超声鉴别诊断痛风性关节炎与焦磷酸钙沉积病

目的 观察超声鉴别诊断痛风性关节炎(GA)与焦磷酸钙沉积病(CPPD)的价值。方法 选取85例GA(GA组)、60例CPPD (CPPD组),比较临床资料和超声表现,分析超声鉴别二者的价值。结果 组间性别、年龄及尿酸差异均有统计学意义(P均<0.05)。GA组85例共159个关节受累,以跖趾关节和趾间关节(42/159,26.42%)及膝关节(40/159,25.16%)最常见;CPPD组60例共75个关节受累,以膝关节(38/75,50.67%)最常见。GA组 平均每例受累关节数目大于CPPD组 (Z=4.425,P<0.001),而组间受累关节累积评分 差异无统计学意义(Z=-0.541,P=0.588)。GA组关节软骨双轨征、滑膜炎、肌腱内强回声、皮下强回声及骨侵蚀发生率均高于CPPD组(P均<0.05),关节软骨内钙化及退行性变发生率均低于CPPD组(P均<0.05);组间滑膜Adler血流分级情况差异无统计学意义(Z=-0.531,P=0.595)。结论 超声有助于鉴别诊断GA与CPPD。

Ultrasonic differential diagnosis of gouty arthritis and calcium pyrophosphate deposition disease

Objective To observe the value of ultrasound for differential diagnosis of gouty arthritis (GA) and calcium pyrophosphate deposition disease (CPPD). Methods Eighty-five GA patients (GA group) and 60 CPPD patients (CPPD group) were enrolled. Clinical data and ultrasonic manifestations of the lesions were observed and compared between groups, and the value of ultrasound for differential diagnosis of GA and CPPD was analyzed. Results Significant differences of patients'' gender, age and uric acid found were between groups (all P<0.05). In 85 patients with GA, 159 affected joints were observed, the most common was metatarsophalangeal and interdigital joint (42/159, 26.42%) and then knee joint (40/159, 25.16%). In 60 patients with CPPD, 75 affected joints were detected, and the most common was knee joint (38/75, 50.67%). The average number of affected joints per case in GA group (2.00) was greater than that in CPPD group (1.00) (Z=4.425, P<0.001), while there was no significant difference of the cumulative score of affected joints (3.00 vs. 3.00) between groups (Z=-0.541, P=0.588). The incidence of articular cartilage double contour sign, synovitis, tendinous hyperecho, subcutaneous hyperecho and bone erosion in GA group were all higher than those in CPPD group (all P<0.05), while the incidence of calcification in articular cartilage and joint degeneration in GA group were both lower than those in CPPD group (both P<0.05). No significant difference of synovial Adler blood flow grade was found between groups (Z=-0.531, P=0.595). Conclusion Ultrasound was helpful for differential diagnosis of GA and CPPD.