[摘要] 目的 探析X線、CT、MRI在痛风性关节炎患者中的诊断价值。方法 在该院2017年10月—2019年3月收治的痛风性关节炎患者中便利选出120例为对象，均进行X线、CT、MRI检查，收集整理3种方法的诊断准确率等。结果 X线、CT、MRI对痛风性关节炎的诊断准确率（69.17% vs 85.00% vs 95.00%）对比差异有统计学意义（χ2=28.936，P<0.05）;X线的诊断准确率低于CT，CT诊断准确率低于MRI（P<0.05）;病变关节检出率对比：X线、CT、MRI分别为62.72%、77.19%、93.42%，3种方法之间差异有统计学意义（χ2=62.239，P<0.05）;相关征象检出率对比3种方法之间差异有统计学意义（P<0.05），两两比较其中骨内痛风石检出率和关节面下囊变的检出率CT与MRI之间差异无统计学意义（P>0.05）;软组织肿胀、关节软骨侵蚀、关节积液和滑膜韧带损伤的检出率比较，CT明显低于MRI（P<0.05）。结论 X线、CT、MRI在痛风性关节炎的诊断中均有一定价值，MRI的诊断准确率高，发现病变关节、病变征象的准确率高，CT在骨质破坏方面检出上有优势，X线则适用于中晚期病变复查中;3种影像学手段各有侧重，应合理应用。

[关键词] 痛风性关节炎;诊断准确率;X线;CT;MRI;检出率

[中图分类号] R589.7;R816.8          [文献标识码] A          [文章编号] 1674-0742（2020）02（b）-0180-03

The Diagnostic Value of X - ray， CT and MRI in Gouty Arthritis

XU Biao

Department of Medical Imaging， Nanping First Hospital， Fujian Medical University， Nanping， Fujian Province， 353000 China

[Abstract] Objective To explore the diagnostic value of X-ray and CT，MRI in patients with gouty arthritis. Methods From October 2017 to March 2019， 120 patients with gouty arthritis were convenienty selected and examined by X-ray and CT，MRI， and the diagnostic accuracy of the three methods was collected and sorted out. Results The diagnostic accuracy of X-ray， CT and MRI for gouty arthritis （69.17% vs 85.00% vs 95.00%） was significantly different（χ2=28.936， P<0.05）.The diagnostic accuracy of X-ray was lower than that of CT， and that of CT was lower than that of MRI（P<0.05）. Comparison of detection rate of diseased joints： X-ray， CT and MRI were 62.72%， 77.19% and 93.42%， respectively. The differences between the three methods were statistically significant （χ2=62.239， P<0.05）.And there was significant difference in the detection rate of related signs between the three methods （P<0.05）. There was no statistically significant difference between CT and MRI in the detection rate of intraosseous gouty stone and subarticular bursa （P>0.05）. The detection rate of soft tissue swelling， articular cartilage erosion， joint fluid accumulation and synovial ligament injury was significantly lower than that of MRI （P<0.05）. Conclusion X-ray and CT，MRI have certain value in the diagnosis of gouty arthritis. The diagnostic accuracy of MRI is high， and the accuracy of finding diseased joints is high. CT has advantages in the detection of bone destruction， X-ray is suitable for the reexamination of middle and late lesions， and each of the three imaging methods has its own emphasis and should be used reasonably.

[Key words] Gouty arthritis; Diagnostic accuracy; X-ray; CT; MRI; Detection rate

痛风是指引嘌呤代谢异常引起的代谢性疾病，以血尿酸水平升高为基本特征，导致单钠尿酸晶体在关节内或是关节周围软组织中沉积，进而引起急性或慢性痛风性关节炎，在晚期可能导致关节畸形[1-2]。近年来随着人们生活水平的提高和饮食结构的改变，痛风的发生率明显提高，痛风性关节炎（GA）患者越来越多，早期诊断痛风性关节炎并及早对症治疗，有助于改善预后[3]。关节镜检查是诊断痛风性关节炎的金标准，但是关节镜检查是有创检查，X线、CT、MRI是无创方法，该研究便利选取该院2017年10月—2019年3月收治的120例痛风性关节炎患者为对象，探索这3种影像学技术在痛风性关节炎患者中的诊断价值，现报道如下。

1  资料与方法

1.1  一般资料

便利选取该院收治的痛风性关节炎患者120例为对象，患者均签署知情同意书。男89例、女31例;年龄43～73岁，平均（55.8±4.6）岁;病程3～18年，平均（12.5±2.1）年;单关节发病43例、多关节发病77例;共检查228个关节，其中跖趾关节112个、膝关节31个、踝关节25个、腕关节20个、掌指关节28个、肘关节12个。……