双能CT足踝部尿酸盐结晶解剖部位沉积特点与痛风病程相关性研究

Correlation Between the Course of Gout and the Characteristics of Deposition of Monosodium Urate Crystals in the Foot Based on Dual-Energy CT

目的:研究足踝部尿酸盐结晶解剖部位的沉积特点随痛风病程变化规律。方法:根据痛风病程将101例痛风患者分别纳入痛风首发组(32例,病程小于2周)、早期痛风组(31例,病程大于6个月小于3年)与晚期痛风组(38例,病程大于3年)。比较不同病程间足踝部尿酸盐结晶总体积,特定解剖部位处尿酸盐结晶检出率及形态学评分情况,总结足踝部尿酸盐结晶解剖部位沉积特点随痛风病程变化的规律。结果:3组痛风患者足踝部尿酸盐结晶体积间差异有统计学意义(P<0.05),体积分别为0.015(0.01,0.0625)mm^(3)、0.06(0.01,0.24)mm^(3)与0.135(0.01,0.7425)mm^(3)。3组痛风患者在足背小腿前群肌腱、踝关节、跗跖关节及跖趾关节等处的尿酸盐结晶检出率随病程延长而增大(P<0.05)。3组痛风患者在小腿后群肌腱、足背小腿前群肌腱、踝关节及跖趾关节处尿酸盐结晶形态评分随病程延长而增大(P<0.05)。3组痛风患者在踝关节(3.1%、9.7%与26.3%)及跖趾关节(0%、6.5%与34.2%)处痛风石检出率随病程延长而增加,而3组亚毫米尿酸盐结晶检出率均以小腿后群肌腱处最高(87.5%、64.5%与55.3%)。结论:足踝部尿酸盐结晶沉积在痛风早期进展缓慢;至痛风晚期易在踝关节、跖趾关节处形成巨大痛风石。

Purpose:To study the relationship between changes in the characteristics of anatomical deposition of monosodium urate(MSU)crystals in the foot and the course of gout based on dual-energy CT(DECT).Method:This study included 101 patients with gout,of these patients,32 experiencing the first-onset episodes(<2 weeks),31 had early gout with no first-onset(>6 months and<3 years),and 38 had late gout(>3 years).We retrospectively compared the total volumes of MSU crystals,the detection rates,and the morphology of MSU crystals at specific anatomical sites in the foot of the patients with different gout durations.We also explored the relationship of changes in the characteristics of anatomical deposition of MSU crystals in the foot with the course of gout.Results:There were significant difference in the total volume of MSU crystals on DECT in the foot between the patients in firstonset,early and late gout(P<0.05).The total volumes of MSU crystals of the foot in the gout patients in three groups were 0.015(0.01,0.0625)mm^(3),0.06(0.01,0.24)mm^(3)and 0.135(0.01,0.7425)mm^(3).With the prolongation of the duration of gout,the detection rates of MSU crystals increased in the anterior calf tendons,the ankle joints,the tarsometatarsal joints and the metatarsophalangeal joints(P<0.05),and the morphology of MSU crystals increased in the posterior calf tendons,the anterior calf tendons,the ankle joints and the metatarsophalangeal joints(P<0.05).With the prolongation of the duration of gout,significantly more huge tophaceous in the ankle and metatarsophalangeal joints in the patients with gout.And the detection rates of huge tophaceous in the ankle and metatarsophalangeal joints for three groups were 3.1%,9.7%,26.3%and 0%,6.5%,34.2%respectively.The submillimeter MSU crystal deposition was most common in the tendons of the posterior calf in the three groups,and the proportions of the submillimeter MSU crystal deposition in three groups were 87.5%,64.5%and 55.3%respectively.Conclusion:The deposition of MSU crystals in the foot progressed slowly in the early stages of gout,while huge tophaceous deposits formed more easily in ankle joints and metatarsophalangeal joints of the foot in the late stages of gout.