| Objective: To analyze the correlation between the semiquantitative grading of synovial blood flow by ultrasound microangiography and laboratory indices and Chinese medical evidence in patients with gouty arthritis(GA),to compare and analyze the difference of semiquantitative grading of synovial blood flow by ultrasonic microvascular imaging technology among TCM syndromes of GA patients.To explore the application value of ultrasound microvascular imaging technology in semiquantitative grading of synovial blood flow in evaluating the activity degree of synovitis in GA patients,and to study the feasibility of semiquantitative classification of synovial blood flow by ultrasound microvascular imaging technology in assisting the evaluation of synovitis in GA patients with integrated traditional Chinese and western medicine.Methods: The general data,laboratory indexes,TCM syndrome types and semi-quantitative grading data of ultrasonic synovial blood flow of 121 joints involved in 73 patients with GA who met the inclusion criteria were collected retrospectively.Semi-quantitative grading of ultrasonic synovial blood flow was evaluated by Doppler flow imaging(CDFI)and twodimensional gray-scale blood flow imaging(B-flow),and was divided into CDFI group and B-flow group.To analyze the situation of affected joints and the distribution of TCM syndromes in GA patients,and compare the positive rate of synovial blood flow and semi-quantitative grading between CDFI group and B-flow group in GA patients,to explore the correlation between the semi-quantitative grading score of synovial blood flow and laboratory indexes(erythrocyte sedimentation rate,highsensitivity C-reactive protein and serum uric acid level)in the two groups,and analyze the correlation between semi-quantitative classification of synovial blood flow and TCM syndrome types in B-flow group of GA patients,further compare the difference of semi-quantitative grading of synovial blood flow in B-flow group among TCM syndromes of GA patients.Results:(1)In 73 patients with GA,121 joints were involved,among which metatarsophalangeal joint(39.67%)was the main joint involved,followed by ankle joint(34.71%),knee joint(15.70%),wrist joint(5.79%),elbow joint(2.48%),and hand joint was the least(1.65%).(2)In this study,the main type of GA patients is damp-heat accumulation type(38.36%),followed by phlegm stagnation type(27.40%),stasis-heat stagnation type(21.92%)and liver-kidney yin deficiency type(12.32%).Among the joints involved in GA patients,the main type is dampheat accumulation type(37.19%),followed by phlegm stagnation type(29.75%),stasis-heat stagnation type(23.14%)and liver-kidney yin deficiency type(9.92%).(3)The rate of positive synovial blood flow was higher in the B-flow group than in the CDFI group in GA patients with involved joints(P < 0.05).(4)There was a correlation between the semiquantitative synovial blood flow grading score and blood sedimentation and ultrasensitive C-reactive protein in both the B-flow and CDFI groups of patients with GA(P < 0.05),and no correlation with blood uric acid levels(P > 0.05).(5)Blood sedimentation and ultrasensitive C-reactive protein were higher in patients of GA with damp-heat accumulation type and phlegm stagnation type than in patients of GA with stasis-heat stagnation type and liver-kidney yin deficiency type(all P < 0.01).The blood uric acid levels in patients with damp-heat accumulation type,phlegm stagnation type,and liver-kidney yin deficiency type of GA were all higher than those in patients with stasis-heat stagnation type of GA(all P < 0.05).The rest of the differences between the two comparisons were not statistically significant(all P > 0.05).(6)The proportion of synovial blood flow of grade II(42.22%)in B-flow group was the highest in the affected joints of GA patients with damp-heat accumulation type.The proportion of synovial blood flow of grade I(36.11%)and grade II(36.11%)in B-flow group was the highest and equal in the affected joints of GA patients with phlegm stagnation type.The proportion of synovial blood flow of grade I(53.57%)in B-flow group was the highest in the affected joints of GA patients with stasis-heat stagnation type.The proportion of synovial blood flow of grade 0(66.67%)in B-flow group was the highest in the affected joints of GA patients with liver-kidney yin deficiency type.(7)The positive rate of synovial blood flow in B-flow group of GA patients with damp-heat accumulation type was higher than that with stasis-heat stagnation type(P < 0.01)and liver-kidney yin deficiency type(P < 0.01),the positive rate of grade I synovial blood flow in B-flow group of GA patients with damp-heat accumulation type was lower than that with phlegm stagnation type(P < 0.01)and stasis-heat stagnation type(P < 0.01)and liver-kidney yin deficiency type(P <0.05),the positive rate of grade II synovial blood flow in B-flow group of GA patients with damp-heat accumulation type was higher than that with stasis-heat stagnation type(P < 0.01)and liver-kidney yin deficiency type(P < 0.01),the positive rate of grade III synovial blood flow in Bflow group of GA patients with damp-heat accumulation type was higher than that with phlegm stagnation type and stasis-heat stagnation type(P< 0.01)and liver-kidney yin deficiency type(P < 0.01).The positive rate of synovial blood flow in B-flow group of GA patients with phlegm stagnation type was higher than that with stasis-heat stagnation type(P< 0.01)and liver-kidney yin deficiency type(P < 0.01),the positive rate of grade I synovial blood flow in B-flow group of GA patients with phlegm stagnation type was lower than that with stasis-heat stagnation type(P < 0.05),the positive rate of grade II synovial blood flow in Bflow group of GA patients with phlegm stagnation type was higher than that with stasis-heat stagnation type(P < 0.01)and liver-kidney yin deficiency type(P < 0.01),the positive rate of grade III synovial blood flow in B-flow group of GA patients with phlegm stagnation type was higher than that with liver-kidney yin deficiency type(P < 0.01).The positive rate of synovial blood flow in B-flow group of GA patients with stasis-heat stagnation type was higher than that with liver-kidney yin deficiency type(P < 0.01),the positive rate of grade I synovial blood flow in B-flow group of GA patients with stasis-heat stagnation type was higher than that with liver-kidney yin deficiency type(P < 0.01),the positive rate of grade II synovial blood flow in B-flow group of GA patients with stasis-heat stagnation type was higher than that with liver-kidney yin deficiency type(P < 0.05).Conclusion: A higher rate of positive synovial blood flow in the B-flow group than in the CDFI group in GA patients with involved joints.There was a correlation between the semi-quantitative synovial blood flow grading score and the hematocrit and ultrasensitive C-reactive protein in both groups of affected joints in GA patients,and all of them were positively correlated,and the correlation between the semi-quantitative synovial blood flow grading score and the hematocrit and ultrasensitive C-reactive protein in the B-flow group was better than that in the CDFI group.Blood sedimentation and ultrasensitive C-reactive protein were higher in patients of GA with damp-heat accumulation type and phlegm stagnation type than in patients of GA with stasis-heat stagnation type and liver-kidney yin deficiency type.The blood uric acid levels in patients with damp-heat accumulation type,phlegm stagnation type,and liver-kidney yin deficiency type of GA were all higher than those in patients with stasis-heat stagnation type of GA.The positive rate of Bflow synovial blood flow in the affected joints of GA patients was higher in the damp-heat accumulation type and phlegm stagnation type than in the stasis-heat stagnation type and the liver-kidney yin deficiency type,and the positive rate of B-flow synovial blood flow was higher in the stasisheat stagnation type than in the liver-kidney yin deficiency type.When the B-flow of the affected joints in GA patients shows a semiquantitative grade III or II of synovial blood flow,the Chinese medical evidence of gout is mainly of the damp-heat accumulation type and phlegm stagnation type,when B-flow shows that the semi-quantitative grade of synovial blood flow is grade I,the Chinese medical evidence of gout is mainly of the stasis-heat stagnation type,when B-flow shows a negative semiquantitative grading of synovial blood flow,the gout TCM evidence is dominated by liver-kidney yin deficiency type.Ultrasound microangiography of the affected joints in GA patients with semiquantitative grading of synovial blood flow correlates with blood sedimentation and ultrasensitive C-reactive protein,which can reflect the degree of activity of synovial inflammation in patients,and can be used to assist in the assessment of synovial inflammation in the affected joints in patients with GA by combining Chinese and Western medicine. |
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