不同分期痛风性关节炎的超声特征  

Differential Diagnosis of Different Gouty Arthritis Stages by Musculoleletal Ultrsound

作　　者：侯晓慧 张明琴 HOU Xiaohui;ZHANG Mingqin(Department of Ultrasound Medicine,The Fourth Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210031)

机构地区：[1]南京医科大学第四附属医院超声医学科,江苏南京210031

出　　处：《智慧健康》2025年第5期15-18,共4页Smart Healthcare

摘　　要：目的 探讨超声在不同时期(急性发作期、无症状高尿酸血症期、慢性期)痛风关节炎患者中的膝关节或第一跖趾关节中不同表现。方法 本研究收集了2019年12月—2021年7月本院门诊及住院患者中处于急性发作期的痛风性关节炎患者36例、无症状高尿酸血症患者42例以及慢性期痛风性关节炎患者48例,共计126例。收集这些患者的年龄、BMI等一般资料以及尿酸、血沉、超敏C反应蛋白等实验室指标。对患者进行二维超声检查,记录病变部位的滑膜炎、双轨征及痛风石等二维超声表现。同时,应用彩色多普勒(CDFI)和超微血管成像(SMI)技术,对不同组别间的血流信号进行了分级,并在SMI模式下测量了病变部位新生血管的阻力指数(RI)。血流信号分级分为四级(0~3级)。总结并比较一般资料、实验室指标与超声特征,并对SMI与CDFI两种模式下的血流分级进行对比分析,同时探讨超敏C反应蛋白(hs-CRP)与超声血流分级(SMI和CDFI两种模式下)以及SMI模式下病变部位新生血管RI之间的相关性。结果 ①急性发作期、无症状高尿酸血症期与慢性期三组之间在年龄及BMI方面对比,差异无统计学意义(P>0.05)。②急性发作期患者的尿酸水平低于其余两组、而血沉及hs-CRP值明显高于其余两组,差异有统计学意义(P<0.001)。③急性期患者与其余两组比较多表现为滑膜炎(58.3%),无症状高尿酸血症期与其余两组比较多表现为双轨征(76.2%),慢性期患者多表现为痛风石(54.2%),差异均有统计学意义(P<0.001)。④急性发作期病变内的CDFI血流分级及SMI血流分级均较其余两组丰富,SMI在三组患者中血流分级比CDFI敏感,急性发作期病变处新生血管的RI低于其余两组,差异有统计学意义(P<0.05);与CDFI血流分级相比较呈正相关(r=0.55,P<0.001),hs-CRP与SMI血流分级的相关性稍高(r=0.56,P<0.001),hs-CRP与RI呈弱相关(r=0.46,P<0.001)。结论 ①不同�Objective To investigate the differential ultrasound manifestations in the knee joints or first metatarsophalangeal joints of gouty arthritis patients across distinct phases (acute attack phase,asymptomatic hyperuricemia phase,and chronic phase).Methods A total of 126 gouty arthritis patients were enrolled,including 36 in the acute attack phase,42 in the asymptomatic hyperuricemia phase,and 48 in the chronic phase.General data (age and BMI) and laboratory parameters (Serum uric acid,erythrocyte sedimentation rate,and hypersensitive C-reactive protein) were collected.Two-dimensional ultrasound was performed to evaluate synovitis,double contour sign,and tophus.Blood flow signal grading (classified as 0~3) was assessed using both color Doppler flow imaging (CDFI) and superb microvascular imaging (SMI).Additionally,the resistance index (RI) of intralesional neovascularization under SMI was measured.General data,laboratory parameters,and ultrasound characteristics were compared among groups.The correlation between hs-CRP and blood flow grading (under both SMI and CDFI) and RI under SMI was analyzed.Results① There was no statistically significant difference (P>0.05) in age and BMI between the acute attack period,asymptomatic hyperuricemia period,and chronic period groups.② The uric acid level of patients in the acute attack period was lower than the other two groups,while the erythrocyte sedimentation rate and hs CRP values were significantly higher than the other two groups,with statistically significant differences (P<0.001).③ Patients in the acute phase showed more synovitis compared to the other two groups (58.3%),while those in the asymptomatic hyperuricemia phase showed more double track signs compared to the other two groups (76.2%).Patients in the chronic phase showed more gouty stones (54.2%),and the differences were statistically significant (P<0.001).④ The CDFI blood flow grading and SMI blood flow grading within the lesions during the acute attack period were richer than the other two groups.SMI was

关 键 词：微血流成像 痛风关节炎 高尿酸血症 肌骨超声 

分 类 号：R445.1[医药卫生—影像医学与核医学]