超声随访中图像特征与痛风性关节炎降尿酸疗效的相关性研究  

Correlation between image features in ultrasound follow-up and urate-lowering therapic efficacy in gouty arthritis

作　　者：赵荻 张玮婧[1] 王颖 姚静 金志斌[1] ZHAO Di;ZHANG Wei-jing;WANG Ying;YAO Jing;JIN Zhi-bin(Department of Ultrasound,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院超声医学科,江苏南京210008

出　　处：《中国实用内科杂志》2024年第12期1039-1043,1048,共6页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金面上项目(82371981)。

摘　　要：目的分析痛风性关节炎降尿酸治疗(ULT)过程中超声图象特征的变化。方法选取2018年1月至2019年1月期间在南京大学医学院附属鼓楼医院就诊并接受ULT治疗,且连续随访1年的痛风性关节炎患者65例。根据是否规律服用降尿酸药物,将患者分为规律组(38例)和不规律组(27例)。收集患者ULT前以及ULT后3个月、6个月及12个月超声图像(双轨征,痛风石)和临床资料[血尿酸值(SUA)、视觉模拟评分(VAS)、患者总体评估(PGA)],分析超声特征变化与临床资料相关性。结果与治疗前相比,规律组患者的VAS和PGA在ULT 3个月后均较不规律组低,差异有统计学意义[规律组VAS 3.00(0,5.00)分vs.不规律组VAS 5.00(3.75,7.00)分,Z=-2.757,P=0.006;规律组PGA 5.00(3.00,6.00)分vs.不规律组PGA 7.00(5.75,8.25)分,Z=-4.326,P<0.001]。ULT 6个月后,规律组及不规律组SUA差异有统计学意义[规律组(388.42±81.35)μmol/L vs.不规律组(462.42±146.85)μmol/L,t=2.600,P=0.012],ULT12个月后,规律组SUA达标(≤300μmol/L)比例显著高于不规律组(26.32%vs.3.70%,χ2=4.245,P=0.039)。此外,ULT 12个月后,规律组患者的双轨征数目较不规律组减少更多(24个vs.1个),差异有统计学意义(χ2=7.502,P=0.006);规律组痛风石面积较ULT前减小[0.85(0.61,1.42)cm2vs.0.69(0.23,1.47)cm2],而不规律组则增加[0.49(0,0.95)cm2vs.0.85(0.63,1.25)cm2],两组痛风石面积在ULT12个月后差异有统计学意义[规律组0.69(0.23,1.47)cm2vs.不规律组0.85(0.63,1.25)cm2,Z=-2.153,P=0.031]。结论ULT能够改善痛风性关节炎患者临床症状及超声征象,其中规律组各项参数改善优于不规律组。Objective To analyze the changes in ultrasound characteristics in urate-lowering therapy(ULT)for gouty arthritis.Methods A total of 65 patients with gouty arthritis who received ULT at Nanjing Drum Tower Hospital from January 2018 to January 2019 and were with a 1-year follow-up were selected.Based on adherence to uric acid-lowering medication,patients were divided into two groups:compliance group(n=38)and non-compliance group(n=27).Ultrasound images(double contour sign,tophus)and clinical data[serum uric acid(SUA),visual analogue scale(VAS),patient global assessment(PGA)]were collected at baseline,and at 3,6,and 12 months after ULT.The relationship between clinical indicators and the changes in ultrasound characteristics was analyzed.Results Compared with before treatment,VAS and PGA in compliance group were lower than those in non-compliance group after 3 months of ULT,with significant differences between the two groups[VAS:compliance group 3.00(0,5.00)vs.non-compliance group 5.00(3.75,7.00),Z=-2.757,P=0.006;PGA:compliance group 5.00(3.00,6.00)vs.non-compliance group7.00(5.75,8.25),Z=-4.326,P<0.001].After 6 months of ULT,SUA levels differed significantly between the two groups[compliance group(388.42±81.35)μmol/L vs.non-compliance group(462.42±146.85)μmol/L,t=2.600,P=0.012].After 12 months of ULT,the proportion of patients with SUA levels≤300μmol/L was significantly higher in compliance group than in non-compliance group(26.32%vs.3.7%,χ2=4.245,P=0.039).Additionally,the number of double contour sign in compliance group decreased more significantly than in non-compliance group(24 vs.1),and the difference was statistically significant(χ2=7.502,P=0.006)after 12 months of ULT.The tophus area decreased in compliance group[0.85(0.61,1.42)cm2 vs.0.69(0.23,1.47)cm2]compared with that before ULT,while it increased in noncompliance group[0.49(0,0.95)cm2 vs.0.85(0.63,1.25)cm2].After 12 months of ULT,there was a significant difference in tophus area between the two groups[compliance group 0.69(0.23,1.47)cm2 vsnon-c

关 键 词：痛风 降尿酸治疗 超声 双轨征 痛风石 

分 类 号：R593.9[医药卫生—内科学]