基于双能CT的不同临床分期足踝部痛风对比研究

Comparative Study of Different Clinical Stages of Gout Based on Foot and Ankle Joint Dual-Energy CT

摘要: 目的：本研究旨在比较不同临床分期痛风患者的足踝关节双能CT影像学表现及临床资料，为痛风的准确诊断和有效治疗提供参考。材料与方法：本研究采用回顾性分析，评估了760例根据2015年美国风湿病学会/欧洲抗风湿联盟痛风分类标准诊断的痛风患者的双能CT影像学表现及临床变量。通过单因素和多因素二元逻辑回归分析，确定急性痛风发作的风险因素，并绘制受试者工作特征曲线(ROC曲线)。结果：急性期组痛风初次发作年龄较大、病程较短，常合并软组织肿胀，非急性期组较易出现痛风石沉积且体积较大，骨质侵蚀范围也较大。痛风急性发作与较低的血尿素氮、血肌酐、血尿酸水平、较高的尿肌酐、尿尿酸水平、较小的痛风石体积以及较高的软组织肿胀率显著相关。结合以上因素用于诊断急性痛风发作的曲线下面积为0.767，灵敏度为78.5%，特异性为62.6%。结论：不同临床分期的痛风患者在双能CT影像学表现和临床资料上均存在显著差异，确定了急性痛风发作的危险因素为较小痛风石体积、显著软组织肿胀等，联合DECT影像、血液和尿液生化检查可提高对于痛风急性发作的诊断效能。

Abstract: Objective: This study aims to compare the dual-energy CT (DECT) imaging manifestations and clinical data of gout patients at different clinical stages, providing a reference for the accurate diagnosis and effective treatment of gout. Materials and Methods: This study adopted a retrospective analysis, evaluating the DECT imaging manifestations and clinical variables of 760 gout patients diagnosed according to the 2015 ACR/EULAR gout classification criteria. Univariate and multivariate binary logistic regression analyses were conducted to determine the risk factors for acute gout attacks, and receiver operating characteristic curves (ROC curves) were plotted. Results: The acute stage group had a higher age at the first gout attack, a shorter disease course, and often had soft tissue swelling. The non-acute stage group was more likely to have larger tophi deposits and a larger range of bone erosion. Acute gout attacks were significantly associated with lower blood urea nitrogen, blood creatinine, and blood uric acid levels, higher urine creatinine and urine uric acid levels, smaller tophi volume, and higher soft tissue swelling rate. The area under the curve for diagnosing acute gout attacks using the above factors was 0.767, with a sensitivity of 78.5% and a specificity of 62.6%. Conclusion: There are significant differences in DECT imaging manifestations and clinical data among gout patients at different clinical stages. The risk factors for acute gout attacks were identified as smaller tophi volume and significant soft tissue swelling. The combination of DECT imaging, blood and urine biochemical tests can improve the diagnostic efficiency for acute gout attacks.