能谱CT不同指标对痛风诊断价值的比较研究

Comparative study on the value of different indexes of spectral CT in diagnosing gout

目的探讨应用宝石能谱CT中相关参数尿酸盐浓度和总体积在诊断痛风中的差异。方法回顾性分析天津医科大学朱宪彝纪念医院2020年10月至2021年4月收治的痛风住院患者66例, 根据痛风病程分为早期组和晚期组, 正常志愿者8名作为对照组, 比较3组第1跖趾关节尿酸盐浓度及足踝部尿酸盐总体积的差异性, 受试者工作特征(ROC)曲线比较二者的诊断效能。根据痛风患者尿酸盐浓度分为低浓度组和高浓度组, 比较两组的肾功能及炎性指标的差异性, 并分析尿酸盐浓度与其相关性。比较各组间骨侵蚀率的差异性。结果尿酸盐浓度和骨侵蚀率晚期组>早期组>对照组, 差异有统计学意义(P均<0.05)。尿酸盐总体积晚期组>早期组>对照组, 但早期组与对照组差异无统计学意义。尿酸盐浓度和总体积ROC曲线下面积分别为0.902、0.785, 置信区间分别为0.821~0.982, 0.638~0.932。高浓度组的骨侵蚀率、病程、血尿酸、血肌酐、尿素氮及红细胞沉降率(ESR)、C-反应蛋白(CRP)均大于低浓度组(P均<0.05)。尿酸盐浓度与尿素氮、CRP、ESR呈正相关, 与尿酸排泄分数呈负相关。结论能谱CT尿酸盐浓度比总体积对痛风的诊断效能高。

Objective To explore the difference between the concentration and total volume of urate of Gemstone Spectroscopy CT in the diagnosis of gout.Methods This was a retrospective analysis of 66 gout inpatients admitted to our hospital from October 2020 to April 2021.According to the course of gout,they were divided into early group and late group,and 8 healthy volunteers were served as a control group.The differences in the urate concentration of the first metatarsophalangeal joint and the total volume of urate in the foot and ankle of the three groups were compared.The receiver operating characteristic(ROC)curve was used to ascertain the diagnostic power of the two indicators.According to the urate concentration of gout patients,they were divided into low-concentration group and high-concentration group.The differences in renal function and inflammation indexes between the two groups were compared,and the correlation between urate concentration and kidney function and inflammation were analyzed.The difference of bone erosion rate between each group were analyzed.Results The concentration of urate and bone erosion rate in late group was higher than early group and control group,and the difference were statistically significant(all P<0.05).The total volume of urate late group was higher than early group and control group,but there was no significant difference between the early group and the control group.The area under the ROC curve of urate concentration and total volume were 0.902 and 0.785,respectively,and the confidence intervals were 0.821-0.982 and 0.638-0.932,respectively.The bone erosion rate,disease course,serum uric acid,serum creatinine,blood urea nitrogen,erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)of the high-concentration group were higher than those of the low-concentration group(all P<0.05).The concentration of urate was positively correlated with blood urea nitrogen,CRP,ESR,and negatively correlated with uric acid excretion fraction.Conclusion Urate concentration of the energy spectrum CT has a better diagnostic value in gout than the total volume.