痛风性关节炎患者关节超声不同表现下骨破坏指标的比较  

Comparison of bone destruction markers in patients with gouty arthritis under different musculoskeletal ultrasonic manifestations

作　　者：费雅楠 唐素玫[1] 张舸[2] 李玉慧[1] 邵苗[1] 谢琳峰[1] 钟昱超 张学武[1] Fei Yanan , Tang Sumei, Zhang Ge, Li Yuhui, Shao Miao,Xie Linfeng, Zhong Yuchao, Zhang Xuewu(Department of Rheumatology and Immunology, Peking University People＇s Hospital, Beijing 100044, Chin)

机构地区：[1]北京大学人民医院风湿免疫科,100044 [2]北京市海淀医院(北京大学第三医院海淀院区)风湿免疫科

出　　处：《中华医学杂志》2018年第13期978-981,共4页National Medical Journal of China

摘　　要：目的 观察痛风性关节炎患者关节超声不同表现与骨破坏指标（Dickkopf－1、RANKL）的相关性，从而进一步探讨肌肉骨骼超声对痛风性关节炎的诊断和监测的作用。方法 选择2016年7月至2017年6月就诊于北京大学人民医院风湿免疫科门诊的160例痛风性关节炎患者为研究对象，进行关节超声检查（双足第一跖趾关节、双踝关节及双膝关节）。根据超声检查结果分为以下3组，A组为无聚集体组，B组为聚集体及＂双轨征＂组，C组为痛风石及骨侵蚀组。检测患者血清中Dickkopf－1、RANKL浓度，分析Dickkopf－1、RANKL及其他临床和实验室指标的关系。结果 （1）Dickkopf－1浓度在3组之间差异有统计学意义（P〈0.001）。并且C组[（1 722.2±482.7）ng/L]高于B组[（1 309.3±496.4）ng/L]（t＝4.418，P〈0.001），B组高于A组[（807.9±373.8）ng/L]（t＝6.137，P〈0.001）。（2）RANKL浓度在3组之间差异有统计学意义（P〈0.001）。并且C组[（0.78±0.47） ng/L]高于B组[（0.35±0.29）ng/L]（t＝5.456，P〈0.001），B组高于A组[（0.10±0.09）ng/L]（t＝6.923，P〈0.001）。（3）病程越长，血清Dickkpof－1浓度越高（r＝0.430，P〈0.001），血清RANKL浓度也越高（r＝0.359，P〈0.001）。结论 痛风性关节炎患者关节超声检查可以观察到聚集体、双轨征、痛风石及骨侵蚀等表现。并且病程越长，骨破坏的程度有可能越严重。骨骼肌肉超声检查可以成为痛风性关节炎患者关节受累程度的首选影像学检查方法。Objectives To observe the correlation between the different ultrasonic manifestations of gouty arthritis and the indexes of bone destruction （Dickkopf-1, RANKL）, in order to further explore the role of musculoskeletal ultrasonography in the diagnosis and monitoring of gouty arthritis.Methods 160 cases of gouty arthritis from clinic of the Department of Rheumatology of Peking University People′s Hospital between July 2016 and June 2017 were recruited in this study. These patients were examined by musculoskeletal ultrasonography （bilateral first metatarsophalangeal joints, bilateral ankle joints and bilateral knee joints）. Grouping was based on ultrasound features of joints. Group A showed no aggregate .Group B showed aggregate and double contour signs. Group C showed tophus and bone erosion. Serum concentrations of Dickkopf-1 and RANKL were measured. The correlations of Dickkopf-1 or RANKL and clinical/laboratory parameters were analyzed.Results （1）There was a significant difference in Dickkopf-1 concentration between the three groups（P〈0.001）. And the group C[（1 722.2±482.7）ng/L]was higher than the group B[（1 309.3±496.4）ng/L]（t=4.418, P〈0.001）, and the group B was higher than group A[（807.9±373.8）ng/L]（t=6.137, P〈0.001）. （2）There was a significant difference in RANKL concentration between the three groups （P〈0.001）. And the group C[（0.78±0.47）ng/L]was higher than the group B[（0.35±0.29）ng/L]（t=5.456, P〈0.001）, and the group B was higher than group A[（0.10±0.09）ng/L]（t=6.923, P〈0.001）. （3）The level of Dickkopf-1 was associated with the disease duration（r=0.430, P〈0.001）, and the level of RANKL was associated with the disease duration（r=0.359, P〈0.001）.Conclusion Aggregates, double contour signs, tophus and bone erosion can be observed in the ultrasonic examination of gouty arthritis. And the longer the duration of the disease, the more likely the extent of bone destruction is. Joint ultrasound can be the first imag

关 键 词：关节炎 痛风性 超声检查 胞间信号肽类和蛋白质类 RANK配体 

分 类 号：R445.1[医药卫生—影像医学与核医学] R589.7[医药卫生—诊断学]