痛风石形成的影响因素分析

Analysis of the factors affecting the formation of tophi

目的应用高频超声探究痛风石形成的影响因素。方法收集临床确诊的145例痛风性关节炎患者的临床资料，利用高频超声观察患者双侧第一跖趾关节（MTP1）、踝关节、膝关节共6个关节的关节滑膜炎、积液、骨破坏、双轨征、痛风石及聚集体情况。根据超声下有无痛风石分为有痛风石组（44例）及无痛风石组（101例），采用t检验、χ^2验或Fisher确切概率法、Logistic回归分析等对可能引起痛风石的相关因素进行统计学分析。结果①超声特征分析显示：MTP1滑膜炎（χ^2=8.479，P=0.004）、积液（χ^2=9.740，P=0.002）多见于无痛风石患者，即痛风早期或急性期；MTP1骨破坏（χ^2=9.593，P=0.003）更多见于有痛风石患者；有痛风石的患者更易出现踝关节双轨征（χ^2=14.069，P=0.000）及骨破坏（χ^2=5.870，P=0.020）、膝关节双轨征（χ^2=8.224，P=0.006）；无痛风石的患者MTP1更易发现聚集体（χ^2=9.649，P=0.003）。②Logistic回归分析结果显示痛风性关节炎首发关节为MTP1[OR=9.725，95%CI（2.765，34.209），P=0.000]、多关节受累[OR=1.908，95% CI（1.190，3.057），P=0.007]、MTP1骨破坏[OR=4.339，95% CI（1.300，14.490），P=0.017]是发生痛风石的主要危险因素，MTP1滑膜炎常发生在无痛风石患者[OR=0.108，95%CI（0.026，0.441），P=0.002]。结论高频超声结合临床指标分析对痛风病情发展及治疗具有重要的指导意义。

ObjectiveTo explore the factors what may influence the formation of tophi by high frequency ultrasound.MethodsThe gouty patients who were experiencing an acute attack and were clinically diagnosed with gouty arthritis were divided into two groups： the tophi group （44 cases） and the no tophi group （101 cases） group, clinical data and ultrasound features of joints were collected. The differences of ultrasound features and clinical characteristics between the two groups were analyzed.Results① Ultrasound features showed that synovitis （χ^2=8.479, P=0.004） and effusion （χ^2=9.740, P=0.002） of the first metatarsophalangeal joint （MTP1） were most frequently observed in the no tophi group; bone erosion of MTP1 （χ^2=9.593, P=0.003）, double contour （DC） sign （χ^2=14.069, P=0.000） and bone erosion （χ^2=5.870, P=0.020） of ankle joint, DC sign of knee joint （χ^2=8.224, P=0.006） were most frequently observed in the tophi group. Hyperechoic aggregates of MTP1 （χ^2=9.649, P=0.003） were most frequently observed in no tophi group. ② Logistic regression analysis showed that MTP1 was the first attacked joint [OR=9.725, 95%CI（2.765, 34.209）, P=0.000], the multiple joints involved [OR=1.908, 95%CI （1.190, 3.057）, P=0.007] and bone erosion of MTP1 [OR=4.339, 95%CI（1.300, 14.490）, P=0.017] were the main risks of the formation of tophi. Synovitis of MTP1 often presented in no tophi patients [OR=0.108, 95%CI（0.026, 0.441）, P=0.002].ConclusionHigh frequency ultrasound combine with clinical data is of great value for evaluating the development and treatment of gout.