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目的采用双能量能谱CT分析男性痛风患者足踝关节周围尿酸盐(MSU)沉积特点,评价MSU沉积与痛风性关节炎急性发作的相关解剖学和形态学特征。方法对27例近期足踝部位痛风急性发作的男性痛风患者行双足踝关节双能量能谱扫描,采用χ~2检验分析MSU沉积的形态学特征及解剖学部位与相应区急性关节炎发作的关系。结果 27例患者均检测到MSU,分布于266处沉积区,最常出现MSU沉积的部位依次为软组织(66/266,24.81%)、第一跖趾关节(45/266,16.92%)、皮下(41/266,15.41%)、肌腱(27/266,10.15%)、距骨(26/266,9.77%)、胫骨下端(26/266,9.77%)、腓骨下端(18/266,6.77%)、跟骨(12/266,4.51%)、第一趾中远端(5/266,1.88%)。足关节中第一跖趾关节(χ~2=5.05,P<0.05)有MSU沉积、呈点状分布(χ~2=8.02,P<0.01)更易引起相应部位的急性关节炎发作。对于踝关节,无论MSU沉积的部位及形态均易引起相应部位关节炎的急性发作。足踝关节中多个MSU沉积亦易引起相应部位痛风性关节炎的急性发作。结论双能量能谱CT可清晰显示MSU的沉积,MSU在足踝关节周围最易沉积于软组织及第一跖趾关节。MSU在足踝关节的沉积部位、形态及数目等对痛风性关节炎的急性发作有影响。
Objective To analyze the characteristics of deposition of urate (MSU) around the ankle joint in male gout patients by dual-energy spectral CT, and to evaluate the anatomic and morphological characteristics of MSU deposition and acute attacks of gouty arthritis. Methods Twenty-seven male gout patients with acute gout at the ankle and foot were scanned with double energy ankle joint energy spectrum. Χ ~ 2 test was used to analyze the morphological and anatomical features of MSU and the corresponding acute arthritis attack relationship. Results MSU were detected in all 27 cases, and were located in 266 sedimentary areas. The areas with the most common MSU deposition were soft tissue (66 / 266,24.81%), first metatarsophalangeal joint (45 / 266,16.92%), subcutaneous (41/266, 15.41%), tendon (27 / 266,10.15%), talus (26 / 266,9.77%), lower tibia (26 / 266,9.77%) and lower fibula (18 / 266,6.77% , Calcaneus (12 / 266,4.51%), first toe middle and distal (5/266, 1.88%). MSU deposition in the first metatarsophalangeal joint (χ ~ 2 = 5.05, P <0.05) in the foot joints showed a spot-like distribution (χ ~ 2 = 8.02, P <0.01) and more likely caused the acute arthritis attack. For the ankle joint, regardless of the location of MSU deposition and morphology are easily caused by the corresponding site of acute attack of arthritis. Multiple MSU depositions in the foot and ankle also easily cause an acute attack of gouty arthritis at the corresponding site. Conclusion Dual energy energy spectrum CT can clearly show the deposition of MSU. MSU is most likely to deposit in the soft tissue and the first metatarsophalangeal joint around the foot and ankle joint. MSU deposition sites in the ankle, shape and number of acute attacks on gouty arthritis have an impact.