[1]宾俊杰,吴梅,王忠启,等.能谱CT对高尿酸血症患者尿酸盐沉积的定量分析价值[J].国际放射医学核医学杂志,2018,(6):507-512.[doi:10.3760/cma.j.issn.1673-4114.2018.06.006]
 Bin Junjie,Wu Mei,Wang Zhongqi,et al.Quantitative analysis value of uric acid deposition in patients with hyperuricemia by Gemstone spectal CT[J].International Journal of Radiation Medicine and Nuclear Medicine,2018,(6):507-512.[doi:10.3760/cma.j.issn.1673-4114.2018.06.006]
点击复制

能谱CT对高尿酸血症患者尿酸盐沉积的定量分析价值(/HTML)
分享到:

《国际放射医学核医学杂志》[ISSN:1673-4114/CN:12-1381/R]

卷:
期数:
2018年第6期
页码:
507-512
栏目:
临床研究
出版日期:
2018-12-31

文章信息/Info

Title:
Quantitative analysis value of uric acid deposition in patients with hyperuricemia by Gemstone spectal CT
作者:
宾俊杰1 吴梅3 王忠启1 陈惠玲1 李冠2
1. 516002, 广州医科大学附属惠州医院放射科;
2. 516002, 广州医科大学附属惠州医院综合科;
3. 510180, 广州市第一人民医院放射科
Author(s):
Bin Junjie1 Wu Mei3 Wang Zhongqi1 Chen Huiling1 Li Guan2
1. Department of Radiology, Huizhou Hospital, Guangzhou Medical University, Huizhou 516002, China;
2. Department of Synthesis, Huizhou Hospital, Guangzhou Medical University, Huizhou 516002, China;
3. Department of Radiology, Guangzhou First People’s Hospital, Guangzhou 510180, China
关键词:
高尿酸血症尿酸盐结晶宝石能谱CT定量分析
Keywords:
HyperuricemiaUric acid salt depositionGemstone spectral CTQuantitative analysis
DOI:
10.3760/cma.j.issn.1673-4114.2018.06.006
摘要:
目的 探讨能谱CT对高尿酸血症患者第一跖趾关节及关节旁软组织尿酸盐沉积的定量分析价值。方法 选取2016年10月至2017年6月就诊并经临床证实的高尿酸血症患者84例。根据影像学表现分为影像学正常患者36例(A组)、单纯骨质破坏患者23例(B组)、骨质破坏+尿酸盐结晶形成患者25例(C组)。采用宝石能谱CT对A、B、C 3组患者的足部行宝石能谱CT扫描,分别测量3组患者第一跖趾关节骨皮质、骨松质及关节旁软组织的尿酸(钙)的基物质浓度。3组患者的年龄、血尿酸值和基物质浓度的比较,采用单因素方差分析。组内两两比较,方差齐者采用LSD法,方差不齐性采用Tamhane’s T2检验。运用线性回归方法分析所有高尿酸血症患者的血尿酸值与其第一跖趾关节骨皮质、骨松质及关节旁软组织尿酸(钙)浓度的相关性。结果 3组患者的年龄[A组:(39.1±11.1)岁,B组:(48.5±13.9)岁,C组:(43.2±12.5)岁](LSD法,P=0.019)、血尿酸值[A组:(489.5±90.6)μmol/L,B组:(494.7±77.2)μmol/L,C组:(581.3±69.2)μmol/L](LSD法,P<0.001)及第一跖趾关节关节旁软组织尿酸(钙)浓度[A组:(1169.58±7.88)mg/cm3,B组:(1193.13±16.35)mg/cm3,C组:(1308.20±85.89)mg/cm3](χ2=61.698,P<0.001)之间的差异均有统计学意义。第一跖趾关节骨皮质[A组:(1324.8±31.4)mg/cm3,B组:(1335.6±37.3)mg/cm3,C组:(1320.4±43.5)mg/cm3](LSD法,P=0.346)、骨松质尿酸(钙)浓度[A组:(1134.3±13.3)mg/cm3,B组:(1145.8±23.3)mg/cm3,C组:(1145.8±30.9)mg/cm3](χ2=3.464,P=0.177)之间的差异均无统计学意义。所有高尿酸血症患者的血尿酸值与第一跖趾关节关节旁软组织尿酸(钙)浓度呈线性正相关,与第一跖趾关节骨皮质、骨松质的尿酸(钙)浓度没有相关性。结论 能谱CT基物质图可以定量测量关节内外基物质浓度,明确尿酸盐沉积情况,为临床判断病情提供依据。
Abstract:
Objective To evaluate the quantitative analysis value of gemstone spectral CT for diagnosing urate deposition in the first metatarsophalangeal joint and periarticular soft tissue of patients with hyperuricemia. Methods This work involved 84 patients with hyperuricemia who underwent foot gemstone spectral CT from October 2016 to June 2017. The patients were divided into three groups:36 patients (group A) with normal imaging, 23 patients(group B) with bone destruction, and 25 patients(group C) with bone destruction and uric acid crystallization. The basal concentrations of uric acid(calcium) in the first metatarsophalangeal joint cortical bone, cancellous bone and periarticular soft tissue were measured using gemstone spectral CT scanning. The age, serum uric acid value, and basal concentration of uric acid(calcium) were compared by univariate ANOVA among the three groups. In intra-group comparison, LSD method was used for the data with equal variance, and Tamhane’s T2 test was used for the data with unequal variance.Correlation of serum uric acid value with the uric acid(calcium) level of the first metatarsophalangeal joint cortical bone, cancellous bone, and periarticular soft tissue in all hyperuricemia patients was analyzed by linear regression. Results Significant differences in age, serum uric acid value, and uric acid (calcium) concentration were found for periarticular soft tissues of the first metatarsophalangeal joints(P<0.05). No differences were observed between the uric acid(calcium) concentration in the first metatarsophalangeal joint cortical bone and cancellous bone. The following values were obtained for age:group A(39.1±11.1) years old, group B (48.5±13.9) years old, and group C (43.2±12.5) years old (LSD, P=0.019); for serum uric acid value:group A(489.5±90.6) μmol/L, group B(494.7±77.2) μmol/L, and group C(581.3±69.2) μmol/L(LSD, P<0.001); for the uric acid (calcium) concentration in the periarticular soft tissues of the first metatarsophalangeal joints:group A (1169.58±7.88) mg/cm3, group B (1193.13±16.35) mg/cm3, and group C (1308.20±85.89) mg/cm3(χ2=61.698,P<0.001); for the uric acid(calcium) concentration in the first metatarsophalangeal joints:group A (1324.8±31.4) mg/cm3, group B (1335.6±37.3) mg/cm3, and group C (1320.4±43.5) (LSD,P=0.346); for the uric acid(calcium) concentration in the cancellous bone of the first metatarsophalangeal joints:group A (1134.3±13.3) mg/cm3, group B (1145.8±23.3) mg/cm3, and group C (1145.8±30.9) mg/cm3 (χ2=3.464,P=0.177). The serum uric acid value was linearly positively correlated with the uric acid(calcium) concentration in periarticular soft tissues of the first metatarsophalangeal joints, but not with the uric acid(calcium) concentration in cortical bone and cancellous bone of the first metatarsophalangeal joints. Conclusion Gemstone spectral CT can measure quantitatively the internal and external base material concentrations of joints and define the crystallization of uric acid salt, which can provide a basis for clinical judgment.

参考文献/References:

[1] Roddy E, Zhang W, Doherty M. The changing epidemiology of gout[J]. Nat Clin Pract Rheumatol, 2007, 3(8):443-449. DOI:10.1038/ncprheum0556.
[2] 中华医学会风湿病学分会. 原发性痛风诊断和治疗指南[J]. 中华风湿病学杂志, 2011, 15(6):410-411. DOI:10.3760/cma.j.issn.1007-7480.2011.06.013. Chinese Rheumatology Association. Guidelines for the diagnosis and treatment of primary gout[J]. Chin J Rheumatol, 2011, 15(6):410-413. DOI:10.3760/cma.j.issn.1007-7480.2011.06.013.
[3] 王旭, 刘斌. 痛风性关节炎的影像学诊断及进展[J]. 国际医学放射学杂志, 2012, 35(3):251-254. DOI:10.3784/j.issn.1674-1897. 2012.03.Z0309. Wang X, Liu B. Imaging diagnosis and progress of gouty arthritis[J]. Int J Med Radiol, 2012, 35(3):251-254. DOI:10.3784/j.issn.1674-1897. 2012.03.Z0309.
[4] Bongartz T, Glazebrook KN, Kavros SJ, et al. Dual-energy CT for the diagnosis of gout:an accuracy and diagnostic yield study[J]. Ann Rheum Dis, 2015, 74(6):1072-1077. DOI:10.1136/annrheumdis-2013-205095.
[5] Finkenstaedt T, Manoliou A, Toniolo M, et al. Gouty arthritis:the diagnostic and therapeutic impact of dual-energy CT[J]. Eur Radiol, 2016, 26(11):3989-3999. DOI:10.1007/s00330-016-4237-2.
[6] 李小虎, 刘斌, 余永强, 等.能谱CT的原理与临床应用价值[J].中国医疗器械信息, 2011, 17(10):1-5. DOI:10.3969/j.issn.1006-6586. 2011.10.001. Li XH, Liu B, Yu YQ, et al. The Principle and Clinical Value of Spectral CT[J]. China Med Dev Info, 2011, 17(10):1-5. DOI:10.3969/j.issn.1006-6586. 2011.10.001.
[7] Li X, Wang X, Yu Y, et al. Detection of uric acid depositing in tophaceous gout using a new dual energy spectral CT technology[J]. J Xray Sci Technol, 2014, 22(4):541-549. DOI:10.3233/XST-140444.
[8] 张琳, 闫雅更, 董凤丽, 等. 饮食饮酒及肥胖对无症状高尿酸血症发生痛风的影响[J]. 军医进修学院学报, 2012, 33(2):135-136, 147. DOI:10.3969/j.issn.1672-4860.2014.01.009. Zhang L, Yan YG, Dong FL, et al. Effects of diet, drinking and obesity on development of gout in patients with asymptomatic hyperuricemia[J]. J Chinese PLA Postgrad Med Sch, 2012, 33(2):135-136, 147. DOI:10.3969/j.issn.1672-4860.2014.01.009.
[9] 刘炜, 薛华丹, 曾学军, 等. 双能量CT检测痛风患者尿酸盐沉积的初步应用[J].中国医学科学院学报, 2010, 32(6):645-648. DOI:10.3881/j.issn.1000-503X.2010.06.011. Liu W, Xue HD, Zeng XJ, et al. Application of Dual-energy Computed Tomography for Detecting Uric Acid Deposition in Patients with Gout[J]. Acta Acad Med Sin, 2010, 32(6):645-648. DOI:10.3881/j.issn.1000-503X.2010.06.011.
[10] 盛雪霞, 曹志宏, 闵志刚, 等. 双源CT诊断痛风性关节炎准确性的Meta分析[J]. 实用放射学杂志, 2015, 31(6):974-977. DOI:10.3969/j.issn.1002-1671.2015.06.023. Sheng XX, Cao ZH, Min ZG, et al. Accuracy of dual-energy CT in diagnosing gouty arthritis:a Meta-analysis[J]. J Pract Radiol, 2015, 31(6):974-977. DOI:10.3969/j.issn.1002-1671.2015.06.023.
[11] 任洁, 周毅, 吴会霞, 等. 双能CT检查在痛风性关节炎中的应用价值[J]. 南方医科大学学报, 2015, 35(3):384-386. DOI:10.3969/j.issn.1673-4254.2015.03.14. Ren J, Zhou Y, Wu HX, et al. Value of dual-energy computed tomography in the diagnosis of gouty arthritis[J]. J South Med Univ, 2015, 35(3):384-386. DOI:10.3969/j.issn.1673-4254. 2015.03.14.
[12] 窦小锋, 张波, 田为中.双源CT双能量成像在痛风患者尿酸盐沉积诊断中的应用价值[J]. 现代医用影像学, 2015, 24(4):550-552. Dou XF, Zhang B, Tian WZ. Value of Dual-energy Computed Tomography in the Diagnosis of Patients with Gout[J]. M M I Bimonthly, 2015, 24(4):550-552.
[13] 张娅梅, 陈谦, 殷信道, 等. 双源CT双能量成像在急性期和非急性期痛风患者尿酸盐沉积诊断中的对比研究[J]. 中国医学计算机成像杂志, 2016, 22(6):537-541. DOI:10.3969/j.issn.1006-5741.2016.06.009. Zhang YM, Chen Q, Yin XD, et al. Comparative Study of Urate Deposition in Acute and Non-acute Gout Patients by Dual-energy Computed Tomography[J]. Chin Comput Med Imag, 2016, 22(6):537-541. DOI:10.3969/j.issn.1006-5741.2016.06.009.
[14] 郑玲, 周长圣, 张龙江, 等. 双源双能量CT检测痛风石的初步经验[J]. 中国临床医学影像杂志, 2011, 22(2):105-107. DOI:10.3969/j.issn.1008-1062.2011.02.009. Zheng L, Zhou CS, Zhang LJ, et al. Preliminary experience of dual source, dual energy CT in detection of gout[J]. J Chin Clin Med Imaging, 2011, 22(2):105-107. DOI:10.3969/j.issn.1008-1062. 2011. 02.009.
[15] 李小虎, 余永强, 王万勤, 等. CT能谱成像对肾结石成分分析的初步研究[J]. 中华放射学杂志, 2011, 45(12):1216-1219. DOI:10.3760/cma.j.issn.1005-1201.2011.12.034. Li XH, Yu YQ, Wang WQ, et al. Spectral CT imaging in the evaluation of composition of kidney stones[J]. Chin J Radiol, 2011, 45(12):1216-1219. DOI:10.3760/cma.j.issn.1005-1201.2011.12. 034.
[16] Dalbeth N, Clark B, Gregory K, et al. Mechanisms of bone erosion in gout:a quantitative analysis using plain radiography and computed tomography[J]. Ann Rheum Dis, 2009, 68(8):1290-1295. DOI:10.1136/ard.2008.094201.
[17] Manger B, Lell M, Wacker J, el al. Detection of periarticular urate deposits with dual energy CT in patients with acute gouty arthritis[J]. Ann Rheum Dis, 2012, 71(3):470-472. DOI:10.1136/ard.2011. 154054.

备注/Memo

备注/Memo:
收稿日期:2018-02-20。
通讯作者:吴梅,Email:may9@sina.com
更新日期/Last Update: 2018-12-31