基于DECT的足踝部痛风骨侵蚀的危险因素 研究

Research on Risk Factors for Bone Erosion in Gout of the Feet and Ankles Based on Dual-Energy Computed Tomography

摘要: 目的：使用双能计算机断层扫描(DECT)分析痛风骨侵蚀(BE)的相关危险因素，为减缓骨侵蚀的进展提供参考。方法：回顾性纳入足踝部痛风患者404例，根据DECT有无BE分为骨侵蚀组(n = 192例)与非骨侵蚀组(n = 212例)。比较两组痛风患者的临床数据、实验室指标和DECT测量的单钠尿酸盐(MSU)晶体负荷，通过多因素logistic回归分析骨侵蚀的独立危险因素，趋势性检验评估各独立危险因素与骨侵蚀风险的关联趋势。结果：多因素logistic回归分析显示，MSU晶体体积是骨侵蚀最强的独立危险因素，体积 ≥ 0.17 cm³者骨侵蚀风险明显升高(OR = 13.405, 95% CI: 5.934~30.282, P < 0.001)。年龄 ≥ 60岁(OR = 4.334)、近1年急性发病次数 ≥ 4次(OR = 2.622)以及病程 > 10年(OR = 3.319)同样为骨侵蚀的独立危险因素。且随着年龄增长、近1年急性发病次数增多、病程延长以及MSU晶体负荷增加，骨侵蚀风险均呈现上升趋势(P for trend < 0.05)。结论：年龄、近1年急性发病次数、病程及MSU晶体负荷是促进骨侵蚀发生与进展的独立危险因素。临床需早期诊断与干预痛风患者以减少晶体沉积，是预防痛风性骨侵蚀的关键。

Abstract: Objective: To investigate the risk factors associated with bone erosion (BE) in gout using dual-energy computed tomography (DECT), and to provide evidence for delaying the progression of bone erosion. Methods: A total of 404 patients with gout involving the feet and ankles were retrospectively enrolled and divided into a bone erosion group (n = 192) and a non-bone erosion group (n = 212) based on the presence or absence of BE on DECT. Clinical characteristics, laboratory parameters, and monosodium urate (MSU) crystal burden measured by DECT were compared between the two groups. Multivariate logistic regression analysis was performed to identify independent risk factors for bone erosion, and trend tests were conducted to evaluate the dose-response relationships between these factors and the risk of bone erosion. Results: Multivariate logistic regression analysis revealed that MSU crystal volume was the strongest independent risk factor for bone erosion. Patients with an MSU crystal volume ≥ 0.17 cm³ had a significantly increased risk of bone erosion (OR = 13.405, 95% CI: 5.934~30.282, P < 0.001). In addition, age ≥ 60 years (OR = 4.334), frequency of acute attacks ≥ 4 times in the past year (OR = 2.622), and disease duration > 10 years (OR = 3.319) were also identified as independent risk factors for bone erosion. Trend analysis revealed that the risk of BE increased significantly in correlation with advancing age, higher flare frequency, prolonged disease duration, and increased MSU crystal burden (all P for trend < 0.05). Conclusion: Age, frequency of acute attacks in the past year, disease duration, and MSU crystal burden are independent risk factors contributing to the development and progression of bone erosion in gout. Early diagnosis and intervention to reduce crystal deposition are crucial for the prevention of gouty bone erosion.