双能量CT评估慢性痛风性关节炎尿酸盐结晶的相关因素研究

Evaluation of dual-energy CT on chronic gouty arthritisurate crystals and factors of urate crystals

目的双能量CT测定慢性痛风性关节炎患者尿酸盐结晶情况,探讨双能量CT测定尿酸盐结晶对慢性痛风性关节炎的诊断价值及尿酸盐结晶的影响因素。方法选择2014年1月～2015年12月慢性痛风性关节炎患者90例作为痛风组和非痛风性关节炎患者90例作为非痛风组,并根据血尿酸水平分为正常尿酸组和高尿酸组,双能量CT扫描患者尿酸盐结晶情况。结果高尿酸组双能量CT检测尿酸盐结晶阳性率高于正常尿酸组(P<0.05)。痛风组90例患者中,双能量CT测定尿酸盐结晶诊断痛风(尿酸盐结晶阳性)81例,非痛风9例;非痛风组90例患者中,双能量CT诊断痛风24例,非痛风56例。双能量CT对痛风性关节炎的诊断灵敏度、特异度分别为89.0%、89.9%,阳性预测值和阴性预测值分别为90.0%、88.9%,Youden指数和诊断符合率分别为78.9%、89.4%。单因素分析:尿酸盐结晶组男性所占比例高于无尿酸盐结晶组(P<0.05),尿酸盐结晶组病程和血尿酸水平高于无尿酸盐结晶组(P<0.05)。logistic回归多因素分析:血尿酸水平影响尿酸盐结晶沉积(P<0.05)。结论双能量CT通过评估尿酸盐结晶情况对慢性痛风性关节炎有良好的诊断价值,血尿酸水平是尿酸盐结晶的独立影响因素。

Objective To measure the chronic gouty arthritis patients urate crystals by dual-energy CT, and to explore the diagnosis of chronic gouty arthritis by the dual-energy CT determined urate crystals and the factors of urate crystals. Methods We selected 90 patients with chronic gouty arthritis as gout group and 90 patients with non-gouty arthritis as non-gout group in Second Hospital of Ningbo City from January 2014 to December 2015 and were divided into normal uric acid group and high uric acid group according to blood uric acid levels. The urate crystal situation was scanned dual-energy CT. Results The positive rate of urate crystals detected by dual-energy CT in high uric acid group was higher than that of normal uric acid group （ P 〈0.05）. In 90 patients of gout group, the gout （urate crystals positive） by dual-energy CT-measured urate crystals diagnosis was 81 cases, the non-gout was nine cases; in 90 patients of non gout group,the gout by dual-energy CT-diagnosis was 24 cases, non-gout was 56 cases. Dual-energy CT diagnosed gouty arthritis sensitivity and specificity were 89.0% and 89.9%, positive predictive value and negative predictive value were 90.0% and 88.9%, Youden index and the diagnosis rate were 78.9% and 89.4%. Univariate analysis showed that the proportion of men in urate crystals group was higher than that in non-urate crystals group （ P 〈0.05）, the course and serum uric acid levels in urate crystals group were higher than that in non-urate crystals group （ P 〈0.05）. Multivariate logistic regression analysis showed that blood uric acid levels affected urate crystal deposition （ P 〈0.05）. Conclusion Dual-energy CT has a good diagnostic value on chronic gouty arthritis by assessing the urate crystals, serum uric acid level that is independent predictors of urate crystals.