肌骨超声联合临床指标对不同时期痛风性关节炎的应用价值

The value of musculoskeletal ultrasound combined with clinical indicators in different stages of gouty arthritis

目的对比分析肌骨超声联合临床指标对首次发作急性痛风性关节炎及慢性痛风性关节炎的应用价值。方法选取40例急性期首次发作痛风性关节炎(A组),40例慢性痛风性关节炎(B组);40例非痛风性关节炎(C组),对比分析不同时期痛风性关节炎的超声表现及临床特征(血尿酸值、受累关节数目、VAS及PGA等)。采用χ2检验进行数据分析。结果纳入的三组患者共计120例,男性105例,女性15例,年龄19~72岁,平均年龄(44.6±14.7)岁。血尿酸值在A组与B组间差异有统计学意义(455.8±127.3,519.3±115.5,P=0.022);两组间压痛关节(受累关节)数差异有统计学意义(32/240,49/240,P=0.038)。VAS及PGA在A组与B组间差异有统计学意义(6.3±1.9和4.9±3.1,P=0.017;7.3±2.1和5.5±3.0,P=0.003)。本文中双轨征、痛风石、聚集体仅见痛风性关节炎组。双轨征的发生率于A组与B组之间差异有统计学意义(6/240,54/240,P=0.000),B组中又以膝关节多见(26/54)。滑膜炎的发生率于A组与B组之间差异有统计学意义(57/240,25/240,P=0.000),A组中又以第一跖趾关节多见(23/57)。结论首次发作急性痛风性关节炎血尿酸值较慢性痛风性关节炎低;滑膜炎的发生率高;VAS及PGA分值更高;肌骨超声联合临床指标是诊断不同时期痛风性关节炎的安全有效方法。

Objective To compare and analyze the value of musculoskeletal ultrasound combined with clinical indicators for the first attack of acute gouty arthritis and chronic gouty arthritis.Methods The ultrasomographic and clinical featwes of goutyerthirtis were analyzed among the fivst atlack group a acute gouty arthritis(n=40 group A)chronic gouty arthrits group(n=40)and no gouty arthritis group(n=40,group C)respecitively.The ultrasonographic manifestations,tender and swollen joint count,VAS and PGA were compared and analyzed.Chi-square test was used for data analysis.Results A total of 120 patients(105 males and 15 females)were enrolled in the three groups.Their age ranged from 19 to 72 years,with an average age of 44.6±14.7.The serum uric acid value had significant difference between group A and group B(455.8±127.3,519.3±115.5,P=0.022).There was significant difference in the number of tender joints(involved joints)between the two groups(32/240,49/240,P=0.038).There were significant differences in VAS and PGA between group A and group B(6.3±1.9 and 4.9±3.1,P=0.017;7.3±2.1 and 5.5±3.0,P=0.003).In this study,the double track sign,tophus and aggregates were only found in gouty arthritis groups.There were significant differences in synovitis between group A and group B(57/240,25/240,P=0.000).The incidence of double track sign was significantly different between group A and group B(6/240,54/240,P=0.000).Double track signs were common in knee joint(26/54).The incidence of synovitis was significantly different between group A and group B(57/240,25/240,P=0.000).Synovitis of the first metatarsoph joint was more common in group A(23/57).Conclusion The values of serum uric acid in first attack acute group are lowerthan that of chroaic gouty arthritis group,moreover,the incidence of synovitis,the scores of VAS and PGA are higher.Musculoskeletal ultrasound combined with clinical indicators is a safe and effective method for the diagnosis of gouty arthritis at different stages.