降尿酸治疗痛风72例超声影像学特征变化研究  

Change of ultrasonographic signs during urate lowering therapy in patients with gout

作　　者：王昱[1] 郇稳 邓雪蓉[1] 张卓莉[1] WANG Yu;HUAN Wen;DENG Xuerong;ZHANG Zhuo-li(Department of Rheumatology and Clinical Immunology,First hospital of Peking University,Beijing 100034,China)

机构地区：[1]北京大学第一医院风湿免疫科,北京100034 [2]郑州人民医院风湿免疫科,河南郑州450003

出　　处：《中国实用内科杂志》2019年第3期274-277,共4页Chinese Journal of Practical Internal Medicine

基　　金：首都卫生发展科研专项项目(首发2011-4021-03)

摘　　要：目的研究降尿酸治疗过程中,痛风患者超声特征随时间的变化,并探讨导致影像学特征改变的相关影响因素。方法选取2012年12月至2017年6月北京大学第一医院风湿免疫科收治的72例痛风患者,进行双膝、双踝、双足第一跖趾关节(MTP1)超声检查,以确诊为痛风并进行关节超声首次检查的时间作为观察起点,规律降尿酸治疗1年,每个月检测血尿酸水平。以末次行关节超声检查为观察终点。根据尿酸值和测定时间计算曲线下面积,评估尿酸负荷。结果 72例患者所检查的216个关节中,双轨征占51.85%,痛风石占32.87%。在MTP1中双轨征占22.22%,痛风石32.64%;在踝关节中双轨征占32.64%,痛风石占13.89%;在膝关节中双轨征为22.92%,痛风石为2.78%。72例患者中,基线双轨征阳性患者55例,随访终点双轨征消失38例,占69.09%。其中双轨征消失的中位数时间为148 (63～985 d)。基线痛风石阳性患者45例中,在随访终点时痛风石消失18例,占40%。其中痛风石消失的中位数时间为382.5(91～686 d)。双轨征消失组与未消失组在年龄、体重指数、病程及合并症(糖尿病、高血压、血脂代谢异常、心脏病)方面差异无统计学意义(P>0.05)。双轨征消失组在基线以及随访第2、3、4、9个月时的尿酸明显低于未消失组(P<0.05),而且双轨征消失组的尿酸负荷(S总)较未消失组明显降低(P<0.05)。双轨征消失组血尿酸水平随时间变化较未消失组显著下降(F=9.57,P<0.05)。双轨征消失组从基线至随访第4个月时,血尿酸水平明显下降(P<0.05),在随访的第6个月时平均血尿酸最低。结论在降尿酸治疗开始和随访期间,应用超声筛查痛风的特征如DCS或痛风石是一种有用的和有效的方法,可以检测痛风关节中尿酸负荷减少和消失。Objective To explore related factors of changes in gouty patients by ultrasonography after initiation of uric acid lowering therapy.Methods There were 72 gout patients enrolled who admitted to First hospital of Peking University from December 2012 to June 2017.All the patients had clinical and ultrasound examination at both knees,ankles and feet joints at the baseline.Regular uric acid lowering therapy started for one year.The endpoint was the last time who repeat the ultrasound examination during the follow up.According with uric acid level and its measuring time,the area under the curve was calculated to reflect the uric acid burden.Results In the 216 jonts of 72 patients,double contour sign were detectable in 112/216(51.85%),tophi were detectable in71/216(32.87%).Among MTP Joints,DCS was detected in 32/144(22.22%),and tophi in 47/144(32.64%).Among Knees joints,DCS was detected in 33/144(22.92%),tophi in 4/144(2.78%).Among ankle joints,DCS was detected in 47/144(32.64%),tophi in 20/144(13.89%).DCS disappearance occurred in 38/55(69.09%)joints positive for DCS at baselineTime-to-disappearance was 148 days(985~133 days).Tophi disappeared completely in 18/45 joints(40%).Time-to-disappearance was 382.5 days(686~397.25 days).There was no significant difference in age,BMI,duration of disease and complications between DCS persisted group and DCS disappearance group.SUA in the DCS disappeared group at baseline,second,third,fourth and ninth months of follow-up.was significantly lower than that of the non-disappeared group.SUA load in the DCS group was significantly lower than the non-disappeared group.Post hoc tests showed that SUA levels fell significantly from baseline through fourth month of follow-up in DCS disappearance group,and SUA of the sixth months was the lowest.Conclusion To screen for specific features of gout such as DCS or tophi by US at initiation of ULT and during follow-up is a useful,and effective way to detect the lowering and often disappearance of burden of urate load in gouty joints.

关 键 词：痛风 肌肉骨骼超声 双轨征 痛风石 

分 类 号：R589[医药卫生—内分泌]