痛风患者第一跖趾关节超声征象与临床疼痛的相关性分析  

Correlation analysis between ultrasound signs and clinical pain in patients with gout in the first metatarsophalangeal joint

作　　者：杜梅霞 闫萌萌 肖丽珊 张芳芳 姜彩云[1] 赵诚[1] 姚国栋 宁春平[1] Du Meixia;Yan Mengmeng;Xiao Lishan;Zhang Fangfang;Jiang Caiyun;Zhao Cheng;Yao Guodong;Ning Chunping(Department of Ultrasound,Affiliated Hospital of Qingdao University,Qingdao 266071,China;Department of Pathology,Affiliated Hospital of Qingdao University,Qingdao 266071,China)

机构地区：[1]青岛大学附属医院腹部超声科,266071 [2]青岛大学附属医院病理科,2266071

出　　处：《中华诊断学电子杂志》2024年第1期31-37,共7页Chinese Journal of Diagnostics(Electronic Edition)

基　　金：科技部国家重点研发计划项目(2022YFC2503302)。

摘　　要：目的探讨超声征象评估痛风患者第一跖趾关节临床疼痛程度的可行性。方法回顾性分析2022年3月至2023年4月在青岛大学附属医院痛风科就诊的109例痛风患者的临床及超声资料,根据患者疼痛程度分为4组:无疼痛组(n=25)、轻度疼痛组(n=25)、中度疼痛组(n=31)、重度疼痛组(n=28)。多组间计量资料比较采用方差分析或Kruskal-Wallis H检验,多组间计数资料比较采用卡方检验或Fisher确切概率法,多组间等级资料比较采用Kruskal-Wallis H秩和检验。疼痛程度与超声特征之间的相关性采用Spearman相关性分析。采用Kappa一致性检验、ICC组内相关系数进行医师间超声图像评估结果的一致性分析。结果109例患者均为男性,平均年龄(44.62±14.91)岁。4组患者之间临床分期(χ^(2)=76.31,P<0.01)、痛风石检出例数(χ^(2)=14.39,P<0.01)、痛风石数量(H=55.39,P<0.01)、滑膜内血流信号评分(H=15.49,P<0.01)、痛风石内血流信号评分(H=11.26,P<0.05)、超声血流总分(H=20.64,P<0.01)差异有统计学意义。滑膜血流信号(r=0.30,P<0.01)、痛风石内血流信号(r=0.35,P<0.01)、超声血流总分(r=0.43,P<0.01)均与疼痛程度呈正相关。结论彩色多普勒超声能够客观地评估痛风患者的疼痛,滑膜及痛风石内血流信号与患者的疼痛程度密切相关,在超声报告中提示血流信号分级对痛风患者的精准诊疗具有指导意义。Objective To explore the feasibility of utlizing ultrasonography in evaluating the level of clinical pain in patients with gout in the first metatarsophalangeal joint.Methods From March 2022 to April 2023,the clinical and ultrasound data of 109 gout patients treated at the Gout Department of Affiliated Hospital of Qingdao University,were evaluated retrospectively.Patients were separated into 4 groups based on their pain intensity:no pain(n=25),mild pain(n=25),moderate pain(n=31),and severe pain(n=28).The ANOVA or Kruskal-Wallis H test was used to compare measurement data differences between groups.The Chi-square test or Fisher exact probability approach was used to examine differences in count data between groups.To compare rank data,the Kruskal-Wallis H test was utilized.Spearman correlation analysis was used to examine the relationship between pain level and ultrasonic characteristics.The Kappa consistency test and intra-class correlation coefficient(ICC)were used to assess the consistency of ultrasound image assessment among radiologists.Results All 109 patients were male,with an average age of(44.62±14.91)years old.Among the 4 groups,clinical stage(χ^(2)=76.31,P<0.01),number of tophus-positive cases(χ^(2)=14.39,P<0.01),number of tophi(H=55.39,P<0.01),color Doppler(CD)signal in the synovium(H=15.49,P<0.01),CD signal in tophi(H=11.26,P<0.05)and total CD signal score(H=20.64,P<0.01)were statistically different.CD signal of the synovium(r=0.30,P<0.01),CD signal of the tophi(r=0.35,P<0.01),and the total CD signal score(r=0.43,P<0.01)were positively correlated with the pain intensity.Conclusions Gout patients′pain can be accurately assessed using color Doppler ultrasound.Color Doppler signals in synovium and tophi are connected to patients′pain level.Blood flow signal grading should be provided in ultrasonography reports to help with clinical staging and treatment decision-making.

关 键 词：痛风 疼痛 二维超声检查 超声检查 多普勒 彩色 第一跖趾关节 

分 类 号：R589.7[医药卫生—内分泌]