王昱;邓雪蓉;季兰岚;张晓慧;耿研;张卓莉;

• 1:北京大学第一医院风湿免疫科

摘要(Abstract)：

目的:通过超声检查的方法,分析痛风关节炎患者下肢关节以及肌腱的异常表现,探讨在肌腱部位通过超声检测发现尿酸钠(monosodium urate,MSU)晶体沉积的危险因素,并探讨其在痛风患者诊断中的应用价值。方法:选择2017年1月至2019年1月在北京大学第一医院风湿免疫科门诊连续就诊并资料完整的痛风患者共80例作为病例组,选择同期北京大学第一医院体检人群中年龄匹配的健康志愿者80例作为对照组进行回顾性分析,由超声医生对双侧跟腱、髌腱、股四头肌腱进行检查,超声医生不知晓患者的临床诊断。超声检查根据患者是否出现肌腱尿酸钠晶体沉积,对患者进行分组比较,探讨相关的危险因素。以偏振光显微镜下在关节滑液或痛风石中发现尿酸钠晶体做为金标准,计算患者是否出现肌腱尿酸钠晶体沉积对于痛风诊断的敏感性和特异性。结果:病例组共80例患者,临床查体发现33例(47.5%)存在痛风石。超声肌腱内出现MSU晶体沉积,按照出现的频率从高到低依次为跟腱、股四头肌腱、髌腱,例数分别为41例(51.2%)、22例(27.5%)、10例(12.5%),健康志愿者均未发现痛风石以及肌腱受累表现。与肌腱内未见MSU晶体组患者相比较,肌腱内MSU晶体阳性组患者的痛风平均病程更长[(87.3±40.9)个月vs.(7.7±2.6)个月,P=0.001],平均痛风每年的发作频率更高[2(1,2)次/年vs.1(1,1)次/年,P=0.001],体重指数(body mass index,BMI)更高[(26.3±2.5) kg/m~2和(23.3±2.1) kg/m~2,P=0.05]。肌腱内MSU晶体阳性组的痛风患者平均血清尿酸水平和平均血清肌酐水平明显高于肌腱内未见MSU晶体沉积者[(584.6±87.6)μmol/L vs.(460.4±96.7)μmol/L,P=0.001;(90.9±33.3)μmol/L vs.(70.6±40.2)μmol/L,P=0.02]。Logistic回归分析显示,既往病程、既往痛风发作频率均为痛风患者肌腱内出现MSU晶体沉积的独立危险因素(P <0.01)。所有痛风患者均进行关节腔或痛风石穿刺术,以偏振光显微镜下找到MSU晶体为诊断痛风的金标准,超声检测肌腱内出现MSU沉积的敏感性以及特异性分别为94.0%和78.0%。结论:通过超声检查,痛风患者下肢肌腱受累很常见,既往病程及发作频率是肌腱内出现晶体沉积的危险因素。超声对于探测肌腱内的痛风石以及聚集物有较好的敏感性和特异性。

关键词(KeyWords)： 痛风;肌腱;水尿酸钠;超声检查;诊断价值

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(81771740)~~

作者(Author): 王昱;邓雪蓉;季兰岚;张晓慧;耿研;张卓莉;

Email:

DOI: 10.19723/j.issn.1671-167X.2021.01.022

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