海勤官兵无症状高尿酸血症与痛风膝关节病变的超声声像图特征及相关性分析

Ultrasonographic characteristics and correlation analysis of asymptomatic hyperuricemia and gout knee joint lesions in naval officers and sailors

目的探讨海勤官兵无症状高尿酸血症(HUA)和痛风的膝关节病变肌骨超声声像图特征,以期加强海勤官兵HUA的预防和管理。方法选取2016年1月至2021年12月入住联勤保障部队北戴河康复疗养中心康复疗养的海勤官兵,经临床确诊HUA患者168例,其中,确诊为痛风22例(痛风组),其余146例为无症状HUA(无症状HUA组);选取同期在本中心康复疗养的58例血尿酸正常的海勤官兵作为对照组。对上述3组人员的膝关节、踝关节、第一跖趾关节及关节周围肌腱、软组织行高频和彩色多普勒肌骨超声检查,分析比较3组海勤官兵血清尿酸水平与关节软骨等病变的相关性。结果与无症状HUA组比较,痛风组血尿酸水平和体质量指数(BMI)明显增高(P<0.05),滑膜增生、滑膜炎、滑膜囊积液、双轨征、骨侵蚀、痛风石6个特征性声像图发生率也明显增高(P<0.05),平均软骨厚度和最大痛风石直径均明显增加(P<0.05)。Logistic回归分析结果显示,无症状HUA组双轨征、痛风石是海勤官兵HUA发病的影响因素(P<0.05或P<0.01)。痛风组滑膜增生、滑膜炎、滑膜囊积液、双轨征、骨侵蚀、痛风石6个特征声像图及平均软骨厚度、最大痛风石直径均为海勤官兵痛风的危险因素(P<0.05或P<0.01)。结论肌骨超声可识别早期无症状HUA尿酸盐晶体沉积及关节结构的改变,能为早期诊断无症状HUA和痛风提供依据。

Objective To explore the ultrasonographic characteristics of asymptomatic hyperuricemia(HUA)and gout knee joint lesions in naval officers and sailors,so as to improve the HUA prevention and treatment in them.Methods A total of 168 HUA cases were selected from the naval officers and sailors admitted to the Beidaihe Rehabilitation and Recuperation Center of Joint Logistic Support Force from January 2016 to December 2021,of whom 22 cases were diagnosed as gout(gout group),and the other 146 cases were asymptomatic hyperuricemia(HUA group).Another 58 cases with normal blood uric acid who were admitted to the center during the same period were selected as the control group.All three groups underwent high-frequency and color doppler musculoskeletal ultrasonography on knee joints,ankle joints,first metatarsophalangeal joints,and the surrounding soft tissues.The correlations between serum uric acid level and articular cartilage lesions in the three groups were analyzed and compared.Results Compared with the HUA group,the gout group had significantly higher serum uric acid level and body mass index(BMI)(P<0.05),and a significant higher detection rate of sonographic features,such as synovial hyperplasia,synovitis,synovial sac effusion,double track sign,bone erosion,and gout stone(P<0.05);besides,the mean cartilage thickness and maximum gout stone diameter in the gout group were significantly increased(P<0.05).Logistic regression analysis showed that the double track sign and gout stone in the HUA group were the influencing factors of the incidence of HUA in naval officers and sailors(P<0.05 or P<0.01).In the gout group,six typical sonographic features of synovial hyperplasia,synovitis,synovial sac effusion,double track sign,bone erosion,and gout stone,as well as mean cartilage thickness and maximum gout stone diameter,were the risk factors of gout in naval officers and sailors(P<0.05 or P<0.01).Conclusion Musculoskeletal ultrasonography can detect the uric acid salt crystallization and the changes of joint structure in early stage of HUA,thus providing basis for early diagnosis of HUA and gout.