能谱CT对早期痛风降尿酸治疗疗效的定量评价

Quantitative evaluation of the efficacy of urate-lowering therapy with spectral CT imaging in early-stage gouty arthritis

目的探讨能谱CT物质分离技术在早期痛风患者降尿酸治疗疗效定量评估中的价值。方法回顾性分析临床确诊的32例早期足部痛风患者降尿酸治疗前、后的能谱CT图像,采用物质分离技术获取尿酸(钙)基物质图,两名医师双盲法分别测量治疗前、后第一跖趾关节周围的尿酸盐沉积浓度。对患者治疗前、后的血尿酸浓度与尿酸盐沉积浓度分别进行配对t检验,采用Spearman相关分析评价治疗后血尿酸浓度下降值与尿酸盐沉积浓度下降值的相关性。结果治疗前能谱CT所测关节周围尿酸盐沉积平均浓度为(1178.78±11.63)mg/L,血尿酸平均浓度为(421.59±115.27)μmol/L。治疗后能谱CT尿酸盐沉积平均浓度为(1162.55±9.50)mg/L;血尿酸平均浓度为(309.41±87.59)μmol/L。治疗后血尿酸浓度与能谱CT所测第一跖趾关节周围尿酸盐浓度明显低于治疗前(P<0.01;P<0.01);治疗前、后血尿酸浓度差与能谱CT尿酸盐浓度差有相关性(r=0.53,P<0.01)。结论能谱CT成像能够通过测定第一跖趾关节周围尿酸盐沉积浓度在治疗前后的改变,对早期痛风降尿酸治疗的疗效进行定量评价,为临床的治疗与监测提供依据。

Objective To assess the value of material separation technical of spectral CT in evaluating the efficacy of urate-lowering therapy in early-stage gouty arthritis patients.Methods The clinical and imaging data of 32 early-stage gouty arthritis patients were retrospectively analyzed.Spectral CT scan was conducted on the foot before and after the therapy.Selected uric acid-calcium as basics,two radiologists performed material separation on spectral CT images,and measured the concentration of uric acid around the first metatarsophalangeal joint on uric acid based mapping.The differences of concentration of uric acid and serum uric acid levels before and after treatment were compared by paired t test respectively.Spearman correlation coefficient was used to analyze the association between changes in serum urate levels and spectral CT results.Results Before the therapy,the mean concentration of uric acid was(1178.78±11.63)mg/L,mean serum urate level was(421.59±115.27)μmol/L;after the treatment,the mean concentration of uric acid was(1162.55±9.50)mg/L,mean serum urate level was(309.41±87.59)μmol/L.Compared to the former data,the concentration of uric acid and serum urate level were significantly lower after treatment(P<0.01;P<0.01).The decrease in serum urate levels was positively related to the decrease in the concentration of uric acid on the uric acid based mapping(r=0.53,P<0.01).Conclusion The spectral CT can evaluate the efficacy of urate-lowering therapy quantitatively through comparing the concentration of uric acid around the first metatarsophalangeal joint in early-stage gouty arthritis,and it can provide more quantitative data for clinical treatment and monitoring.