痛风性关节炎超声分类及其骨代谢指标与临床表现的相关性

Ultrasonic classfication of gouty arthritis and its correlation between bone metabolism indexes and clinical manifestations

目的分析痛风性关节炎患者的超声特征及其骨代谢指标与临床表现间的相关性。方法对180例痛风性关节炎患者行肌骨超声检查,根据不同超声表现分为无聚集体组58例、聚集体组68例及痛风石组54例。检测各组患者血清中骨代谢指标骨钙素N端中段(OC-N-MID)、1型胶原蛋白交联羧基末端肽(CTX)、Wnt抑制因子Dickkopf1(DKK1)及核因子κB受体激活蛋白配体(RANKL)的含量,比较各组患者骨代谢指标的差异,分析其与病程和血尿酸水平的相关性。结果无聚集体组超声表现为未见点状强回声;聚集体组关节内可见点状强回声、双轨征;痛风石组关节内可见痛风石或骨质侵蚀。各组患者血清OC-N-MID、CTX水平比较差异均无统计学意义,DKK1和RANKL水平比较差异均有统计学意义(均P<0.001)。相关性分析显示,痛风性关节炎患者血清DKK1、RANKL水平与病程和血尿酸水平均呈正相关(均P<0.05),血清CTX、OC-N-MID水平与患者病程均无明显相关。结论肌骨超声可探查痛风性关节炎聚集体、双轨征、痛风石及骨质破坏等特异性表现。随着病程延长,血尿酸水平越高,骨质破坏越严重;超声表现结合病程在一定程度上能够反映患者的骨质代谢情况。

Objective To analyze the ultrasonic manifestations of gouty arthritis and its correlation between bone metabolism indexes and clinical manifestations.Methods A total of 180 patients with gouty arthritis were examined by musculoskeletal ultrasound.According to different ultrasonic manifestations,the patients were divided into the non-aggregate group(58 cases),aggregation group(68 cases)and tophus group(54 cases).The contents of CTX,OC-N-MID,DKK1 and RANKL in serum were measured.The differences of bone metabolism indexes among the three groups were compared,and the correlation between them and course of disease,serum uric acid level were analyzed.Results Ultrasound showed that there was no punctate strong echo in the non-aggregate group,there was punctuate strong echo and double track sign in the joint of the aggregate group,and tophus or bone erosion in the joint of the tophus group.There were no significant difference of CTX and OC-N-MID among the three groups,but there were statistical difference of DKK1 and RANKL(both P<0.01).Correlation analysis showed that serum DKK1,RANKL level were positively correlated with course of disease and serum uric acid level in gouty arthritis(all P<0.05),while serum CTX,OC-N-MID were not correlated with course of disease and serum uric acid level.Conclusion Musculoskeletal ultrasound can detect the specific manifestations of gouty arthritis such as aggregation,double track sign,tophus and bone destruction.With the prolongation of the course of disease,the increase of bone metabolism indexes indicates the aggravation of bone destruction.Musculoskeletal ultrasound combined with bone metabolism indexes can dynamically monitor the joint involvement of patients.