肌骨超声评价痛风性关节炎患者骨质破坏的临床应用价值

目的 应用高频肌骨超声对痛风性关节炎患者进行超声扫查,分析不同超声表现与骨代谢指标的相关性,探究肌骨超声对痛风性关节炎的临床诊断和监测的应用价值。方法 回顾性分析2016年6月至2019年8月于我院风湿免疫科就诊的180名痛风性关节炎患者的病史及临床资料,对所有患者行关节超声检查,扫查双膝关节、双踝关节、双足第一跖趾关节。根据关节超声不同表现将患者分为3组：无聚集体组,聚集体组,和痛风石组。检测患者血清中骨代谢指标CTX、OC-N-MID、DKK1、RANKL的含量。分析三组患者骨代谢指标的差异,以及其与临床和实验室指标的相关性。结果：三组患者血清中CTX、OC-N-MID含量无显著性差异,而DKK1、RANKL浓度有统计学差异,痛风石组含量高于聚集体组,聚集体组高于无聚集体组。Pearson相关分析发现,病程越长,血尿酸水平越高,患者血清中DKK1浓度就越高,RANKL含量也增高。结论：肌骨超声可探查痛风性关节炎患者聚集体、双轨征、痛风石及骨质破坏的阳性表现。随着病程延长,骨质破坏指标升高提示骨质破坏加重,这表明肌骨超声能用于评价痛风性关节炎患者疾病进展,联合骨代谢指标能动态监测患者关节受累情况。

The clinical value of muscle bone ultrasound in the evaluation of bone destruction in patients with gouty arthritis

Objective High frequency ultrasound was used to evaluate the different ultrasonic manifestations of patients with gouty arthritis, to analyze the correlation between different ultrasonic manifestations and bone metabolism indexes, and to explore the role of muscle and bone ultrasound in the clinical diagnosis and disease monitoring of gouty arthritis. Methods The history and clinical data of 180 patients with gouty arthritis who were treated in rheumatology and Immunology Department of our hospital from June 2016 to August 2019 were analyzed retrospectively. According to the different manifestations of joint ultrasound, patients were divided into three groups: no aggregation group, aggregation group, and gouty stone group. The contents of CTX, oc-n-mid, DKK1 and RANKL were measured. The differences of bone metabolism indexes among the three groups were analyzed, as well as their correlation with clinical and laboratory indexes. Results There was no significant difference in CTX and oc-n-mid among the three groups, but there was statistical difference in DKK1 and RANKL. The content of gouty stone group was higher than that of aggregate group, while that of aggregate group was higher than that of non aggregate group. Pearson correlation analysis found that the longer the course of disease, the higher the serum uric acid level, the higher the serum DKK1 concentration, and the higher the RANKL content Conclusion Muscle bone ultrasound can detect the positive manifestations of gouty arthritis such as aggregation, double track sign, gouty stone and bone destruction. With the prolongation of the course of disease, the increase of bone destruction index indicates the aggravation of bone destruction, which indicates that muscle bone ultrasound can be used to evaluate the disease progress of patients with gouty arthritis, and combined with bone metabolism index can dynamically monitor the joint involvement of patients.