【摘要】 目的:研究双源CT和超声单独或联合应用对痛风的诊断效能，并分析二者诊断不同时期痛风的差异，以探讨其应用价值。方法:回顾性搜集就诊于青岛大学附属医院痛风专病门诊、同时接受双源CT和超声检查的326例患者，根据改良的2015年美国风湿病学会/欧洲抗风湿联盟痛风分类标准(排除双源CT及超声),搜集患者的临床及影像资料。计算双源CT和超声单独或联合应用诊断痛风的准确性，采用受试者操作特征曲线(ROC)比较诊断效能，同时比较二者诊断不同时期痛风的差异。结果:326例患者中，痛风患者243例，非痛风患者83例。双源CT和超声诊断痛风的准确率分别为84.1%、77.3%,ROC曲线下面积(AUC)分别为0.865、0.796(t=2.323,P=0.020)。将双源CT与超声联合使用诊断痛风，双阳性(两种检查结果均为阳性)、单阳性(至少一种检查结果为阳性)的准确率分别为77.6%、83.7%,AUC值分别为0.850、0.812,与单独使用双源CT相比，诊断效能没有提高。双源CT和超声诊断早期痛风(病程<1年)阳性率42.9%、71.4%,中期痛风(病程1～3年)81.8%、66.9%,晚期痛风(病程>3年)93.3%、80.0%,且二者在检测不同时期痛风时的差异均有统计学意义(χ~2=10.083、8.100、16.056,P值均<0.05)。结论:双源CT对痛风的诊断效能高于超声，应作为首选检查用于痛风的诊断；与超声联合应用无法提高诊断效能，无需进行联合检查。超声诊断早期痛风比双源CT敏感，推荐早期痛风患者首选超声检查。更多还原

【Abstract】 Objective:To examine the accuracy of dual-energy computed tomography(DECT),ultrasound(US) and DECT-US combination for the diagnosis of gout, and to analyze the differences between the two examination methods in the diagnosis of gout in different stages.Methods:A total of 326 patients who attended the Gout Specialized Clinic of the Affiliated Hospital of Qingdao University were retrospectively collected.All patients had undergone DECT and US examinations.We collected the data of patients according to modified 2015 American College of Rheumatology/European League Against Rheumatism(ACR/EULAR) gout classification criteria(excluding DECT and US).The diagnostic accuracy of DECT,US and DECT-US combination were calculated respectively.The receiver operating characteristic curve(ROC) was used to evaluate the diagnostic efficacy.In addition, we compared the differences of DECT and US for diagnosing gout in different stages.Results:There were 243 gout patients and 83 non-gout patients in 326 patients.The diagnostic accuracy for DECT and US were: 84.1% and 77.3%;area under the ROC(AUC):0.865 and 0.796(t=2.323,P=0.020).Combining DECT with US,the diagnostic accuracy for double-positive(both of DECT and US were positive) and single-positive(at least one of DECT and US was positive) were 77.6% and 83.7%,AUC were 0.850 and 0.812.There was no improvement in diagnostic accuracy compared to DECT.In the different stage of gout, the positive rate of DECT and US were: in the early-stage: 42.9%,71.4%;in the middle-stage: 81.8%,66.7%;in the late-stage: 93.3%,80.0%;and the differences between the two examination methods were statistically significant(χ~2=10.083,8.100,16.056;P<0.05).Conclusion:DECT has higher diagnostic efficacy than US for gout and should be the first choice to diagnose gout.The DECT-US combination offers no additional increase in diagnostic efficacy.There is no need to use both DECT and US at the same time.US is more sensitive than DECT for the diagnosis of gout patients in the early-stage.Therefore, it is proposed to use US as the first line of investigation in patients with early-stage of gout.更多还原