双能 CT 评估尿酸钠负荷预测痛风发作风险：一项为期 12 个月的观察性研究：MSU 负荷与痛风发作风险。

Monosodium urate burden assessed with dual-energy computed tomography predicts the risk of flares in gout: a 12-month observational study : MSU burden and risk of gout flare.

机构信息

Department of Rheumatology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.

EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, 59000, Lille, France.

出版信息

Arthritis Res Ther. 2018 Sep 17;20(1):210. doi: 10.1186/s13075-018-1714-9.

DOI:10.1186/s13075-018-1714-9

PMID:30223875

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6142357/

Abstract

BACKGROUND

Predicting the risk of flares in patients with gout is a challenge and the link between urate burden and the risk of gout flare is unclear. The objective of this study was to determine if the extent of monosodium urate (MSU) burden measured with dual-energy computed tomography (DECT) and ultrasonography (US) is predictive of the risk of gout flares.

METHODS

This prospective observational study recruited patients with gout to undergo MSU burden assessment with DECT (volume of deposits) and US (double contour sign) scans of the knees and feet. Patients attended follow-up visits at 3, 6 and 12 months. Patients having presented with at least one flare at 6 months were compared to those who did not flare. Odds ratios (ORs) (95% confidence interval) for the risk of flare were calculated.

RESULTS

Overall, 64/78 patients included attended at least one follow-up visit. In bivariate analysis, the number of joints with the double contour sign was not associated with the risk of flare (p = 0.67). Multivariate analysis retained a unique variable: DECT MSU volume of the feet. For each 1 cm increase in DECT MSU volume in foot deposits, the risk of flare increased 2.03-fold during the first 6 months after initial assessment (OR 2.03 (1.15-4.38)). The threshold volume best discriminating patients with and without flare was 0.81 cm (specificity 61%, sensitivity 77%).

CONCLUSIONS

This is the first study showing that the extent of MSU burden measured with DECT but not US is predictive of the risk of flares.

摘要

背景

预测痛风患者的发作风险是一个挑战，尿酸盐负担与痛风发作风险之间的关系尚不清楚。本研究旨在确定双能 CT（DECT）和超声（US）测量的单钠尿酸盐（MSU）负担程度是否可预测痛风发作风险。

方法

这项前瞻性观察性研究招募了痛风患者，对其膝关节和足部进行 DECT（沉积体积）和 US（双重轮廓征）扫描以评估 MSU 负担。患者在 3、6 和 12 个月时进行随访。将在 6 个月时至少出现一次发作的患者与未发作的患者进行比较。计算发作风险的比值比（OR）（95%置信区间）。

结果

共有 78 例患者中的 64 例至少进行了一次随访。在单变量分析中，具有双重轮廓征的关节数量与发作风险无关（p=0.67）。多变量分析保留了一个独特的变量：足部 DECT MSU 体积。在初次评估后的前 6 个月内，足部 DECT MSU 沉积体积每增加 1 cm，发作风险增加 2.03 倍（OR 2.03 [1.15-4.38]）。最佳区分有无发作的阈值体积为 0.81 cm（特异性 61%，敏感性 77%）。