双能量CT对急性痛风结晶的评估及相关因素分析

Evaluation of urate crystallization in acute gouty arthritis by dual energy CT and analysis of related factors

目的:采用单源双能量CT(dual energy CT,DECT)处理技术测定痛风性关节炎患者急性发作时的尿酸盐结晶沉积量多少,评估其临床诊断价值,探讨尿酸盐结晶及相关影响因素。方法:选取2018年1月—2020年12月在高新区人民医院因急性痛风性关节炎住院的116例拟诊患者的病例资料并进行分析。所有患者均接受关节DECT扫描。确诊痛风患者根据尿酸水平分组,分析痛风结晶与患者年龄、性别、体质量指数(body mass index,BMI)、病程、尿酸水平的关系。结果:116例纳入患者中,按2015年EULAR/ACR痛风最新分类标准,106例患者确诊痛风,DECT检测痛风特异度为80.0%,灵敏度为88.7%,准确率为87.9%。106例痛风性关节炎DECT阳性与阴性结果与患者BMI、病程呈正相关。依据尿酸水平420μmol/L为界点,分为正常尿酸组和高尿酸组两组,>420μmol/L的另细分为三小组,发现尿酸值>420μmol/L与<420μmol/L的患者的DECT结晶检出率差异具有统计学意义。结论:单源双能量CT痛风的诊断具有较好的敏感性及特异性。双能量CT检测痛风结晶沉积量与血尿酸水平呈正相关,可为痛风性关节炎患者病情严重程度的评估分级提供临床诊疗依据,双能量CT通过评估尿酸盐结晶沉积情况对急慢性痛风性关节炎有良好的诊断价值,同时提示患者病程及BMI对痛风结晶检出率呈正相关,血尿酸水平是尿酸盐结晶的独立影响因素,为临床进一步治疗痛风起重要的临床指导作用。

Objective To determine the amount of urate crystal deposition in patients with gouty arthritis during acute attack by dual energy CT(DECT),evaluate its clinical diagnostic value,and explore urate crystal and related influencing factors.Methods The case data of 116 patients hospitalized for acute gouty arthritis in High tech Zone People's hospital from January 2018 to December 2020 were selected and analyzed.All patients underwent joint DECT scanning.The patients with gout were divided into groups according to the level of uric acid.The relationship between gout crystallization and age,gender,body mass index(BMI),course of disease and uric acid level was analyzed.Results Among the 116 patients,106 were diagnosed as gout according to the latest classification standard of EULAR/ACR gout in 2015.The specificity,sensitivity and accuracy of DECT were 80.0%,88.7%and 87.9%.The positive and negative results of DECT in 106 patients with gouty arthritis were positively correlated with BMI and course of disease.According to the uric acid level 420μmol/L as the boundary point,they were divided into normal uric acid group and high uric acid group.Those greater than 420μmol/L were subdivided into three groups.It was found that there was a statistically significant difference in the detection rate of DECT crystallization between patients with uric acid value greater than 420μmol/L and those less than 420μmol/L.Conclusion Single source dual energy CT has good sensitivity and specificity in the diagnosis of gout.The detection of gout crystal deposition by dual energy CT is positively correlated with the level of blood uric acid,which can provide clinical diagnosis and treatment basis for the evaluation and classification of the severity of gouty arthritis.Dual energy CT has good diagnostic value for acute and chronic gouty arthritis by evaluating the deposition of urate crystal,At the same time,it is suggested that the course of disease and BMI are positively correlated with the detection rate of gout crystallization.The level of blood uric acid is an independent influencing factor of urate crystallization,which plays an important clinical guiding role in the further treatment of gout.