双源CT对痛风性关节炎早期诊断的价值(1)
[摘要]目的 探讨双源CT对痛风性关节炎早期诊断的价值。方法 选取2015年1月～2016年1月我院收治的临床疑似痛风患者227例，其中108例足踝部疼痛，63例手部疼痛，56例膝关节处疼痛，分别对这三组痛风患者进行双源CT扫描，以美国风湿病学会(ACR)的分类标准作为痛风诊断的“金标准”，通过对图片进行分析详细记录三组的扫描结果，对其所有数据及特异度和灵敏度进行统计学分析。结果 108例双侧足部及踝关节疼痛患者中，确诊96例，双源CT诊断的准确度为95.37%，特异度75.00%，灵敏度97.92%；63例双侧手部及腕关节疼痛患者中，确诊痛风50例，双源CT诊断的准确度为88.89%，特异度61.54%，灵敏度96.00%；在56例膝关节处疼痛的患者中，确诊46例，双源CT诊断的准确度为89.28%，特异度80.00%，灵敏度91.30%。结论 双源CT作为现在临床上一种诊断痛风性关节炎的主要方法之一，具有无创性和可重复性，对提高痛风的诊断率有积极意义，且安全性更高，值得临床推广应用。
[关键词]双源CT；痛风性关节炎；早期诊断；价值
[中图分类号]R445.3 [文献标识码] A [文章编号] 1674-4721(2016)06(a)-0119-03
[Abstract]Objective To explore early diagnostic value of dual-source CT on gouty arthritis. Methods From January 2015 to January 2016，227 patients diagnosed as suspected gout were admitted into our hospital and selected.Among them，108 cases with foot and ankle pain，63 cases with hand pain，and 56 cases with knee joint pain.All these gout patients were performed with dual-source CT scanning.According to gold standard of gout diagnosis drafted by American College of Rheumatology (ACR) classification，the scanning outcomes were analyzed and recorded in detail on these images.The data，specificity，and sensitivity were statistically analyzed.Results Among these 108 patients with bilateral foot and ankle pain，96 cases were definitely diagnosed by dual-source CT in clinic，the diagnostic accuracy，specificity and sensitivity was 95.37%，75.00% and 97.92% respectively.Among these 63 patients with bilateral hand and wrist pain，50 ones were definitely diagnosed，the diagnostic accuracy，specificity and sensitivity of dual-source CT was 88.89%，61.54% and 96.00% respectively.Among these 56 patients with knee joint pain，46 cases were definitely diagnosed in clinic，the diagnostic accuracy，specificity and sensitivity of dual-source CT was 89.28%，80.00% and 91.30% respectively.Conclusion Dual-source CT as a principal means to diagnose gouty arthritis in modern clinic has advantages of non-invasion and repeatability as well as plays a positive significance on improving diagnostic possibility of gout.It is in higher safety and worthy of promotion and application in clinic.
[Key words]Dual-source CT；Gouty arthritis；Early diagnosis；Value
随着越来越多人生活方式及饮食结构的不断变化，痛风已成为临床上的常见病[1]，患者数量不仅呈现逐年增加的趋势，且越来越趋于年轻化[2]。痛风性关节炎的主要发病原因是体内嘌呤代谢发生紊乱，致使尿酸以钠盐的形式沉积在滑膜、关节囊或其他结缔组织中[3]，从而引起一种炎症性反应。此病的早期临床症状并不十分典型，主要表现为各种急性或慢性的关节炎，如早期不及时发现并治疗，一旦病情发展到晚期会对关节造成严重破坏，导致关节功能障碍。痛风诊断的“金标准”是抽取疑似病变部位的关节滑液进行偏振光显微镜检查，但是此方法会对患者造成创伤，甚至导致感染或出血，对患者造成的伤害较大，且会受到关节大小的影响等造成取材困难。随着CT技术的不断进步，双源CT逐渐成为无创检查尿酸盐的主要手段[4]，其在临床上的应用价值也越来越受到人们的重视。本研究就双源CT对痛风性关节炎的早期诊断价值进行研究与分析，现报告如下。 (张凯 侯刚强 薛水培)
[关键词]双源CT；痛风性关节炎；早期诊断；价值
[中图分类号]R445.3 [文献标识码] A [文章编号] 1674-4721(2016)06(a)-0119-03
[Abstract]Objective To explore early diagnostic value of dual-source CT on gouty arthritis. Methods From January 2015 to January 2016，227 patients diagnosed as suspected gout were admitted into our hospital and selected.Among them，108 cases with foot and ankle pain，63 cases with hand pain，and 56 cases with knee joint pain.All these gout patients were performed with dual-source CT scanning.According to gold standard of gout diagnosis drafted by American College of Rheumatology (ACR) classification，the scanning outcomes were analyzed and recorded in detail on these images.The data，specificity，and sensitivity were statistically analyzed.Results Among these 108 patients with bilateral foot and ankle pain，96 cases were definitely diagnosed by dual-source CT in clinic，the diagnostic accuracy，specificity and sensitivity was 95.37%，75.00% and 97.92% respectively.Among these 63 patients with bilateral hand and wrist pain，50 ones were definitely diagnosed，the diagnostic accuracy，specificity and sensitivity of dual-source CT was 88.89%，61.54% and 96.00% respectively.Among these 56 patients with knee joint pain，46 cases were definitely diagnosed in clinic，the diagnostic accuracy，specificity and sensitivity of dual-source CT was 89.28%，80.00% and 91.30% respectively.Conclusion Dual-source CT as a principal means to diagnose gouty arthritis in modern clinic has advantages of non-invasion and repeatability as well as plays a positive significance on improving diagnostic possibility of gout.It is in higher safety and worthy of promotion and application in clinic.
[Key words]Dual-source CT；Gouty arthritis；Early diagnosis；Value
随着越来越多人生活方式及饮食结构的不断变化，痛风已成为临床上的常见病[1]，患者数量不仅呈现逐年增加的趋势，且越来越趋于年轻化[2]。痛风性关节炎的主要发病原因是体内嘌呤代谢发生紊乱，致使尿酸以钠盐的形式沉积在滑膜、关节囊或其他结缔组织中[3]，从而引起一种炎症性反应。此病的早期临床症状并不十分典型，主要表现为各种急性或慢性的关节炎，如早期不及时发现并治疗，一旦病情发展到晚期会对关节造成严重破坏，导致关节功能障碍。痛风诊断的“金标准”是抽取疑似病变部位的关节滑液进行偏振光显微镜检查，但是此方法会对患者造成创伤，甚至导致感染或出血，对患者造成的伤害较大，且会受到关节大小的影响等造成取材困难。随着CT技术的不断进步，双源CT逐渐成为无创检查尿酸盐的主要手段[4]，其在临床上的应用价值也越来越受到人们的重视。本研究就双源CT对痛风性关节炎的早期诊断价值进行研究与分析，现报告如下。 (张凯 侯刚强 薛水培)