| Objective:Dual-energy CT(DECT)is a kind of imaging based on the principle that substances decay differently at different energy X-ray lines.It is used in the diagnosis of gout because it can distinguish urate crystal from other crystals.Recent studies have found that DEPC could give false negative results in gout patients with short duration of disease,low uric acid levels and low uric acid nodules.In order to select the appropriate time for DECT and explain the results of DECT,we choose a group of patients with suspected gout to further explore the better clinical application of DECT.Methods:We recruited 152 with gout or suspected gout who were admitted to the Department of General Medicine of Peking Union Medical College Hospital from October 2015 to May 2020.All patients completed the DECT examination,the final results were determined by two attending radiologists.At the same time,clinical data,laboratory examination and imaging results of all patients were collected.The univariate analysis and multivariate logistic regression model were used to analyze the related factors affecting the results of DECT.Nomogram method was used to construct the prediction model of DECT results.Results:1.152 patients with suspected gout included 121 patients with gout and 31 with other types of arthritis according to the 2015 ACR/EULAR classification criteria.2.DECT and arthrocentesis were performed in 44 patients.Compared with the gold standard of arthrocentesis,the sensitivity,specificity,positive predictive value and negative predictive value of DECT in the diagnosis of gout were 89.7%,80%,89.7%and 80%respectively.3.Among the 121 gout patients,84(68.9%)had positive DECT results and 37(31.1%)had negative DECT results.① The univariate analysis showed that the DECT positive patients with higher BMI,longer course of disease,higher number of attacks in recent 1 year and higher percentage of limited activity(P=0.004,<0.001,0.006,0.008,respectively).Patients in the positive group had higher rates of hypertension,hyperlipidemia(P=0.008,0.008,respectively),and higher levels of blood uric acid and creatinine(P=0.006,P=0.010,respectively).Gout patients were grouped according to the frequency of attack and the affected joint location,and no difference was found in DECT positive rate.② Among the 78 gout patients without tophi,45(57.7%)patients had positive DECT results and 33(42.3%)had negative DECT results.Patients in the positive group had longer duration of disease and more frequent attacks in the last 1 year than those in the negative group(P=0.001,0.014,respectively;Course:Positive group 61.9±57.2 vs Negative group 33.1±41.0;Frequency:Positive group 4.3±3.6 vs Negative group 2.6±1.4).③ There was no significant difference in DECT results between first attack gout patients and non-first attack gout patients.④According to the location,size and number of affected joints,the positive rate of DECT in patients with multi-joint involvement was higher than that in patients with single-joint involvement(P=0.016).⑤Multivariate logistic regression analysis showed that long duration,MTP1 involvement,recurrent attacks,high serum uric acid level and combined with chronic kidney disease may contribute to DECT positive outcome.4.The five independent risk factors were selected to construct a prediction model of DECT outcome.The Bootstrap method was used for internal validation of the model,and the C index was 0.839,which suggesting that the model had good differentiation and calibration.Conclusion:DECT is recommended for atypical patients with long duration of attack,long course of disease and chronic renal insufficiency when they were suspected of gout.DECT is not recommended for patients with tophaceous gout and patients with a likely negative outcome calculated by the predictive model.Gout patients with long course of disease,foot MTP1 involvement,non-first attack,high blood uric acid level and combined with CKD were prone to DECT positive results.However,gout patients with low BMI,short course of disease,fewer attacks,unlimited activity during attacks,and low blood uric acid were prone to DECT false negative results.Objective:Innate immune response plays a major role in the pathogenesis of gout,in which innate immune cells are the main participants.However,the role of many innate immune cells in the pathogenesis of gout is unknown.In order to explore whether the innate immune cells and their subtypes(ILC,NKT,Monocyte,γδT)were involved in gout,we used flow cytometry to detect the innate immune cells and subtypes in gout patients.Methods:Acute gout patients meeting the 2015 ACR/EULAR diagnostic criteria were included and matched with healthy controls of the same age and sex.The expressions of ILC,NKT,Monocyte,γδT cell and their subtypes in different groups were compared by flow cytometry.The correlation between the different cells and the clinical features was analyzed.The expression of γδT cells and their subtypes in gout patients with different stages was compared and the trend was analyzed.Flow cytometry was used to compare the expression of γδT cells and subtypes in the synovial fluid of patients with gout and their peripheral blood,as well as in the synovial fluid of control patients with positive diseases(RA,SpA and OA).The cytokine concentrations in serum and joint fluid supernatant of patients with different stages were detected,and the differential cytokines were analyzed.The cytokines secreted by γδT cells were further detected.Results:1.There were no significant differences in ILC,NKT,Monocyte and their subtypes between acute gout and healthy controls.The proportion of γδT and γδT2 in peripheral blood of patients with acute gout decreased(P=0.026;P<0.001).The proportion ofγδT2 was positively correlated with WBC,neutrophils,monocytes,and triglyceride.2.γδT cells and their subsets in PBMC of gout patients at different stages① The proportion of γδT cells decreased in acute gout patients(P=0.026),increased in remission(P=0.016),and remained normal in intercritical(P=0.737);there was no difference in the proportion of γδT1 cells in all stages;the proportion of γδT2 cells decreased significantly in the acute gout(P<0.001),increased in the remission gout(P=0.016),and remained lower than normal in the intercritical phase(P=0.032).② There was no significant difference in the proportion of γδT cells and subsets in peripheral blood between acute gout patients and tophaceous gout patients with attack.3.The proportion of γδT cells in the synovial fluid was increased compared with that in the peripheral blood,but there was no statistical difference(P=0.065).Compared with that in the peripheral blood,the proportion of γδT2 cells was significantly increased(P=0.001).The percentage of γδT cells and subsets in the synovial fluid of gout patients was not different from that of rheumatoid arthritis,spondyloarthritis and osteoarthritis.4.Compared with the normal control,IL-6,IL-1,IL-5 and IL-8 were increased in acute gout(P=0.001;P=0.006;P=0.030;P=0.002),there was no significant change in the remission gout and intercritical gout.IL-6 and IL-8 were significantly increased in tophaceous gout patients with acute state(P=0.001;P=0.002),IL-10 was significantly elevated in those with remission state(P=0.020).The levels of IL-6,IL-10,IFN-γ,IL-17,IL-1,IL-5,IL-12,IL-8 in the synovial fluid were significantly higher than those in the peripheral blood(P=0.006;P=0.002;P=0.002;P=0.033;P=0.004;P=0.044;P=0.015;P=0.009).5.The proportion of IL-17+γδT2 cells in acute gout was significantly higher than that in normal controls(P<0.001),and there were no significant differences in the proportion of IL-1β+γδT2 cell,TNF-α+γδT2 cell and IFN-γ+γδT2 cell(P=0.548;P=0.687;P=1.000).Conclusion:This was the first study to investigate the role of γδT cells and their subtypes in gout.Our study suggest that We speculate that γδT2 cells from the peripheral blood accumulate into the inflammatory joints during acute gout inflammation,and participate in the pathogenesis of gout by secreting a large amount of inflammatory cytokine IL-17. |
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