肌骨超声在不同时期痛风性关节炎中的超声表现特征及其与关节活动度的相关性分析

Characteristics of musculoskeletal ultrasound in gouty arthritis and its correlation with joint mobility

目的:探讨肌骨超声在不同时期痛风性关节炎中的超声表现特征及其与关节活动度的相关性。方法:选取2020年1月—2023年12月新疆医科大学第六附属医院收治的痛风性关节炎患者80例,将处于慢性期间歇期急性发作和首次发作的患者分为急性发作组(n=50),将慢性期非急性发作的患者分为非急性发作组(n=30)。依照DAS28评分结果进行不同关节活动度分组,分为缓解期组(n=15),低活动期组(n=21)、中活动期组(n=32)与高活动期组(n=12),对比不同关节活动度痛风性关节炎患者肌骨超声评分,并分析相关性。结果:急性发作组的病程短于非急性发作组(P<0.05);急性发作组的痛风石、双轨征人数低于非急性发作组,滑膜炎人数高于非急性发作组(P<0.05);肌骨超声诊断痛风性关节炎急性发作的准确率、灵敏度、阳性预测值分别为90.00%、93.75%、95.74%;不同关节活动度患者关节积液评分、骨侵蚀评分、血流信号评分、滑膜增生评分及总分对比,差异有统计学意义(P<0.05),且高活动期组高于中活动期组、低活动期组与缓解期组(P<0.05);Spearman相关分析结果显示:关节积液评分、骨侵蚀评分、血流信号评分、滑膜增生评分及肌骨超声总评分与痛风性关节炎关节活动度呈正相关(P<0.05)。结论:不同时期痛风性关节炎肌骨超声表现特征具有一定差异,通过肌骨超声可对急性期痛风性关节炎的诊断提供重要参考,且肌骨超声评分与痛风性关节炎关节活动度具有密切关系,可作为评估患者疾病活动度的重要手段。

Objective To explore the ultrasonic features of musculoskeletal ultrasound in gouty arthritis in different periods and its correlation with joint range of motion.Methods 80 patients with gouty arthritis admitted to The Sixth Affiliated Hospital of Xinjiang Medical University were selected from January 2020 to December 2023.Patients with acute attack and first attack in the intermittent period of chronic phase were divided into acute attack group(n=50)and patients with non-acute attack in chronic phase were divided into non-acute attack group(n=30).According to the Disease Activity Score in 28 joints,the patients were divided into remission group(n=15),low activity group(n=21),middle activity group(n=32)and high activity group(n=12).The musculoskeletal ultrasound scores of gouty arthritis patients with different joint activities were compared and the correlation was analyzed.Results The course of disease in acute attack group was shorter than that in non-acute attack group(P<0.05).The number of tophi and double track sign in acute attack group was significantly lower than that in non-acute attack group,and the number of synovitis was higher than that in non-acute attack group(P<0.05).The diagnosis of acute attack of gouty arthritis by musculoskeletal ultrasound showed that the accuracy,sensitivity and positive predictive value were 90.00%,93.75%and 95.74%respectively.There were significant differences in joint effusion score,bone erosion score,blood flow signal score,synovial hyperplasia score and total score in patients with different joint mobility(P<0.05),and the high activity group was significantly higher than the middle activity group,low activity group and remission group(P<0.05).The results of Spearman correlation analysis showed that joint effusion score,bone erosion score,blood flow signal score,synovial hyperplasia score and total score of musculoskeletal ultrasound were positively correlated with joint mobility of gouty arthritis(P<0.05).Conclusion There are some differences in the characteristics of musculoskeletal ultrasound in different periods of gouty arthritis.The musculoskeletal ultrasound can provide an important reference for the diagnosis of acute gouty arthritis,and the musculoskeletal ultrasound score is closely related to the joint activity of gouty arthritis,which can be used as an important means to evaluate the disease activity of patients.