本文選題：痛風(fēng)　切入點：痛風(fēng)性關(guān)節(jié)炎　出處：《青島大學(xué)》2017年碩士論文

【摘要】：目的:探究單能量能譜CT監(jiān)測下合并慢性痛風(fēng)石性關(guān)節(jié)炎患者分別使用非布司他、別嘌醇治療過程前后痛風(fēng)石體積的變化情況及血尿酸水平的改變。材料與方法:采用能譜CT單能量成像對2016年7月-2017年2月期間44例符合2015年美國風(fēng)濕病學(xué)會標(biāo)準(zhǔn),經(jīng)臨床診斷慢性痛風(fēng)石性關(guān)節(jié)炎患者行雙足踝關(guān)節(jié)痛風(fēng)石單能量CT能譜成像。全部患者采用治療劑量,44例患者平均年齡為(51±11.2)歲,其中非布司他組26例,全部為男性。別嘌醇組18例,男性17例,女性1例。非布司他組(萬邦醫(yī)藥優(yōu)力通2片/天80mg/d,n=26)。對照組采用別嘌醇(華東醫(yī)藥3片/天300mg/d,n=18)。兩組患者降尿酸治療期間急性發(fā)作時配合秋水仙堿、非甾體抗炎藥治療;降尿酸治療前后進行血尿酸水平檢查、肝腎功能檢查、能譜CT雙足踝關(guān)節(jié)能譜成像。圖像處理:所得單能量Mono序列輸入Matlab矩陣軟件進行分析。掃描方法:患者取仰臥位,足先進方式,掃描基線采用橫斷面連續(xù)掃描,范圍自第一遠(yuǎn)節(jié)趾骨至踝關(guān)節(jié)。統(tǒng)計方法:定量資料采用獨立樣本t檢驗;定性資料采用Pearson卡方檢驗。結(jié)果:1.足踝關(guān)節(jié)痛風(fēng)結(jié)晶分布規(guī)律:跖趾關(guān)節(jié)(28)較跗跖關(guān)節(jié)(12)、趾骨間關(guān)節(jié)(20)、肌腱及韌帶痛風(fēng)結(jié)晶(6)分布數(shù)量明顯增多,差異具有顯著的統(tǒng)計學(xué)意義;跖趾關(guān)節(jié)(28)、踝關(guān)節(jié)(22)、距下關(guān)節(jié)(27),痛風(fēng)結(jié)晶分布差異沒有統(tǒng)計學(xué)意義;2.降尿酸治療之前非布司他組s UA水平為602.5±39.26μmol/L,痛風(fēng)石體積22.35±18.03cm3。對照使用常規(guī)藥物別嘌醇組,血尿酸水平為586.35±42.36μmol/L,痛風(fēng)石體積20.01±15.34 cm3,降尿酸治療之前兩組s UA、痛風(fēng)石體積差異不具有統(tǒng)計學(xué)意義P0.05。兩組患者經(jīng)24周的治療后s UA都有不同程度的減少,非布司他組s UA水平為312.78±31.72μmol/L,痛風(fēng)石體積3.46±2.69cm3。別嘌醇組s UA平均水平為425.78±38.36μmol/L,痛風(fēng)石體積均數(shù)為12.23±5.92cm3。非布司他組、別嘌醇組s UA水平、痛風(fēng)石體積均較治療前減小,差異具有統(tǒng)計學(xué)意義P0.05。3.以360μmol/L血尿酸水平為基準(zhǔn):實驗組達標(biāo)19例(73%),對照組達標(biāo)6例(33.3%),卡方值6.85(P0.05)。結(jié)論:1.能譜CT單能量成像對于合并痛風(fēng)石的痛風(fēng)性關(guān)節(jié)炎患者治療過程中,能夠起到長期的療效檢測與評估作用2.慢性痛風(fēng)石性關(guān)節(jié)炎患者,其中跖趾關(guān)節(jié)尿酸鹽結(jié)晶沉積數(shù)量較其余小關(guān)節(jié)多3.非布司他較別嘌醇具有更好的降低血尿酸水平、縮小痛風(fēng)結(jié)晶體積的能力,對于長期痛風(fēng)結(jié)晶體積的控制具有更好的表現(xiàn)
[Abstract]:Objective: to investigate whether patients with chronic gout arthritis treated with single energy spectrum CT were treated with fentinastatin, respectively. Changes of gout volume and serum uric acid levels before and after allopurinol treatment. Materials and methods: 44 cases of patients from July 2016 to February 2017 met the 2015 American Society of Rheumatology standard by energy dispersive CT single energy imaging. Patients with chronic gout arthritis were treated with single energy CT energy spectrum imaging of gout stone of ankle joint. The average age of 44 patients with chronic gout arthritis was 51 鹵11.2 years old, 26 patients in Festalta group. Allopurinol group 18 cases, male 17 cases, One female case, Festa group (2 tablets / day, 80 mg / d, n = 26). The control group was treated with allopurinol (3 tablets / day, 300 mg / d), two groups of patients were treated with colchicine and non-steroidal anti-inflammatory drugs during acute attack during the period of reducing uric acid therapy, the two groups were treated with colchicine and non-steroidal anti-inflammatory drugs. The patients in the control group were treated with colchicine and non-steroidal anti-inflammatory drugs. Serum uric acid level, liver and kidney function, energy spectrum CT energy spectrum imaging of ankle joint were performed before and after hypouric acid treatment. Image processing: single energy Mono sequence was input into Matlab matrix software for analysis. In the advanced mode of foot, the baseline scan was continuous cross-sectional, ranging from the first distal phalangeal bone to the ankle joint. Statistical method: the quantitative data were examined by independent sample t-test. Pearson chi-square test was used for qualitative data. Results the distribution of gout crystals in the ankle and foot joints: metatarsophalangeal joint 28) was significantly higher than that of tarsometatarsal joint (12m), interphalangeal joint (20m), tendon and ligaments gout (6). The difference was statistically significant. There was no significant difference in the crystal distribution of gout between the metatarsophalangeal joint and ankle joint. The level of SA was 602.5 鹵39.26 渭 mol / L and the volume of gout was 22.35 鹵18.03 cm 路cm ~ (3) in control group, which was treated with allopurinol. The level of uric acid was 586.35 鹵42.36 渭 mol / L, the volume of gout stone was 20.01 鹵15.34 cm ~ (3). There was no significant difference in the volume of serum uric acid between the two groups before the treatment (P 0.05). The mean level of UA and gout stone were 312.78 鹵31.72 渭 mol / L and 3.46 鹵2.69 cm ~ (3) in non-bustrast group, 425.78 鹵38.36 渭 mol / L and 12.23 鹵5.92 cm ~ (3) in allopurinol group, respectively. The difference was statistically significant (P0.05.3). According to the level of serum uric acid of 360 渭 mol/L, the experimental group (19 cases) reached the standard of 73m, the control group (6 cases) reached the standard, the chi-square value was 6.85 (P0.05) .Conclusion 1.EDS CT single energy imaging was used in the treatment of gouty arthritis patients with gout. 2. In patients with chronic gout arthritis, the amount of uric acid crystal deposition in metatarsophalangeal joint is 3% more than that in the other facet joints, and the level of uric acid in the metatarsophalangeal joint is lower than that in allopurinol. The ability to reduce the volume of gout crystallization is better for controlling the volume of gout crystallization for a long time.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R589.7;R816.8

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