 11.76%, 26.09% VS 13.04%, 91.89% VS 95.24%, 53.85% VS 71.43%）（P〈0.05）. The two methods were compared with the clinical diagnostic criteria for the diagnosis of GA, and the ROC curve was drawn. The area under ROC curve of high-frequency ultrasound was 0.79, and the area of 320 slice CT was 0.92（P〈0.05）. The Kappa values of the two methods in the diagnosis of uric acid crystals, bone defects and joint effusion were 0.578, 0.892 and 0.824, respectively（P〈0.05）. Conclusion The sensitivity and specificity of 320 slice CT and ultrasound are high in the diagnosis of GA. The sensitivity of 320 slice CT is higher than high-frequency ultrasound in the detection of uric acid crystals and it show the bone destruction and urate deposition better.