Dual-source CT For Gouty Arthritis Early Diagnosis And Curative Effect Evaluation Research Of Value

Objective:To analyze the clinical data of the patients with gout in the department of rheumatology of Shanxi Da hospital, so as to see the clinical features of the patients with gout. Methods:To collect the clinical data of 128 patients with primary gout in the department of rheumatology of Shanxi Da hospitals from 2013.11 to 2014.11, and taking the ten-year course of disease as a cut point to divide the patients into a short-duration group and a long-duration group, then investigate the clinical features of the patients with gout more than ten years. Results:1: Of the 128 patients with gout,122 male cases, 6 female cases, aging from 21 to 83 years old, and their average is(45±14), BMI(27.2±3.9)Kg/m2; the first-episode and first metatarsophalangeal joint are happened more often, account for 53.6%; followed by the ankle, makes up 37.3%. Their professions are mainly cadres and individual households, the percentage is 33.9%, serum uric acid level is 589.6±215.9umol/L.2: The BMI、SBP、DBP、SUA、TG、CHO、FPG of the long-duration group are raised than the short-duration, and among them, the increase of TG is more obvious,(p<0.05); compared with the short- duration group, the patients in the opposite group are more often to be misdiagnosed with other disease(38.9%vs21.1%), the most frequent is infection(30.9%), the longer ethanol intake history is(21.5%vs36.6%), the easier to cause gouty tophus(27.8%vs15.6%), all these have statistical significance.3: Complication condition, the long- duration group patients are more have hypertension(57.6%vs65%), type 2 diabetes(31.8%vs45%), insulin resistance(11.6%vs23.2%), impaired glucose regulation(9.1%vs18.9%), fatty liver(53.8%vs61.9%), kidney calculi(20%vs30%), coronary disease(9.1%vs10.2%), cerebral apoplexy(4.3%vs7.6%), and have statistical significance. Conclusions:With the improvement of living standards and economic level, the morbidity of patients with gout in Shanxi is increasingly rise, the complication of the long-duration patients is higher, and the treatment of gout is desperately needed to be standardized. Objective:Evaluate the DSCT technique’s diagnosis value to gout which detects the joints and surrounding tissues’ urate crystals of the patients’ with gout. Method:Collected 86 cases of patients with gout as experimental group, 15 patients as control group(10 cases of RA, 5 cases of OA), after sampling the patients’ clinical data including age, gender, duration etc, scan their feet ankles and knees by DSCT, using the DSCT gout recognition software processing the original image, asking two imaging diagnostic doctors see and analyze the image, and get whether the patients’ checking area has green depositions. Result:After the two imaging diagnostic doctors examination, they found that 68/86(79.1%) patients could find the green crystal, 18/86(20.1%) did not find the green crystal; and the control group were not found green crystal. The sensitivity of this diagnostic method is 68/86(79.1%), specificity of 15/15(100%). Conclusion:The DSCT gout identification technology is a kind of sensitive, non-invasive and repeatable diagnostic methods, of which do great assistive help to the establishment of the clinical diagnosis. Objective:The aim of this study was to compare the frequency and volume of Dual-source CT urate deposits in people with asymptomatic hyperuricaemia and symptomatic gout. Method:We analysed DSCT scans of the knees from asymptomatic individuals with serum urate(man>420μmol/L,feman>357μmol/L)(n=25) and those with crystal proven gout without clinically apparent tophi(n=33). Result:DSCT urate deposits were observed in 6/25(24%) participants with asymptomatic hyperuricaemia, 11/14(79%) with early gout(predefined as disease duration ≤3 years) and 16/19(84%) with late gout(p<0.001). DSCT urate deposition was observed in both joints and tendons in the asymptomatic hyperuricaemia group, but significantly less frequently than in those with gout(p≤0.001 for both joint and tendon sites). The volume of urate deposition was also significantly lower in those with asymptomatic hyperuricaemia, compared with the early and the late gout groups(p<0.01 for both comparisons). Similar urate volumes were observed in the early and late gout groups. Conclusion:Although subclinical urate deposition can occur in people with asymptomatic hyperuricaemia, these deposits occur more frequently and at higher volumes in those with symptomatic gout. These data suggest that a threshold of urate crystal volume may be required before symptomatic disease occurs. Objective:This study made a summary analysis to the 12 children and adolescents with gout admitted in our hospital, to explore the clinical characteristics of children and adolescents’ gout, andimprove the understanding of teenager gout. Method:Made a summary analysis of the 12 children and adolescents with gout admitted in our hospital. Result:Collect 12 children and adolescents with gout. All were men, onset age from 6 to 25,duration from 1 d to 5 y. There is a clear family history in 5 cases, no family history of 7 cases. Patients with a clear high purine diet in 10 cases, without in 2 cases. The main symptomsoriginates from the double digit toe joints in 5 cases(46.2%), from the ankle joints in 2 cases(19.2%), mixed joints onset in 1 case; 1 case of gout merger juvenile idiopathic arthritis; 1 case of ureteral stone with hydronephrosis. Blood uric acid is higher than normal in 8 cases, 2 cases of gouty nephropathy, and with clinical manifestations of gout stone formation in 1 case, dual-source CT tip 8 cases of multiple tophus. Misdiagnosed in 5 cases(38.5%), of which, the misdiagnosis for rheumatoid arthritis(RA) for 3 cases(50%), the pain, 1 case(20%), infectious arthritis, 1 case(20%), kidney disease, 1 case(10%). Conclusion:The children and adolescents with gout are similar compared with the elder ones, the majority is males. The Clinical symptoms are various, the misdiagnosis rate of the patients whom onset from atypical gout clinical syndromes is extremely high. And with the extension ofgout duration, the formation of tophus and bone destruction added. Objective:To define the correlation between serum uric level with the uric acid load changes examined by Dual source computed tomography(DSCT), during the therapeutic process of urate lowering on people with gout. Methods:For this research, we enrolled ten patients diagnosed with gout and did a six-month follow-up to all of them, we made the DSCT detection of patients at the initial and terminal point of the research, at the same time, monitoring the patients’ SUA fluctuation level and episodes frequency.The urate crystal distribution are defined as follows:(1) N: the number of crystal’s diameter that ≥3mm;(2) M: the number of crystal’s diameter that <3mm;(3) T: the total number of crystal. Results:During the therapeutic process of urate lowering,the number of urate crystal(N,29.5±34vs13±14,P<0.01;M,26.5±32 vs6.5±13,P<0.01;T,29±33vs10±13.5,P<0.01)and the maximum urate area(1.99±1.21vs0.6±0.59,P<0.01)all make a significant reduction,and correlates with the serum uric acid lowering(T:Z=-2.232,P=0.026;面积:Z=-2.859,P=0.004).Conclusions:Serum uric acid lowering can reduce the urate crystal’s number examined by DSCT and the maximum urate area, the variable quantities are: N,14.5±9;M,20±19;T,15±22; the maximum urate area is 1.2±0.71; DSCT has a certain value for monitoring the curative effect of gout.