肌肉骨骼超声在痛风性关节炎不同时期检查中的应用

Application of musculoskeletal ultrasound in different stages of gouty arthritis

目的:探究肌肉骨骼超声在痛风性关节炎不同时期检查中的应用价值,为临床早期诊治提供指导。方法:选取2017年8月至2019年8月在四川省林业中心医院就诊的患有痛风性关节炎的80例患者进行研究,其中34例为急性期,26例患者为间歇发作期,20例处于慢性关节炎期。采用肌肉骨骼超声检查各组患者痛风性关节炎各期受累关节及分布,检查各期受累关节滑膜增生、骨侵蚀、双轨征及痛风石症状,并评估患者骨膜上的血流情况及关节炎症程度。结果:急性关节炎期、间歇发作期及慢性关节炎期最常累及的关节为第1跖趾关节的患者分别有15例(44.11%)、16例(61.54%)、15例(75%),随后依次为足踝关节10例(29.41%)、7例(26.92%)、3例(15%),膝关节6例(17.64%)、3例(11.54%)、2例(10%)。各期同时累及2个以上关节区的患者分别有3例(8.82%)、2例(7.69%)、2例(10%)。急性期受累关节部位滑膜炎症的发生率(58.82%)明显高于间歇发作期(3.84%)及慢性关节炎期(20.00%),差异有统计学意义(P<0.05)。间歇发作期受累关节部位双轨征发生率(46.15%)明显高于急性期(32.35%)及慢性关节炎期(30.00%),差异有统计学意义(P<0.05)。慢性关节炎期受累关节部位痛风石发生率(40.00%)明显高于间歇发作期(30.76%)及急性期(2.94%),差异有统计学意义(P<0.05)。各组骨侵蚀、高回声点、韧带高回声点的发生率相比,差异无统计学意义(P>0.05)。结论:经肌肉骨骼超声有助于痛风性关节炎不同时期的早期诊治,临床应用价值大,值得推广应用。

Objective:To study and analyze the application of musculoskeletal ultrasound in different stages of gouty arthritis,so as to provide guidance for early clinical diagnosis and treatment.Methods:From August 2017 to August 2019,80 patients with gouty arthritis in Sichuan Forestry Central Hospital were selected for study,including 34 patients in acute stage,26 patients in intermittent stage and 20 patients in chronic arthritis stage.Musculoskeletal ultrasound was used to examine the affected joints and their distribution in each stage of gouty arthritis.Synovial hyperplasia,bone erosion,double track sign and symptoms of gouty stone in each stage of the affected joints were examined.The blood flow on the periosteum and the degree of joint inflammation were evaluated.Results:The first metatarsophalangeal joint was the most frequently involved joint in the acute,intermittent and chronic stages,which were 15 cases(44.11%),16 cases(61.54%),15 cases(75%),followed by 10 cases(29.41%),7 cases(26.92%),3 cases(15%),6 cases(17.64%),3 cases(11.54%)and 2 cases(10%).Three patients(8.82%),two patients(7.69%)and two patients(10%)involved more than two joint areas at the same time.The incidence of synovitis in acute stage(58.82%)was significantly higher than that in intermittent stage(3.84%)and chronic stage(20.00%).The difference between the three groups was statistically significant(P<0.05).The incidence of double track sign in the affected joint in intermittent period(46.15%)was significantly higher than that in acute period(32.35%)and chronic period(30.00%).The difference between the three groups was statistically significant(P<0.05).The incidence of gouty stone in chronic stage(40.00%)was significantly higher than that in intermittent stage(30.76%)and acute stage(2.94%).The difference between the three groups was statistically significant(P<0.05).There was no significant difference in the incidence of bone erosion,hyperechoic points and hyperechoic points of ligaments(P>0.05).Conclusion:Musculoskeletal ultrasound can help in the early diagnosis and treatment of gouty arthritis in different periods,which has great clinical value and can be widely used.