【摘要】 目的 探讨基于双能量能谱CT尿酸盐沉积定量分析膝关节痛风性膝关节炎急性发作期的影像特征，并分析其与患者血液指标的相关性。资料与方法 回顾性分析2020年1月—2023年9月齐齐哈尔市第一医院72例经临床确诊为急性痛风性膝关节炎患者与87例非痛风性膝关节疾病患者急性发作期的能谱CT资料，评估膝关节不同部位尿酸盐沉积，结合血液检验指标分析尿酸盐沉积的影响因素，并绘制受试者工作特征曲线。结果 中性粒细胞淋巴细胞比值与C反应蛋白、红细胞沉降率、膝关节痛风结节尿酸盐浓度呈正相关（r=0.354、0.326、0.260,P<0.05）。血小板平均体积与单钠尿酸盐晶体半定量数据、膝关节痛风结节尿酸盐浓度呈正相关（r=0.563、0.257,P<0.05）。痛风组患者C反应蛋白与关节旁软组织尿酸盐浓度、骨质尿酸盐浓度呈正相关（r=0.498、0.166,P<0.05），红细胞沉降率与关节旁软组织（肌腱、韧带等）尿酸盐浓度呈正相关（r=0.325,P<0.01），血清尿酸与膝关节痛风结节、关节旁软组织（肌腱、韧带等）尿酸盐浓度呈正相关（r=0.264、0.243,P<0.05）。以最终诊断结果绘制受试者工作特征曲线，中性粒细胞淋巴细胞比值、血小板淋巴细胞比值、血小板平均体积结合双能能谱CT辅助诊断痛风性膝关节炎的最佳截断值为2.190、122.96、9.049。结论 能谱CT可早期识别并定量分析尿酸盐结晶，在此基础上，血小板平均体积、红细胞沉降率、血清尿酸等血液检验指标对评估痛风性膝关节炎患者痛风活动度、病情迁移程度具有潜在应用价值。更多还原

【Abstract】 Purpose To explored the correlation between imaging features and patient’s blood markers based on quantitative analysis of urate deposition in acute exacerbations of gouty arthritis of the knee by dual-energy spectrum CT(DECT).Materials and Methods A retrospective analysis was conducted on energy spectrum CT imaging of 72 patients clinically diagnosed with acute gouty knee osteoarthritis and 87 patients with non-gouty knee disease during the acute exacerbation period at the First Hospital of Qiqihar from January 2020 to September 2023.The analysis aimed to evaluate urate deposition in different parts of the knee joints and to analyze the influencing factors of urate deposition combined with the blood test indexes of the patients via receiver operating characteristic curves.Results The neutrophil lymphocyte ratio showed a positive correlation with C-reactive protein,erythrocyte sedimentation rate,and urate concentration at the site of urate deposition in gouty nodules of the knee(r=0.354,0.326,0.260,respectively,all P<0.05).The mean platelet volume was significantly positive correlated with the semi-quantitative data of monosodium urate crystals and urate concentration in the knee(r=0.563,0.257,respectively,P<0.05).In the gout group,C-reactive protein was positively correlated with pararticular soft tissue urate concentration and bone urate concentration(r=0.498,0.166,P<0.05),while erythrocyte sedimentation rate was positively correlated with pararticular soft tissue(tendons,ligaments,etc) urate concentration(r=0.325,P<0.01).Additionally,serum uric acid was positively correlated with gouty nodules in the knee joints and pararticular soft tissue(tendons,ligaments,etc)(r=0.264,0.243,respectively,P<0.05).The cut-off values of neutrophil lymphocyte ratio,platelet lymphocyte ratio and mean platelet volume combined with dual-energy energetic spectroscopic CT imaging data in the diagnosis of gouty knee osteoarthritis points were 2.190,122.96 and 9.049,respectively.Conclusion Energetic spectrum CT can identify and quantify urate crystals at the early stage.And blood test indexes such as mean platelet volume,erythrocyte sedimentation rate and serum uric acid have potential value in evaluating the activity of gout and the degree of migration of the disease in gouty knee osteoarthritis.更多还原