影响双能CT尿酸盐结晶检出率的因素

doi:10.19723/j.issn.1671-167X.2021.02.005

摘要/Abstract

摘要：

目的: 探讨金标准明确诊断的痛风患者中双能CT(dual energy computed tomography, DECT)检出尿酸盐结晶的影响因素。方法: 选择2011年6月至2018年12月,在北京大学第一医院门诊或住院患者关节滑液偏振光分析尿酸晶体阳性诊断为急性或慢性痛风的病例资料进行回顾性分析,所有患者均接受关节液或痛风石分析和DECT扫描。采用卡方检验、二元Logistics回归及t检验,分析DECT结果与临床资料、实验室检查及药物治疗的关系。结果: 共29例患者入组本研究,22例DECT检出尿酸盐结晶,7例未检出,根据是否检出尿酸盐晶体分为两组,与DECT阴性组相比较,DECT阳性组年龄更高[(47±12)岁vs.(39±11)岁,P=0.15], 体重指数(body bass index,BMI)更高[(27.9±3.7) kg/m²vs.(22.8±2.1) kg/m²,P=0.002],痛风病程更长[(135±102)个月vs.(45±53)个月, P=0.035];阳性组既往血尿酸最高值亦高于DECT阴性组[(643±121) μmol/L vs.(543±103) μmol/L,P=0.043];阳性组患者DECT时血清尿酸值虽然高于DECT阴性组[(558±150) μmol/L vs.(513±88.9) μmol/L,P=0.497], 但差异无统计学意义;DECT检查阳性组与阴性组相比较,检查时处于急性期的患者分别为18例(81.8%) vs.4例(57%), P=0.311;服用降尿酸药物的患者分别为22例(100%) vs.5例(71%), P=0.052;反复典型发作的患者分别为22例(100%) vs.6例(85%), P=0.241。各关节症状与DECT发现尿酸盐结晶一致性比较,右膝关节最高(Kappa=0.627), 其后依次为左第一跖趾(metatarsophalangeal 1, MTP1, Kappa=0.58)、右MTP1(Kappa=0.551)、左膝(Kappa=0.494),均具统计学意义,踝关节症一致性较低(右踝:Kappa=0.19,左踝:Kappa=0.256),均无统计学意义。与DECT尿酸盐晶体检出率有关的变量分别为BMI[2.307(1.139~4.670) kg/m², P=0.02]、痛风病程 [ 0.306(0.906~4.881)年,P=0.186]、既往尿酸最高值 [0.023(0.981~2.764) mg/dL, P=0.137]。结论: BMI较大、既往最高尿酸值较高、痛风病程较长的痛风患者DECT检出的敏感性越高。

关键词: 痛风, DECT, 尿酸盐结晶, 敏感性

Abstract:

Objective: To explore the risk factors of detection of uric acid crystals by dual energy CT (DECT) in patients with gout diagnosed by gold standard. Methods: From June 2011 to December 2018, clinical data of 29 patients were collected who were diagnosed with acute or chronic gout by positive polarized light analysis of joint synovial fluid in First Hospital of Peking University. Chi-square test, Logistic regression and t-test were used. The relationship between DECT and the clinical data, laboratory examination and drug treatment were analyzed. Results: In this study, 29 patients were included, of whom, 22 patients were detected with uric acid crystals by DECT, and 7 patients were not. According to whether the uric acid crystals were detected or not by DECT, the patients were divided into two groups. Compared with the negative group,the patients were older in positive group [(47±12) vs. (39±11) years, P=0.15], had higher body bass index (BMI) [(27.9±3.7) vs. (22.8±2.1) kg/m², P=0.002], longer gout disease duration [(135±102) vs.(45±53) months, P=0.035], higher in the highest serum uric acid in history [(643±121) vs. (543±103) μmol/L, P=0.043]. Although uric acid near DECT in positive group was higher than in negative group, there was no statistical difference [(558±150) vs. (513±89) μmol/L, P=0.497]. Comparing positive group with negative group, the percentage of the patients in acute phase was higher than in chronic phase [18(81.8%) vs. 4(57%), P=0.311];the percentage of the patients taking uric-acid-lowering drugs was higher than the other group [22(100%) vs. 5 (71%), P=0.052];the percentage of the patients with recurrent typical attacks was higher than that of those without typical attacks [22 (100%) vs.6 (85%), P=0.241]. The consistency of symptoms and the finding of uric acid crystals by DECT had been compared between the joints. The right knee joint had the highest consistency (Kappa=0.627), followed by the left MTP1 (Kappa=0.58), the right metatarsophalangeal 1(MTP1, Kappa=0.551) and the left knee (Kappa=0.494), all of which had statistical significance. The consistency of the ankle joint was lower (the right ankle joint: Kappa=0.19, the left ankle joint: Kappa=0.256), showing no statistical significance. BMI (kg/m²) [2.307 (1.139-4.670), P=0.02], gout duration (years) [0.306 (0.906-4.881), P=0.186], and the highest uric acid level in history (mg/dL) [0.023 (0.981-2.764), P=0.137] had relationship to the positive result of urate crystals in DECT. Conclusion: Gout patients with larger BMI, higher previous highest uric acid value and longer gout duration had higher sensitivity of the positive result in DECT.

Key words: Gout, Dual-energy CT, Urate crystal, Sensitivity

中图分类号:

R589.7

谢一帆,王昱,邓雪蓉,耿研,季兰岚,张卓莉. 影响双能CT尿酸盐结晶检出率的因素[J]. 北京大学学报（医学版）, 2021, 53(2): 261-265.

XIE Yi-fan,WANG Yu,DENG Xue-rong,GENG Yan,JI Lan-lan,ZHANG Zhuo-li. Analysis of risk factors influencing the detection rate of urate crystal by dual energy computed tomography[J]. Journal of Peking University (Health Sciences), 2021, 53(2): 261-265.

图/表 5

表1

表2

图1

图2

表3

参考文献 18

[1]	Roddy E, Choi HK. Epidemiology of gout[J]. Rheum Dis Clin North Am, 2014,40(2):155-175. pmid: 24703341
[2]	邓雪蓉, 王昱, 张卓莉. 新型影像学技术在痛风诊治中的应用进展[J]. 中国实用内科杂志, 2018,38(12):1119-1122.
[3]	Wang Y, Deng X, Xu Y, et al. Detection of uric acid crystal deposition by ultrasonography and dual-energy computed tomography: A cross-sectional study in patients with clinically diagnosed gout[J]. Medicine (Baltimore), 2018,97(42):e12834.
[4]	Ogdie A, Taylor WJ, Weatherall M, et al. Imaging modalities for the classification of gout: systematic literature review and meta-analysis[J]. Ann Rheum Dis, 2015,74(10):1868-1874. pmid: 24915980
[5]	Choi HK, Burns LC, Shojania K, et al. Dual energy CT in gout: a prospective validation study[J]. Ann Rheum Dis, 2012,71(9):1466-1471. pmid: 22387729
[6]	Sun C, Qi X, Tian Y, et al. Risk factors for the formation of double-contour sign and tophi in gout[J]. J Orthop Surg Res, 2019,14(1):239. pmid: 31358044
[7]	Loeb JN. The influence of temperature on the solubility of monosodium urate[J]. Arthritis Rheum, 1972,15(2):189-192. pmid: 5027604
[8]	Horvath SM, Hollander JL. Intra-articular temperature as a measure of joint reaction[J]. J Clin Invest, 1949,28(3):469-473. pmid: 16695699
[9]	Fiddis RW, VlachosL N, Calvert PD. Studies of urate crystallisation in relation to gout[J]. Ann Rheum Dis, 1983,42(Suppl 1):5-12.
[10]	Tak HK, Cooper SM, Wilcox WR. Studies on the nucleation of monosodium urate at 37 degrees c[J]. Arthritis Rheum, 1980,23(5):574-580. pmid: 7378087
[11]	Perez-Ruiz F, Calabozo M, Pijoan JI, et al. Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout[J]. Arthritis Rheum, 2002,47(4):356-360. pmid: 12209479
[12]	Becker MA, Schumacher HR Jr, Wortmann RL, et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout[J]. N Engl J Med, 2005,353(23):2450-2461. pmid: 16339094
[13]	Ellmann H, Bayat S, Araujo E, et al. Effects of conventional uric acid lowering therapy on monosodium urate crystal deposits[J]. Arthritis Rheum, 2020,72(1):150-156.
[14]	Wilcox WR, Khalaf AA. Nucleation of monosodium urate crystals[J]. Ann Rheum Dis, 1975,34(4):332-339. pmid: 242279
[15]	Simkin PA. The pathogenesis of podagra[J]. Ann Intern Med, 1977,86(2):230-233. pmid: 319726
[16]	Zhang W, Jin Z, Xiang W, et al. Ultrasonographic features of lower-limb joints in gout: which joints and clinical characteristics would provide more information for diagnosis[J]. J Clin Rheum, 2020,26(1):14-18.
[17]	Dalbeth N, House ME, Aati O, et al. Urate crystal deposition in asymptomatic hyperuricaemia and symptomatic gout: a dual energy CT study[J]. Ann Rheum Dis, 2015,74(5):908-911. pmid: 25637002
[18]	Allen DJ, Milosovich G, Mattocks AM. Inhibition of monosodium urate needle crystal growth[J]. Arthritis Rheum, 1965,8(6):1123-1133. pmid: 5884821

相关文章 15

[1]	任晓萌,李凯一,李春蕾. 基于转录组测序探索口腔扁平苔藓局部激素治疗敏感性相关分子特征[J]. 北京大学学报（医学版）, 2024, 56(1): 32-38.
[2]	董泓,王丽敏,王志强,刘彦卿,张晓刚,张明明,刘娟,李振彬. 急性痛风发作的昼夜差异: 一项男性痛风患者的临床研究[J]. 北京大学学报（医学版）, 2023, 55(5): 915-922.
[3]	田雪丽,宋志强,索宝军,周丽雅,李彩玲,张雨欣. 比较Epsilometer试验法和琼脂稀释法检测幽门螺杆菌对甲硝唑的敏感性[J]. 北京大学学报（医学版）, 2023, 55(5): 934-938.
[4]	叶一林,刘恒,潘利平,柴卫兵. 全膝关节置换术后假体周围痛风发作误诊1例[J]. 北京大学学报（医学版）, 2023, 55(2): 362-365.
[5]	曹瑞洁,姚中强,焦朋清,崔立刚. 不同分类标准对中国大动脉炎的诊断效能比较[J]. 北京大学学报（医学版）, 2022, 54(6): 1128-1133.
[6]	王昱,张慧敏,邓雪蓉,刘伟伟,陈璐,赵宁,张晓慧,宋志博,耿研,季兰岚,王玉,张卓莉. 尿枸橼酸定量检测在原发性痛风患者肾结石诊断中的应用价值[J]. 北京大学学报（医学版）, 2022, 54(6): 1134-1140.
[7]	谢晓炜,李芬,凌光辉,谢希,许素清,陈谊月. 痛风患者健康教育知识知晓度测量问卷的研制及临床应用[J]. 北京大学学报（医学版）, 2022, 54(4): 699-704.
[8]	张学武. 痛风关节炎治疗中几个备受关注的问题[J]. 北京大学学报（医学版）, 2021, 53(6): 1017-1019.
[9]	彭喆,丁亚敏,裴林,姚海红,张学武,唐素玫. 痛风患者发生关节及肌腱内晶体沉积的临床特点[J]. 北京大学学报（医学版）, 2021, 53(6): 1067-1071.
[10]	王贵红,左婷,李然,左正才. 瑞巴派特在大鼠痛风性关节炎急性发作中的作用[J]. 北京大学学报（医学版）, 2021, 53(4): 716-720.
[11]	王昱,邓雪蓉,季兰岚,张晓慧,耿研,张卓莉. 超声检测痛风患者肌腱受累的危险因素和诊断价值[J]. 北京大学学报（医学版）, 2021, 53(1): 143-149.
[12]	王鹏,吴华,车颖,范东伟,刘珏,陶立元. 亚洲骨质疏松筛查工具在健康体检中的筛查准确性评价及适宜切点研究[J]. 北京大学学报（医学版）, 2019, 51(6): 1085-1090.
[13]	季兰岚,郝燕捷,张卓莉. 原发性骨髓纤维化引起的继发性痛风1例[J]. 北京大学学报（医学版）, 2018, 50(6): 1117-1119.
[14]	徐筱，徐莉，江久汇，吴佳琪，李小彤，靖无迪. 锥形束CT评判安氏Ⅲ类错牙合上前牙骨开裂与骨开窗的准确性分析[J]. 北京大学学报(医学版), 2018, 50(1): 104-109.
[15]	张倩茹，王昱，张卓莉. 2015 ACR/EULAR痛风分类标准与既往标准诊断价值的比较研究[J]. 北京大学学报(医学版), 2017, 49(6): 979-984.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

Items	Positive (n=22)	Negative (n=7)	P
Male, n (%)	22 (100)	7 (100)	-
Age/years	47±12	39±11	0.150
BMI/(kg/m²)	27.9±3.7	22.8±2.1	0.002
Duration/months	135±102	45±53	0.035
Height/cm	172±6	177±6	0.043
Weight/kg	83.3±12.4	72.4±5.1	0.021
The highest serum uric acid in history/ (μmol/L)	643±121	543±103	0.043
Uric acid near DECT/(μmol/L)	558±150	513±88.9	0.497
Acute phase, n (%)	18 (81.8)	4 (57)	0.311
Taking uric-acid-lowering drugs, n (%)	22 (100)	5 (71)	0.052
Recurrent typical attacks, n (%)	22 (100)	6 (85)	0.241

Items	Right knee	Left knee	Right ankle	Left ankle	Right MTP1	Left MTP1
Kappa value	0.627	0.494	0.19	0.256	0.551	0.58
Concordance rate/%	82.8	79.3	82.4	86.2	82.7	86.2
P	0.01	0.005	0.300	0.167	0.003	0.002

Items	BMI/(kg/m²)		Duration/years		The highest serum uric acid in history/(μmol/L)
Items	Normal	Overweight or obesity	<10	≥10	<600	≥600
Positive(n=22), n(%)	2(6.9)	20(69)	13(44.8)	9(31)	15(51.7)	7(24.1)
Negative(n=7), n(%)	2(6.9)	5(17.2)	2(6.9)	5(17.2)	1(3.4)	6(20.7)
P	0.003		0.166		0.019