[双能计算机断层扫描影响尿酸盐结晶检出率的危险因素分析]
[Analysis of risk factors influencing the detection rate of urate crystal by dual energy computed tomography].
作者信息
Xie Y F, Wang Y, Deng X R, Geng Y, Ji L L, Zhang Z L
机构信息
Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing 100034, China.
出版信息
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Oct 7;53(2):261-265. doi: 10.19723/j.issn.1671-167X.2021.02.005.
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 -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) . (39±11) years, =0.15], had higher body bass index (BMI) [(27.9±3.7) . (22.8±2.1) kg/m, =0.002], longer gout disease duration [(135±102) .(45±53) months, =0.035], higher in the highest serum uric acid in history [(643±121) . (543±103) μmol/L, =0.043]. Although uric acid near DECT in positive group was higher than in negative group, there was no statistical difference [(558±150) . (513±89) μmol/L, =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%) . 4(57%), =0.311];the percentage of the patients taking uric-acid-lowering drugs was higher than the other group [22(100%) . 5 (71%), =0.052];the percentage of the patients with recurrent typical attacks was higher than that of those without typical attacks [22 (100%) .6 (85%), =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/m) [2.307 (1.139-4.670), =0.02], gout duration (years) [0.306 (0.906-4.881), =0.186], and the highest uric acid level in history (mg/dL) [0.023 (0.981-2.764), =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.
目的
探讨经金标准确诊的痛风患者双能CT（DECT）检测尿酸盐结晶的危险因素。
方法
收集2011年6月至2018年12月在北京大学第一医院经关节滑液偏振光分析确诊为急性或慢性痛风的29例患者的临床资料。采用卡方检验、Logistic回归和t检验。分析DECT与临床资料、实验室检查及药物治疗之间的关系。
结果
本研究共纳入29例患者，其中22例经DECT检测出尿酸盐结晶，7例未检测出。根据DECT是否检测出尿酸盐结晶将患者分为两组。与阴性组相比，阳性组患者年龄更大[（47±12）岁 对 （39±11）岁，P=0.15]，体重指数（BMI）更高[（27.9±3.7）kg/m² 对 （22.8±2.1）kg/m²，P=0.002]，痛风病程更长[（135±...展开102）个月 对 （45±53）个月，P=0.035]，既往最高血清尿酸水平更高[（643±121）μmol/L 对 （543±103）μmol/L，P=0.043]。虽然阳性组DECT附近尿酸水平高于阴性组，但差异无统计学意义[（558±150）μmol/L 对 （513±89）μmol/L，P=0.497]。阳性组与阴性组相比，急性期患者比例高于慢性期[18例（81.8%） 对 4例（57%），P=0.311]；服用降尿酸药物的患者比例高于另一组[22例（100%） 对 5例（71%），P=0.052]；有反复典型发作的患者比例高于无典型发作的患者[22例（100%） 对 6例（85%），P=0.241]。比较各关节症状与DECT尿酸盐结晶检出结果的一致性。右膝关节一致性最高（Kappa=0.627），其次为左第一跖趾关节（Kappa=0.58）、右第一跖趾关节（MTP1，Kappa= ...展开0.551）和左膝关节（Kappa=0.494），均有统计学意义。踝关节一致性较低（右踝关节：Kappa=0.19，左踝关节：Kappa=0.256），无统计学意义。BMI（kg/m²）[2.307（1.139 - 4.670），P=0.02]、痛风病程（年）[0.306（0.906 - 4.881），P=0.186]和既往最高尿酸水平（mg/dL）[0.023（0.981 - 2.764），P=0.137]与DECT尿酸盐结晶阳性结果有关。
结论
BMI较大、既往最高尿酸值较高且痛风病程较长的痛风患者DECT阳性结果的敏感性较高。
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