急性痛风性关节炎首次发作患者双能CT尿酸盐沉积研究

Study on the deposition of monosodium urate in patients with first-episode of acute gouty arthritis by dual energy CT

目的:利用痛风双能CT(DECT)成像技术研究急性痛风性关节炎首次发作(痛风首发)患者尿酸盐沉积特点。方法:收集2019年于北京大学第三医院确诊急性痛风首发患者70例为病例组,男69例,女1例,年龄17~65(39±14)岁。收集同期因运动损伤来诊,明确排除痛风患者15例为对照组,均为男性,年龄19~56(33±12)岁。回顾性分析病例组痛风首发受累/最痛关节、对照组足踝关节的DECT数据,评估并记录受试关节尿酸盐结晶形态、体积及沉积位置情况,总结痛风首发患者尿酸盐沉积关节及与临床症状吻合程度。采用χ^2检验进行组间比较、非参数Kruskal-Walls H检验比较尿酸盐体积差异。结果:病例组DECT尿酸盐检出率为97.1%(68/70),对照组尿酸盐检出率为0。痛风首发入组关节有足踝52例(74.3%)、膝13例(18.6%)、手腕5例(7.1%),三关节均以散在的亚毫米尿酸盐沉积最多,体积较小,形态及体积差异无统计学意义(P>0.05)。三关节尿酸盐沉积最多位置分别为小腿后群肌腱(含跟腱)78.8%(41/52)、膝关节软骨76.9%(10/15)和掌侧肌腱60.0%(3/5),而第一跖趾关节分布较少13.5%(7/52)。DECT检出尿酸盐沉积关节数量多于症状关节者共37例,占比最多(52.8%)。结论:痛风DECT检查对急性痛风首发患者尿酸盐检出敏感度高,有助于提高早期痛风诊断率。

Objectives To investigate the characteristics of monosodium urate(MSU)deposition in patients with the first-episode of acute gouty arthritis(Gout)by using dual energy CT(DECT)imaging technique.Methods A total of 70 first-episode patients with acute Gout diagnosed in Peking University Third Hospital in 2019 were collected as the case group,including 69 males and 1 female,aged 17-65(39±14)years.During the same period,a total of 15 male patients aged 19-56(33±12)years were collected as the control group.They were admitted to the hospital due to sports injuries and were excluded from gout.The DECT data of the first-affected or the most painful joints of gout in the case group and the surgical ankle joints in the control group were retrospectively analyzed.The crystal morphology,volume and deposition location of MSU in the measured joints were evaluated and recorded,and the degree of MSU deposition in the joints of the first-episode patients with Gout and its coincidence with clinical symptoms were summarized.The χ^2 test,and Kruskal-walls were used for statistical analysis.Results The detection rate of MSU by DECT in the case group was 97.1%(68/70),and 0 in the control group.The first-affected joints of Gout included 52 cases of ankles(74.3%),13 cases of knees(18.6%),and 5 cases of wrists(7.1%).The three joints were mainly deposited with scattered submillimeter MCU.There was no significant difference in MSU morphology and volume between the three joints.The locations with the most MCU deposits among the three joints were 78.8%(41/52)of the posterior calf tendons(including Achilles tendon),76.9%(10/15)of the knee articular cartilages,and 60.0%(3/5)of the palmaris tendons,while the distribution of the first metatarsophalangeal joint was less than 13.5%(7/52).The number of MSU deposited joints detected by DECT was 37 cases more than that of symptomatic joints,accounting for 52.8%.Conclusions DECT is highly sensitive in detecting MCU in the first-episode of acute Gout,which helps to improve the early diagnosis rate of gout.