痛风性关节炎急性发作期DECT影像特征与临床表现的相关性研究

Correlation between DECT Imaging Characteristics and Clinical Manifestations of Acute Gouty Arthritis

目的探究痛风性关节炎急性发作期的双源双能CT(DECT)的影像特征与其病程、发作频率及其他代谢性疾病的生化指标的相关性。方法回顾性分析119例经临床确诊痛风性关节炎急性发作期患者的双源DECT影像检查,对其尿酸钠(MSU)结晶沉积量及骨侵蚀严重程度进行评分,并采集患者的临床信息。根据病程将患者分为Ⅰ组(≤1年)、Ⅱ组(1~5年)及Ⅲ组(>5年),分析三组间患者的年龄、性别、发作频率等一般资料;血尿酸(SUA)、血肌酐(SCr)、尿素氮(BUN)、肾小球滤过率估计值(eGFR)等肾功能相关指标;空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及体质指数(BMI)等其他代谢性疾病的相关指标;合并高血压、糖尿病、冠心病、慢性肾功能不全之间的关系。分析患者MSU沉积评分及骨侵蚀评分与上述临床资料间的相关性。结果三组间性别、发作频率及BMI差异有统计学意义(P<0.05)。三组间肾功能相关指标(SCr、BUN、eGFR)、合并高血压病、合并糖尿病、合并慢性肾功能不全差异有统计学意义(P<0.05)。三组间影像表现(MSU沉积、骨侵蚀的检出率及MSU沉积体积)差异有统计学意义(P<0.05)。三组间年龄、血脂相关生化指标(TC、TG、HDL-C、LDL-C、FBG)、合并冠心病无明显差异(P>0.05)。MSU沉积评分与骨侵蚀评分呈明显正相关(r=0.655,P<0.0001);MSU沉积评分与病程及发作频率呈正相关(r=0.374、0.419,P均<0.0001),与年龄、SUA、TG、伴随高血压病及伴随慢性肾功能不全呈正相关(r=0.219、0.228、0.181、0.283、0.123,P均<0.05);骨侵蚀评分与发作频率及伴随高血压病均呈正相关(r=0.573、0.343,P均<0.0001),与病程、年龄、TG及伴随慢性肾功能不全均呈正相关(r=0.300、0.262、0.248、0.220,P均<0.05);而eGFR与MSU沉积评分及骨侵蚀评分呈负相关(r=-0.257、-0.167,P<0.05)。结论双源DECT评分与痛风性关节炎急性发作期患者的病程、发作频率及合并慢性疾病的概率明显相关,可以有效精准地对其病情进行评估,对后续治疗以及随访提供可靠依据。

Objective To study the correlation between the imaging features of dual⁃energy CT(DECT)in acute gouty arthritis and its disease course,attack frequency,and other related biochemical indicators of metabolic diseases.Methods The dual⁃source DECT imaging examinations of 119 patients with clinically diagnosed acute gouty arthritis were retrospec⁃tively analyzed,the amount of monosodium urate(MSU)crystal deposition and the severity of bone erosion were scored,and the clinical information of the patients was collected.According to the disease course,the patients were divided into groupⅠ(≤1 year),groupⅡ(1<n≤5 years)and groupⅢ(>5 years),and the general information such as age,gender,and at⁃tack frequency of the patients among the three groups was analyzed;the kidney function⁃related indicators such as SUA,SCr,BUN,eGFR;other related indicators of metabolic diseases such as FBG,TC,TG,LDL⁃C,HDL⁃C,BMI;the relationship between comorbid hypertension,diabetes,coronary heart disease,and chronic renal insufficiency.The correlations between the MSU deposition score,bone erosion score and the above indexes were compared and analyzed.Results There were significant differences in gender,attack frequency,BMI;renal function⁃related indicators(SCr,BUN,eGFR);comorbid hy⁃pertension,diabetes,and chronic renal insufficiency among the three groups(P<0.05).There were significant differences in imaging manifestations(MSU deposition,bone erosion detection rate,and MSU deposition volume)among the three groups(P<0.05).There were no significant differences in age,blood lipid⁃related biochemical indicators(TC,TG,HDL⁃C,LDL⁃C,FBG),and comorbid coronary heart disease among the three groups(P>0.05).The MSU deposition score was positively correlated with the bone erosion score(r=0.655,P<0.0001);the MSU deposition score was positively correla⁃ted with the disease duration and attack frequency(r=0.374,0.419,both P<0.0001),and was significantly correlated with age,SUA,TG,comorbid hypertension,chronic renal insufficiency(r=0.219,0.228,0.181,0.283,0.123,all P<0.05);the bone erosion score was positively correlated with attack frequency and comorbid hypertension(r=0.573,0.343,all P<0.0001),and were positively correlated with disease duration,age,TG and combined chronic renal insuffi⁃ciency(r=0.300,0.262,0.248,0.220,P<0.05);while eGFR was negatively correlated with MSU deposition score and bone erosion score(r=-0.257,-0.167,P<0.05).Conclusion The dual⁃source DECT score is significantly correla⁃ted with the duration,attack frequency,and the probability of comorbid chronic diseases in patients with acute gouty arthri⁃tis,which can effectively and accurately assess their conditions and provide a reliable basis for follow⁃up treatment.