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中华诊断学电子杂志 ›› 2024, Vol. 12 ›› Issue (01) : 31 -37. doi: 10.3877/cma.j.issn.2095-655X.2024.01.005

临床研究

痛风患者第一跖趾关节超声征象与临床疼痛的相关性分析
杜梅霞1, 闫萌萌1, 肖丽珊1, 张芳芳1, 姜彩云1, 赵诚1, 姚国栋2, 宁春平1,()   
  1. 1. 266071 青岛大学附属医院腹部超声科
    2. 266071 青岛大学附属医院病理科
  • 收稿日期:2023-11-02 出版日期:2024-02-26
  • 通信作者: 宁春平
  • 基金资助:
    科技部国家重点研发计划项目(2022YFC2503302)

Correlation analysis between ultrasound signs and clinical pain in patients with gout in the first metatarsophalangeal joint

Meixia Du1, Mengmeng Yan1, Lishan Xiao1, Fangfang Zhang1, Caiyun Jiang1, Cheng Zhao1, Guodong Yao2, Chunping Ning1,()   

  1. 1. Department of Ultrasound, Affiliated Hospital of Qingdao University, Qingdao 266071, China
    2. Department of Pathology, Affiliated Hospital of Qingdao University, Qingdao 266071, China
  • Received:2023-11-02 Published:2024-02-26
  • Corresponding author: Chunping Ning
引用本文:

杜梅霞, 闫萌萌, 肖丽珊, 张芳芳, 姜彩云, 赵诚, 姚国栋, 宁春平. 痛风患者第一跖趾关节超声征象与临床疼痛的相关性分析[J/OL]. 中华诊断学电子杂志, 2024, 12(01): 31-37.

Meixia Du, Mengmeng Yan, Lishan Xiao, Fangfang Zhang, Caiyun Jiang, Cheng Zhao, Guodong Yao, Chunping Ning. Correlation analysis between ultrasound signs and clinical pain in patients with gout in the first metatarsophalangeal joint[J/OL]. Chinese Journal of Diagnostics(Electronic Edition), 2024, 12(01): 31-37.

目的

探讨超声征象评估痛风患者第一跖趾关节临床疼痛程度的可行性。

方法

回顾性分析2022年3月至2023年4月在青岛大学附属医院痛风科就诊的109例痛风患者的临床及超声资料,根据患者疼痛程度分为4组:无疼痛组(n=25)、轻度疼痛组(n=25)、中度疼痛组(n=31)、重度疼痛组(n=28)。多组间计量资料比较采用方差分析或Kruskal-Wallis H检验,多组间计数资料比较采用卡方检验或Fisher确切概率法,多组间等级资料比较采用Kruskal-Wallis H秩和检验。疼痛程度与超声特征之间的相关性采用Spearman相关性分析。采用Kappa一致性检验、ICC组内相关系数进行医师间超声图像评估结果的一致性分析。

结果

109例患者均为男性,平均年龄(44.62±14.91)岁。4组患者之间临床分期(χ2=76.31,P<0.01)、痛风石检出例数(χ2=14.39,P<0.01)、痛风石数量(H=55.39,P<0.01)、滑膜内血流信号评分(H=15.49,P<0.01)、痛风石内血流信号评分(H=11.26,P<0.05)、超声血流总分(H=20.64,P<0.01)差异有统计学意义。滑膜血流信号(r=0.30,P<0.01)、痛风石内血流信号(r=0.35,P<0.01)、超声血流总分(r=0.43,P<0.01)均与疼痛程度呈正相关。

结论

彩色多普勒超声能够客观地评估痛风患者的疼痛,滑膜及痛风石内血流信号与患者的疼痛程度密切相关,在超声报告中提示血流信号分级对痛风患者的精准诊疗具有指导意义。

Objective

To explore the feasibility of utlizing ultrasonography in evaluating the level of clinical pain in patients with gout in the first metatarsophalangeal joint.

Methods

From March 2022 to April 2023, the clinical and ultrasound data of 109 gout patients treated at the Gout Department of Affiliated Hospital of Qingdao University, were evaluated retrospectively. Patients were separated into 4 groups based on their pain intensity: no pain (n=25), mild pain (n=25), moderate pain (n=31), and severe pain (n=28). The ANOVA or Kruskal-Wallis H test was used to compare measurement data differences between groups. The Chi-square test or Fisher exact probability approach was used to examine differences in count data between groups. To compare rank data, the Kruskal-Wallis H test was utilized. Spearman correlation analysis was used to examine the relationship between pain level and ultrasonic characteristics. The Kappa consistency test and intra-class correlation coefficient (ICC) were used to assess the consistency of ultrasound image assessment among radiologists.

Results

All 109 patients were male, with an average age of (44.62±14.91) years old. Among the 4 groups, clinical stage (χ2=76.31, P<0.01), number of tophus-positive cases (χ2=14.39, P<0.01), number of tophi (H=55.39, P<0.01), color Doppler (CD) signal in the synovium (H=15.49, P<0.01), CD signal in tophi (H=11.26, P<0.05) and total CD signal score (H=20.64, P<0.01) were statistically different. CD signal of the synovium (r=0.30, P<0.01), CD signal of the tophi(r=0.35, P<0.01), and the total CD signal score (r=0.43, P<0.01) were positively correlated with the pain intensity.

Conclusions

Gout patients′ pain can be accurately assessed using color Doppler ultrasound. Color Doppler signals in synovium and tophi are connected to patients′ pain level. Blood flow signal grading should be provided in ultrasonography reports to help with clinical staging and treatment decision-making.

图1 痛风患者第一跖趾关节标准切面超声图像注:a图为MTP1足背面;b图为MTP1内侧面;c图为MTP1底面示籽骨切面;d图为MTP1底面示踇长屈肌腱切面。MTP1为第一跖趾关节;1MT为第一跖骨;1PP为第一近节趾骨;△为关节囊;*为籽骨;黄色箭头为踇长屈肌腱
图2 痛风患者第一跖趾关节超声阳性图像注:a图足背切面显示增厚的低回声滑膜及滑膜上点状高回声(白色箭头所示); b图足背切面显示增厚的滑膜(白色*号所示); c图足背切面显示无回声积液;d图足内侧切面显示双轨征(白色箭头所示); e图足内侧切面显示混合回声痛风石(黄色虚线勾勒所示); f图足内侧双切面显示骨质破坏(黄色*号所示)
图3 痛风患者第一跖趾关节彩色多普勒阳性示意图注:a、b、c图分别表示滑膜内1,2,3分血流信号;d、e、f图分别表示痛风石内1,2,3分血流信号(1分:ROI内可见少量血流信号(≤3个点状血流);2分:ROI内血流信号覆盖区域面积<50%;3分:ROI内血流信号覆盖区域面积≥50%)
表1 4组痛风患者的一般临床资料比较
表2 4组痛风患者的超声征象比较
组别 例数 滑膜厚度[mm,M(Q1Q3)] 关节腔积液深度[mm,M(Q1Q3)] 痛风石大小(mm,±s) 痛风石[例(%)] 痛风石回声[例(%)] 痛风石数量[例(%)]
低回声 高回声 0个 1个 2个 ≥3个
无疼痛 25 1.10(0.80,1.90) 1.50(0,1.90) 10.71±5.46 17(68.00) 6(37.50) 11(62.50) 8(32.00) 14(56.00) 0(0) 3(12.00)
轻度疼痛 25 1.50(1.30,1.60) 2.00(1.10,2.50) 10.00±4.62 18(72.00) 4(22.20) 14(77.80) 7(28.00) 12(48.00) 3(12.00) 3(12.00)
中度疼痛 31 1.55(1.15,2.33) 1.85(0.75,2.23) 10.85±4.82 22(70.97) 6(27.30) 16(72.70) 9(29.03) 19(61.29) 2(6.45) 1(3.23)
重度疼痛 28 1.30(0.98,1.60) 1.35(0,2.00) 10.16±5.06 21(75.00) 5(23.81) 16(76.19) 7(25.00) 16(57.14) 1(3.57) 4(14.29)
统计量   H=0.76 H=0.62 F=0.14 χ2=14.39 χ2=1.47 H=55.39
P   0.384 0.430 0.939 0.002 0.962 <0.01
组别 例数 双轨征[例(%)] 点状高回声沉积[例(%)] 骨质破坏[例(%)] 滑膜血流评分[例(%)]
阴性 可疑 阳性 0分 1分 2分 3分
无疼痛 25 9(36.00) 2(8.00) 14(56.00) 17(68.00) 12(48.00) 18(72.00) 1(4.00) 4(16.00) 2(8.00)
轻度疼痛 25 5(20.00) 7(28.00) 13(52.00) 14(56.00) 10(40.00) 12(48.00) 5(20.00) 5(20.00) 3(12.00)
中度疼痛 31 10(32.26) 2(6.45) 19(61.29) 23(74.19) 7(22.58) 13(41.94) 3(9.68) 6(19.35) 9(29.03)
重度疼痛 28 4(14.29) 5(17.86) 19(67.86) 21(75.00) 13(46.43) 9(32.14) 4(14.29) 5(17.86) 10(35.71)
统计量   H=1.84 χ2=2.84 χ2=5.29 H=15.49
P   0.607 0.417 0.507 0.001
组别 例数 痛风石血流评分[例(%)] 超声血流总评分[例(%)]
0分 1分 2分 3分 0分 1分 2分 3分 4分 5分 6分
无疼痛 25 13(76.47) 2(11.76) 0(0) 2(11.76) 16(64.00) 2(8.00) 3(12.00) 3(12.00) 0(0) 0(0) 1(4.00)
轻度疼痛 25 9(50.00) 1(5.56) 2(11.11) 6(33.33) 8(32.00) 4(16.00) 4(16.00) 6(24.00) 0(0) 1(4.00) 2(8.00)
中度疼痛 31 8(36.36) 2(9.09) 5(22.73) 7(31.82) 8(25.81) 3(9.68) 5(16.13) 7(22.58) 1(3.23) 5(16.13) 2(6.45)
重度疼痛 28 2(9.52) 2(9.52) 9(42.86) 8(38.10) 2(7.14) 3(10.71) 5(17.86) 8(28.57) 3(10.71) 3(10.71) 4(14.29)
统计量   H=11.26 H=20.64
P   0.010 <0.01
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