单能量CT成像对痛风石治疗前后疗效评估

发布时间：2018-03-28 18:20

本文选题：痛风　切入点：痛风性关节炎　出处：《青岛大学》2017年硕士论文

【摘要】：目的:探究单能量能谱CT监测下合并慢性痛风石性关节炎患者分别使用非布司他、别嘌醇治疗过程前后痛风石体积的变化情况及血尿酸水平的改变。材料与方法:采用能谱CT单能量成像对2016年7月-2017年2月期间44例符合2015年美国风湿病学会标准,经临床诊断慢性痛风石性关节炎患者行双足踝关节痛风石单能量CT能谱成像。全部患者采用治疗剂量,44例患者平均年龄为(51±11.2)岁,其中非布司他组26例,全部为男性。别嘌醇组18例,男性17例,女性1例。非布司他组(万邦医药优力通2片/天80mg/d,n=26)。对照组采用别嘌醇(华东医药3片/天300mg/d,n=18)。两组患者降尿酸治疗期间急性发作时配合秋水仙碱、非甾体抗炎药治疗;降尿酸治疗前后进行血尿酸水平检查、肝肾功能检查、能谱CT双足踝关节能谱成像。图像处理:所得单能量Mono序列输入Matlab矩阵软件进行分析。扫描方法:患者取仰卧位,足先进方式,扫描基线采用横断面连续扫描,范围自第一远节趾骨至踝关节。统计方法:定量资料采用独立样本t检验;定性资料采用Pearson卡方检验。结果:1.足踝关节痛风结晶分布规律:跖趾关节(28)较跗跖关节(12)、趾骨间关节(20)、肌腱及韧带痛风结晶(6)分布数量明显增多,差异具有显著的统计学意义;跖趾关节(28)、踝关节(22)、距下关节(27),痛风结晶分布差异没有统计学意义;2.降尿酸治疗之前非布司他组s UA水平为602.5±39.26μmol/L,痛风石体积22.35±18.03cm3。对照使用常规药物别嘌醇组,血尿酸水平为586.35±42.36μmol/L,痛风石体积20.01±15.34 cm3,降尿酸治疗之前两组s UA、痛风石体积差异不具有统计学意义P0.05。两组患者经24周的治疗后s UA都有不同程度的减少,非布司他组s UA水平为312.78±31.72μmol/L,痛风石体积3.46±2.69cm3。别嘌醇组s UA平均水平为425.78±38.36μmol/L,痛风石体积均数为12.23±5.92cm3。非布司他组、别嘌醇组s UA水平、痛风石体积均较治疗前减小,差异具有统计学意义P0.05。3.以360μmol/L血尿酸水平为基准:实验组达标19例(73%),对照组达标6例(33.3%),卡方值6.85(P0.05)。结论:1.能谱CT单能量成像对于合并痛风石的痛风性关节炎患者治疗过程中,能够起到长期的疗效检测与评估作用2.慢性痛风石性关节炎患者,其中跖趾关节尿酸盐结晶沉积数量较其余小关节多3.非布司他较别嘌醇具有更好的降低血尿酸水平、缩小痛风结晶体积的能力,对于长期痛风结晶体积的控制具有更好的表现
[Abstract]:Objective: to investigate whether patients with chronic gout arthritis treated with single energy spectrum CT were treated with fentinastatin, respectively. Changes of gout volume and serum uric acid levels before and after allopurinol treatment. Materials and methods: 44 cases of patients from July 2016 to February 2017 met the 2015 American Society of Rheumatology standard by energy dispersive CT single energy imaging. Patients with chronic gout arthritis were treated with single energy CT energy spectrum imaging of gout stone of ankle joint. The average age of 44 patients with chronic gout arthritis was 51 卤11.2 years old, 26 patients in Festalta group. Allopurinol group 18 cases, male 17 cases, One female case, Festa group (2 tablets / day, 80 mg / d, n = 26). The control group was treated with allopurinol (3 tablets / day, 300 mg / d), two groups of patients were treated with colchicine and non-steroidal anti-inflammatory drugs during acute attack during the period of reducing uric acid therapy, the two groups were treated with colchicine and non-steroidal anti-inflammatory drugs. The patients in the control group were treated with colchicine and non-steroidal anti-inflammatory drugs. Serum uric acid level, liver and kidney function, energy spectrum CT energy spectrum imaging of ankle joint were performed before and after hypouric acid treatment. Image processing: single energy Mono sequence was input into Matlab matrix software for analysis. In the advanced mode of foot, the baseline scan was continuous cross-sectional, ranging from the first distal phalangeal bone to the ankle joint. Statistical method: the quantitative data were examined by independent sample t-test. Pearson chi-square test was used for qualitative data. Results the distribution of gout crystals in the ankle and foot joints: metatarsophalangeal joint 28) was significantly higher than that of tarsometatarsal joint (12m), interphalangeal joint (20m), tendon and ligaments gout (6). The difference was statistically significant. There was no significant difference in the crystal distribution of gout between the metatarsophalangeal joint and ankle joint. The level of SA was 602.5 卤39.26 渭 mol / L and the volume of gout was 22.35 卤18.03 cm 路cm ~ (3) in control group, which was treated with allopurinol. The level of uric acid was 586.35 卤42.36 渭 mol / L, the volume of gout stone was 20.01 卤15.34 cm ~ (3). There was no significant difference in the volume of serum uric acid between the two groups before the treatment (P 0.05). The mean level of UA and gout stone were 312.78 卤31.72 渭 mol / L and 3.46 卤2.69 cm ~ (3) in non-bustrast group, 425.78 卤38.36 渭 mol / L and 12.23 卤5.92 cm ~ (3) in allopurinol group, respectively. The difference was statistically significant (P0.05.3). According to the level of serum uric acid of 360 渭 mol/L, the experimental group (19 cases) reached the standard of 73m, the control group (6 cases) reached the standard, the chi-square value was 6.85 (P0.05) .Conclusion 1.EDS CT single energy imaging was used in the treatment of gouty arthritis patients with gout. 2. In patients with chronic gout arthritis, the amount of uric acid crystal deposition in metatarsophalangeal joint is 3% more than that in the other facet joints, and the level of uric acid in the metatarsophalangeal joint is lower than that in allopurinol. The ability to reduce the volume of gout crystallization is better for controlling the volume of gout crystallization for a long time.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R589.7;R816.8

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