标题：不同肌骨超声特征痛风性关节炎患者骨代谢指标变化及其与病程、血尿酸水平的相关性

      作者：马勇军，周兴伟，张坤，容亚娟，李娟    安康市中医医院超声科，陕西 安康 725000

      卷次： 2023年34卷24期

      【摘要】 目的 探讨不同肌骨超声特征痛风性关节炎患者骨代谢指标变化及其与病程、血尿酸水平的相关性。方法 选取2020年9月至2021年8月在安康市中医医院风湿免疫科治疗的110例痛风性关节炎患者作为研究对象。入院时对所有患者进行肌骨超声检查，根据患者肌骨超声表现分为无聚集体组32例、聚集体组41例和痛风石组37例。比较三组患者的肌骨超声特征表现；检测并比较三组患者的血清1型胶原蛋白交联羧基末端肽(CTX)、Wnt抑制因子Dickkopf1 (DKK1)、骨钙素N端中段(OC-NMID)、核因子κB受体激活蛋白配体(RANKL)水平；采用Pearson相关性分析法分析骨代谢指标与病程和血尿酸的相关性。结果 三组患者的性别、年龄、糖尿病、高脂血、高血压病比较差异均无统计学意义(P>0.05)；痛风石组患者的病程、血尿酸水平明显长于或高于聚集体组及无聚集体组，且聚集组明显长于或高于无聚集体组，差异均具有统计学意义(P<0.05)；无聚集体组患者关节内未发现点状强回声、双轨征、聚集体痛风石或骨质破坏的情况，聚集体组患者的关节内可见点状强回声、双轨征，但未发现痛风石和骨质破坏，痛风石组患者的关节内发现痛风石或骨质侵蚀；三组患者血清CTX、OC-N-MID水平比较差异均无统计学意义(P>0.05)；痛风石组患者血清DKK1、RANKL水平分别为(392.72±55.31) ng/L、(0.86±0.23) ng/L，明显高于聚集体组的(166.32±47.37) ng/L、(0.37±0.12) ng/L，聚集体组患者血清DKK1、RANKL水平明显高于无聚集体组的(138.67±42.56) ng/L、(0.13±0.04) ng/L，差异均具有统计学意义(P<0.05)；经Pearson相关性分析结果显示，痛风性关节炎患者血清CTX、OC-N-MID水平与患者病程无明显相关(r=-0.095、0.037，P>0.05)，血清DKK1、RANKL水平与患者的病程和血尿酸水平均呈正相关(r=0.468、0.343、0.155、0.139，P<0.05)。结论 不同肌骨超声特征痛风性关节炎患者的血清DKK1、RANKL水平存在明显差异，且血清DKK1、RANKL与患者的病程、血尿酸水平存在正相关关系。
      【关键词】 痛风性关节炎；超声特征；骨代谢指标；血尿酸；病程；相关性
      【中图分类号】 R684.3 【文献标识码】 A 【文章编号】 1003—6350（2023）24—3614—04

Changes in bone metabolism indicators and their correlation with disease course and blood uric acid levels ingouty arthritis patients with different muscle-bone ultrasound characteristics.
MA Yong-jun, ZHOU Xing-wei,ZHANG Kun, RONG Ya-juan, LI Juan. Department of Ultrasound, Ankang Hospital of Traditional Chinese Medicine,Ankang 725000, Shaanxi, CHINA
【Abstract】 Objective To analyze the changes in bone metabolism indicators and their correlation with diseasecourse and blood uric acid levels in gouty arthritis patients with different muscle-bone ultrasound features. Methods Atotal of 110 patients with gouty arthritis who were treated in the Department of Rheumatology and Immunology, AnkangHospital of Traditional Chinese Medicine from September 2020 to August 2021 were selected as the research subjects.According to the muscle-bone ultrasound features at admission, the patients were divided into a non-aggregate group of32 cases, an aggregate group of 41 cases, and a gout stone group of 37 cases. The muscle-bone ultrasound features ofthree groups were observed and recorded. The levels of serum type 1 collagen cross-linked carboxyl terminal peptide(CTX), Wnt inhibitory factor Dickkopf1 (DKK1), osteocalcin N-terminal mid segment (OC-NMID), and nuclear factor κBreceptor activating protein ligand (RANKL) were detected. Pearson correlation analysis was used to determine the corre-lation between bone metabolism indicators and disease course and blood uric acid. Results There was no significantdifference in gender, age, diabetes, hyperlipidemia, and hypertension among the three groups (P>0.05). The course of dis-ease and blood uric acid levels of patients were significantly longer or higher in the gout stone group than the aggregategroup and non-aggregate group, and also in the aggregate group than the non-aggregate group, with statistically signifi-cant differences (P<0.05). No punctate hyperechogenicity, double track sign, aggregated gout stones or bone destructionwere found in the joints of patients in the non-aggregated group; punctate hyperechogenicity, double track sign werefound in the joints of patients in the aggregated group; gout stones or bone erosion were found in the joints of patients inthe gout stone group. There was no statistically significant difference in serum CTX and OC-N-MID levels among thethree groups of patients (P>0.05). Serum DKK1 and RANKL levels in the gout stone group were (392.72±55.31) ng/Land (0.86±0.23) ng/L, which were significantly higher than (166.32±47.37) ng/L and (0.37±0.12) ng/L in the aggregategroup; the serum DKK1 and RANKL levels in the aggregate group were significantly higher than (138.67±42.56) ng/Land (0.13±0.04) ng/L in the non-aggregate group; the differences were statistically significant (P<0.05). According toPearson correlation analysis, there was no significant correlation between serum CTX and OC-N-MID levels and thecourse of gouty arthritis in patients (r=-0.095, 0.037, P>0.05), and serum DKK1 and RANKL levels were positively cor-related with the clinical characteristics of the patient's course of disease and blood uric acid levels (r=0.468, 0.343, 0.155,0.139, P<0.05). Conclusion There are significant differences in serum DKK1 and RANKL levels among patients ofgouty arthritis with different muscle bone ultrasound features, and there is a positive correlation between serum DKK1and RANKL and disease course and blood uric acid levels.
      【Key words】 Gouty arthritis; Ultrasound characteristics; Bone metabolism index; Blood uric acid; Course of dis-ease; Correlation