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作者：Shyamashis DAS et,al 翻译:新疆医科大学附属第二医院张继云(jiyunz@sina.com) 发布：高爽 审核：刘佩玲
本研究的目的是评估痛风发作间期和慢性期超声检查的敏感性和特异性，同时对比了痛风患者在不同尿酸水平时的超声特征。方法：研究对象是通过尿酸盐结晶检查确诊的成年痛风患者，并且要求病情处在临床发作间期或慢性期。经过肌肉骨骼超声培训的风湿科医生在单盲情况下对患者的双侧第一跖指关节和膝关节进行超声检查。结果：共有62例痛风患者和30例健康人进行了超声检查。71例(57.3%)第一跖趾关节表现为双轨征，54例（43.5%）第一跖趾关节发现有痛风石。双轨征存在于43例 （69.4%）痛风患者中，但对照组无该项表现（P＜0.001）。双轨征在痛风患者中的敏感性和特异性（95%可信区间）分别是69.4%（56.4–80.4%）和100%（88.3–100%），而痛风石的敏感性和特异性分别是66.1%（53 - 77.7%）和100%（88.3 - 100%）。在高血尿酸（SUA≥7毫克/分升）痛风患者中，双轨征的敏感性增加100%。与对照组相比，低血尿酸（SUA＜7毫克/分升）痛风组第一跖趾关节的骨质破坏(40%)和痛风石(50%)是明显增加的。结论：在痛风的发作间期和慢性期，尿酸盐结晶的诊断是有价值的，尤其是在持续的高血尿酸水平痛风患者中。
Aim: This study aimed to assess the sensitivity and specificity of ultrasonographic features of gout in intercritical and chronic stages andcompared ultrasonographic features of gout between patients with persistenthigh serum uric acid (SUA) and patients with low SUA. Methods: Adult patientswith gout confirmed by demonstration of monosodium urate crystals wererecruited, if they were in intercritical or chronic stage clinically.Ultrasonographic examination of the first metatarsophalangeal joints (MTPJs)and the knee joints of both sides were done by a blinded rheumatologist trainedin musculoskeletal ultrasound. Results: Sixty-two patients with gout and 30control subjects were examined. The double contour sign (DCS) was found in 71(57.3%) first MTPJs and tophi were found in 54 (43.5%) first MTPJs. DCS waspresent in 43 (69.4%) gout patients but none in the control group (P <0.001). Sensitivity and specificity (95% CI) of DCS in gout patients were 69.4%(56.4–80.4%) and 100% (88.3–100%), respectively, while of tophi they were 66.1%
(53–77.7%) and 100% (88.3–100%), respectively. The sensitivity of DCS increasedto 100% in high the SUA subgroup (SUA ≥ 7 mg/dL). The low SUA (SUA < 7mg/dL) gout subgroup showed significantly higher occurrence of erosions (40%)and tophi (50%) in first MTP joints than the control group. Conclusion: MSUS isuseful for diagnosis of gout in intercritical or chronic stages, especially inpatients with persistently high SUA level.
Shyamashis DAS, Alakendu GHOSH et al. Sensitivity andspecificity of ultrasonographic features of gout in intercritical and chronicphase. International Journal of Rheumatic Diseases. 2016, 8:1756-1763.
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