双能CT检查在痛风性关节炎中的应用价值

发布时间：2018-04-08 18:23

本文选题：痛风　切入点：双能CT　出处：《南方医科大学学报》2015年03期

【摘要】：目的探讨双能CT(DECT)检查在痛风性关节炎中的应用价值。方法 61例痛风性关节炎患者、30例强直性脊柱炎(AS)及30例类风湿关节炎(RA)患者行第2代DECT对最痛部位包括手腕关节或肘关节或膝关节或足踝关节及腰椎、骨盆和骶髂关节进行扫描。用DE Image view处理软件独立分析、评价,以检查部位有绿色伪彩结晶沉积作为诊断依据。记录患者人口统计学资料、血尿酸水平。3例痛风患者穿刺活检检查尿酸盐结晶,与DECT结果进行比对。10例入组时DECT显示有尿酸盐结晶沉积的慢性痛风患者服用降尿酸药物6月后复查相同关节部位DECT,比较治疗前后尿酸盐沉积情况。结果痛风性关节炎组、AS组、RA组DECT(+)分别为98.4%(60/61),13.3%(4/30)、6.7%(2/30)(χ2=95.522,P0.05)。21例急性痛风性关节炎患者中DECT(+)为95.2%(20/21),40例慢性痛风性关节炎患者中DECT(+)为100%(40/40)。3组高尿酸血症患者比例分别为60.7%(37/61),30%(9/30),23.3%(7/30)。3组高尿酸血症的患者中DECT(+)分别为97.3%(36/37),44.4%(4/9),28.6%(2/7)(χ2=24.197,P0.05)。痛风组共发现344处尿酸盐结晶,最常出现结晶沉积的部位依次为第一跖趾关节(22.1%)、第一趾中远端(19.8%)、跟骨(17.4%)、胫骨下端(13.4%),AS组共发现17处尿酸盐结晶,RA组共发现5处尿酸盐结晶。3例穿刺活检发现尿酸盐结晶的痛风患者,DECT在活检部位均检测到绿色标记的尿酸盐沉积。10例DECT显示有尿酸盐结晶沉积的慢性痛风患者服用降尿酸药物6月后复查相同关节DECT,发现局部尿酸盐结晶减少。结论 DECT可以清晰显示尿酸盐结晶,有助于痛风与其他关节炎的鉴别诊断及随防。
[Abstract]:Objective to evaluate the value of dual-energy CTD-DECT in gouty arthritis.Methods 61 patients with gouty arthritis, 30 patients with ankylosing spondylitis and 30 patients with rheumatoid arthritis were treated with second generation DECT.Pelvic and sacroiliac joints were scanned.DE Image view software was used to analyze and evaluate independently. The green pseudocolor crystal deposition was used as the diagnostic basis.Demographic data of patients, blood uric acid level and puncture biopsy of 3 patients with gout were recorded.The results were compared with the results of DECT in 10 patients with chronic gout with uric acid crystal deposition.The DECT () of the patients with DECT (97. 3 / 37 / 37 / 44.4, respectively) was 4 / 9 / 28. 6 / 7 (蠂 ~ 2 = 24. 197 / P0. 05).344 uric acid crystals were found in gout group.The most common sites of crystallization deposition were the first metatarsophalangeal joint 22. 1, the distal first toe 19. 810, the calcaneal bone 17. 4 and the lower tibia 13. 4%. 17 uric acid crystals were found in RA group. 5 uric acid crystals were found in RA group. 5 uric acid crystals were found in biopsy.Green labeled uric acid deposits were detected in the biopsy site of all patients with crystallized gout. 10 patients with chronic gout whose DECT showed uric acid crystal deposition were reexamined with hypouric acid drug for 6 months and found that local uric acid crystallization decreased.Conclusion DECT can clearly display the crystallization of uric acid, which is helpful to the differential diagnosis and prevention of gout and other arthritis.
【作者单位】：暨南大学附属第一医院风湿科;暨南大学附属第一医院影像科;
【基金】：国家自然科学基金(81202355)~~
【分类号】：R816.8;R684.3

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