吴彩云　黎金娣

摘要：目的：探討彩色超声波诊断仪鉴别诊断类风湿性与痛风性跖趾关节病变的临床价值。方法：纳入我院2018年8月-2020年1月收治的风湿性与痛风性跖趾关节病变患者各80例，风湿性跖趾关节病变患者为对照组，痛风性跖趾关节病变患者为研究组，两组患者均接受彩色超声波诊断仪鉴别诊断，对比其临床诊断价值。结果：研究组患者与对照组患者在关节积液、滑膜增厚影像特征上无差异（P>0.05）;研究组患者与对照组患者在痛风石、双轨征、点状强回声影像特征上存在显著差异，有统计学意义（P<0.05）;对比跖趾关节背面（the first metatarsophalangeal joint，MTP）骨侵蚀阳性率，研究组与对照组MPT3、MPT4无显著差异（P>0.05）;研究组与对照组MTP1、MTP2、MTP5存在差异，有统计学意义（P<0.05）。结论：运用彩色超声波诊断仪鉴别诊断类风湿性与痛风性跖趾关节病变，可通过超声波影像学特征进行鉴别，诊断灵敏性较高，该诊断方式值得推广。

关键词：彩色超声波诊断仪;鉴别诊断;类风湿性;痛风性跖趾关节病变;临床价值

中图分类号：R445.1;R684.3文献标识码：BDOI：10.3969/j.issn.1001-0270.2021.02.09

Clinical Value of Color Ultrasonic Diagnostic Apparatus in Differential Diagnosis of Rheumatoid and Gouty Metatarsophalangeal Joint Diseases

WU Cai-yun， LI Jin-di

（Department of Function， Maoming Petrochemical Hospital， Guangdong 525000， China）

Abstract： Objective： To explore the clinical value of color ultrasonic diagnostic apparatus in differential diagnosis of rheumatoid and gouty metatarsophalangeal joint diseases.  Methods： 80 patients with rheumatic metatarsophalangeal joint disease and 80 patients with gouty metatarsophalangeal joint disease were admitted to our hospital from August 2018 to January 2020. Patients with rheumatic metatarsophalangeal joint disease were taken as control group and patients with gouty metatarsophalangeal joint disease were taken as study group. Both groups of patients received differential diagnosis with color ultrasonic diagnostic apparatus， and their clinical diagnostic values were compared.  Results： There was no difference in imaging features of joint effusion and synovial thickening between the study group and the control group（P>0.05）.  There were significant differences between the study group and the control group in gout stone， double track sign and punctate hyperechoic image characteristics （P<0.05）.  Compared with the positive rate of bone erosion of the first metatarsophalangeal joint（MPT3）， there was no significant difference between the study group and the control group （p>0.05）.  There are differences in MTP1， MTP2 and MTP5 between the study group and the control group.  There was statistical significance（p< 0.05）.  Conclusion： The differential diagnosis of rheumatoid arthritis and gouty metatarsophalangeal joint diseases with color ultrasonic diagnostic instrument can be made by the imaging features of ultrasonic wave， and the diagnostic sensitivity is high. The diagnostic method is worthy of promotion.

Key Words： Color Ultrasonic Diagnostic Instrument;  Differential diagnosis;  Rheumatoid;  Gouty metatarsophalangeal joint lesions;  Clinical value

风湿性关节炎与痛风性关节炎不同，前者属于免疫系统疾病，后者属于关节损伤性疾病，两种疾病均出现关节疼痛，对患者的日常生活影响较大。随着疾病的发展，风湿性以及痛风性关节炎均可出现跖趾关节病变，对患者生活质量影响较大，故而早期诊断跖趾关节病变十分重要[1]。痛风性关节炎是指体内尿酸沉积于关节囊、肌腱、软骨等组织，随着沉积水平的提升，导致关节病变发生。痛风性关节炎临床表现为多关节周围组织发热、关节剧痛、肿胀等。多数研究均指出[2-3]，类风湿性关节炎与痛风性关节炎之间存在相似性，导致早期鉴别诊断难度较大，极易出现误诊与漏诊，从而耽误患者的最佳治疗时间。因此……