高频超声在筛查无症状高尿酸血症患者关节病变中的价值  

The value of high frequency ultrasound screening for asymptomatic hyperuricemia in patients with joint diseases

作　　者：赵娜[1] 孙小凤[1] 王少坤[1] 汤艳春[1] 

机构地区：[1]山东省烟台毓璜顶医院风湿免疫科,264000

出　　处：《中华风湿病学杂志》2016年第6期387-390,I0001,共5页Chinese Journal of Rheumatology

摘　　要：目的探讨高频彩色多普勒超声在无症状高尿酸血症患者关节病变中的早期诊断价值。方法检测44例无症状高尿酸血症患者（AH组）和52名健康体检者（健康对照组）的血压、血尿酸、TC、TG及血糖水平，并行高频超声观察2组双侧第一跖趾、踝、膝、肘、腕及第一掌指关节的病变情况。采用t检验、χ^2检验及Fisher确切概率法进行统计学分析。结果① AH组高血压、糖尿病及高血脂的发生率[43%（19/44）、23%（10/44）、14%（6/44）]分别明显高于健康对照组（均为0），且差异均有统计学意义（χ2=27.995、13.129、7.564，P均〈0.01）；② AH组和健康对照组两侧第一跖趾、踝、膝、肘关节＂双轨征＂（分别为53、48、23、7个关节与0、0、0、0个关节）差异均有统计学意义（P〈0.05）；AH组双侧第一跖趾、踝关节滑膜增生的发生率[1.5%（8/528），1.3%（7/528）]也分别明显高于健康对照组[0（0/624），0.2%（1/624）]，差异均有统计学意义（χ^2=9.521，P〈0.01；χ^2=5.634，P〈0.05）；2组双膝关节骨侵蚀、关节积液的发生率[1.7%（9/528）比0.3%（2/624），6.0%（32/528）比0.96%（6/624）]差异均有统计学意义（χ^2=5.793，P〈0.05；χ^2=23.623，P〈0.01）；AH组528个关节中4个关节发现痛风石，分别为右侧第一跖趾、双膝及左侧第一掌指关节，健康对照组未发现痛风石，差异有统计学意义（P〈0.05）；2组患者关节内点状强回声差异无统计学意义（P〉0.05）。结论高尿酸血症与高血压、糖尿病、高血脂的发生存在相关性。部分无症状高尿酸血症患者可能已出现类似痛风性关节炎的特异性超声表现，因此高频超声对无症状高尿酸血症患者的关节病变具有早期诊断价值，尤其筛查的重点在第一跖趾、踝及膝关节。Objective To explore the value of high frequency color Doppler ultrasound for the early diagnosis of asymptomatic hyperuricemia in patients with joint disease.Methods Blood pressure, uric acid, total cholesterol, triglyceride and blood glucose were measured in 44 asymptomatic individual with hyperuricemia （the AH group） and 52 healthy persons （the control group）, and the joints of the first metatarsal-phalangeal, ankles, knees, wrists, elbows and the first metacarpophalangeal joints in the two groups were examinedby high frequency and color Doppler ultrasound. T test, Chi-square test, and Fisher exact test were used for statistical analysis.Results ① The incidence rate of hypertension, diabetes and hyperlipidemia in theAH group [43.2% （19/44）, 22.7% （10/44）, 13.6% （6/44）] was significantly higher than the control group （χ^2=27.995, 13.129, 7.564; P〈0.01） ; ② Double contour sign were found in the first metatarsal-phalangeal, ankles, knees and elbows of the AH group, in contrast to none in the control group （P〈0.05） . The incidence of synovial thickening in the first metatarsal-phalangeal [1.5% （8/528）], ankles of the AH group [1.3% （7/528）] was significantly higher than that of the control group [0（0/624）, 0.2%（1/624）] （χ^2=9.521, P〈0.01; χ^2=5.634, P〈0.05） . Similar results were found in the two groups in bone erosion in knees[1.7% （9/528） vs 0.3% （2/624）], in knees effusion [6.0%（32/528） vs 0.96%（6/624）] （χ^2=5.793, P〈0.05; χ^2=23.623, P〈0.01）. The tophi was found in the right first metatarsal-phalangeal, bilateral knees and the left first metacarpophalangeal 4 joints in 528 joints of the AH group, in contrast to none in the control group（P〈0.05）. The difference in hyperechoic spots was no statistically significant between the two groups （P〉0.05）.Conclusion Hyperuricemia is related to hypertension, diabetes and high blood lipids. There are some similar specific sonographic findings of gouty arthritis in the asymp

关 键 词：高尿酸血症 超声检查 多普勒 彩色 关节炎 

分 类 号：R589.7[医药卫生—内分泌] R445.1[医药卫生—内科学]