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痛风是长期血尿酸增高、尿酸盐晶体广泛沉积所引起的炎症性疾病。高尿酸血症是痛风发生的重要生化基础。痛风患者的早期临床表现不典型,多为无症状性高尿酸血症,随着关节及软组织中尿酸盐的沉积增多,形成痛风性关节炎,继而尿酸盐结晶析出形成痛风石,晚期可造成关节破坏及功能障碍等严重后果[1-2]。第一跖趾关节是痛风最常见的且具有特征性的好发部位,因此笔者选择此部位进行研究。影像学检查作为痛风诊断的重要手段,方法众多,但是每种检查方法都有其自身的局限性,特别是对早期痛风性关节炎的诊断存在一定的局限性[3]。双能量CT是近年来新出现的一种检测痛风患者尿酸盐结晶的有效的新方法,其灵敏度和特异度都很高[4-5]。宝石能谱CT的物质分离技术可以把任何一种物质解离成另外两种物质的组合,即基物质对,如尿酸-钙、水-碘等,这种技术在一定程度上实现了定性分离及定量分析[6-7]。笔者通过定量分析高尿酸血症患者足部第一跖趾关节及关节旁软组织的基物质浓度,以期了解高尿酸血症患者不同影像学表现的尿酸沉积情况,并通过与血尿酸的相关性研究,探讨能谱CT对高尿酸血症患者尿酸盐沉积的定量分析价值。
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3组患者的年龄分别为A组(39.1±11.1)岁、B组(48.5±13.9)岁、C组(43.2±12.5)岁,B组最大,A组最小,3组间差异有统计学意义(LSD法,P=0.019);血尿酸值分别为A组(489.5±90.6)μmol/L,B组(494.7±77.2)μmol/L、C组(581.3±69.2)μmol/L,C组最高,A组最低,3组间差异有统计学意义(LSD法,P<0.001)(表 1)。
组别 例数 年龄/岁 血尿酸值/(μmol/L) 尿酸(钙)基物质浓度(mg/cm3) 关节旁软组织 骨松质 骨皮质 影像学正常组(A组) 36 39.1±11.1 489.5±90.6 1169.6±7.9 1134.3±13.3 1324.8±31.4 单纯骨质破坏组(B组) 23 48.5±13.9 494.7±77.2 1193.1±16.3 1145.8±23.3 1335.6±37.3 骨质破坏+尿酸盐结晶形成组(C 组) 25 43.2±12.5 581.3±69.2 1308.2±85.9 1145.8±30.9 1320.4±43.5 F值 4.139 9.49 66.073 1.076 2.685 χ2值 - - 61.698 3.464 - P值 0.019 0 0 0.177 0.346 注:表中,"_"原表示此项采用LSD法检验,无χ2值。 表 1 3组高尿酸血症患者的年龄、血尿酸值、尿酸(钙)基物质浓度的比较(x)
Table 1. Comparison of the levels of uric acid(calcium) in cortical bone, cancellous bone, and periarticular soft tissue of the first metatarsophalangeal joint in 3 groups(x)
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3组患者第一跖趾关节关节旁软组织尿酸(钙)浓度分别为A组(1169.6±7.9)mg/cm3、B组(1193.1±16.3)mg/cm3、C组(1308.2±85.9)mg/cm3,C组最高,A组最低,3组间差异有统计学意义(χ2=61.698,P<0.001)。骨皮质尿酸(钙)浓度分别为A组(1324.8±31.4)mg/cm3、B组(1335.6±37.3)mg/cm3、C组(1320.4±43.5)mg/cm3。骨松质尿酸(钙)浓度分别为A组(1134.3±13.3)mg/cm3、B组(1145.8±23.3)mg/cm3、C组(1145.8±30.9)mg/cm3。3组间骨皮质、骨松质尿酸(钙)浓度差异均无统计学意义(骨皮质:LSD法,P=0.346;骨松质:χ2=3.464,P=0.177)(表 1)。
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3组患者尿酸(钙)浓度与血尿酸值的相关性分析结果见表 2。结果显示,第一跖趾关节关节旁软组织的尿酸(钙)浓度与血尿酸值有关联(图 1),显著性P值=0.047(<0.05),表示两者存在线性关系;B值=0.187(>0),表示两者呈线性正相关,即血尿酸值越高,关节旁软组织的尿酸(钙)浓度越高;决定系数R2为0.047,表示血尿酸值可解释关节旁软组织尿酸(钙)浓度变异性的4.7%,另外95.3%的变异性不能用血尿酸值来解释。第一跖趾关节骨皮质、骨松质的尿酸(钙)浓度与血尿酸值均没有关联,显著性P值分别为0.408、0.810(均>0.05)。
图 1 84例高尿酸血症患者第一跖趾关节关节旁软组织尿酸(钙)浓度与血尿酸值的相关性散点图
Figure 1. Correlation between uric acid (calcium) concentration in the first metatarsophalangeal joint and serum uric acid in 84 patients with hyperuricemia
因变量 R2 调整后R2 B值 T值 显著性(P值) 关节旁软组织的尿酸钙浓度 0.047 0.036 0.187 2.018 0.047 骨皮质的尿酸钙浓度 0.008 -0.004 0.038 0.832 0.408 骨松质的尿酸钙浓度 0.001 -0.011 -0.007 -0.241 0.81 表 2 84例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)浓度的线性回归分析结果
Table 2. Correlation of serum uric acid with uric acid (calcium) concentration in cortical bone, cancellous bone and periarticular soft tissue of the first metatarsophalangeal joint in 84 hyperuricemia patients
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利用尿酸(钙)基图可以明确显示出更多、更小的尿酸盐结晶(图 2中A)。钙(尿酸)基图可以清晰地显示骨质破坏情况,包括破坏骨边缘形成的硬化带(图 2中B)。在尿酸(钙)基图的基础上,使用伪彩色对高尿酸浓度区进行标注可以更加直观地显示出尿酸结晶沉积的分布(图 2中C)。
能谱CT对高尿酸血症患者尿酸盐沉积的定量分析价值
Quantitative analysis value of uric acid deposition in patients with hyperuricemia by Gemstone spectal CT
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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:ObjectiveTo 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. MethodsThis 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. ResultsSignificant 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. ConclusionGemstone 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. -
Key words:
- Hyperuricemia /
- Uric acid salt deposition /
- Gemstone spectral CT /
- Quantitative analysis
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表 1 3组高尿酸血症患者的年龄、血尿酸值、尿酸(钙)基物质浓度的比较(x)
Table 1. Comparison of the levels of uric acid(calcium) in cortical bone, cancellous bone, and periarticular soft tissue of the first metatarsophalangeal joint in 3 groups(x)
组别 例数 年龄/岁 血尿酸值/(μmol/L) 尿酸(钙)基物质浓度(mg/cm3) 关节旁软组织 骨松质 骨皮质 影像学正常组(A组) 36 39.1±11.1 489.5±90.6 1169.6±7.9 1134.3±13.3 1324.8±31.4 单纯骨质破坏组(B组) 23 48.5±13.9 494.7±77.2 1193.1±16.3 1145.8±23.3 1335.6±37.3 骨质破坏+尿酸盐结晶形成组(C 组) 25 43.2±12.5 581.3±69.2 1308.2±85.9 1145.8±30.9 1320.4±43.5 F值 4.139 9.49 66.073 1.076 2.685 χ2值 - - 61.698 3.464 - P值 0.019 0 0 0.177 0.346 注:表中,"_"原表示此项采用LSD法检验,无χ2值。 表 2 84例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)浓度的线性回归分析结果
Table 2. Correlation of serum uric acid with uric acid (calcium) concentration in cortical bone, cancellous bone and periarticular soft tissue of the first metatarsophalangeal joint in 84 hyperuricemia patients
因变量 R2 调整后R2 B值 T值 显著性(P值) 关节旁软组织的尿酸钙浓度 0.047 0.036 0.187 2.018 0.047 骨皮质的尿酸钙浓度 0.008 -0.004 0.038 0.832 0.408 骨松质的尿酸钙浓度 0.001 -0.011 -0.007 -0.241 0.81 -
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