| Objective:To explore the value of dual-energy CT imaging technology in quantitative evaluation of the effect of Tai chi water water treatment on patients with primary gout with high uric acid,and whether dual-energy CT can effectively identify MSU crystals and predict the correlation between uric acid value in blood(umol/L),urinary uric acid value(umol/L),urine PH value and DECT in detecting MSU crystals in clinical diagnosis of gout patients.Methods:A prospective study was conducted on 78 male patients with primary gout and hyperuricemia who met the clinical standardization protocol in the affiliated hospital of Qingdao university from August 2018 to January 2020.The patients were randomly divided into tai chi water group,pure water group and soda water group,each with 26 patients.All patients underwent DECT examination on the same joint with the most obvious systemic involvement before and after medication,and the post-processing GOUT software provided by Siemens was used for analysis to automatically obtain the volume of green pseudo-color urate crystal deposition,and the real effectiveness was evaluated by two bone-muscle imaging physicians.All patients underwent serum uric acid、urinary uric acid and urine PH biochemical examination before and after medication.EXCEL was used to establish the database,and SPSS25.0 was used for statistical analysis of the data.The measurement data were expressed as(?X±s)in accordance with normal distribution.Independent sample t test was used for inter-group comparison,and paired sample t test was used for pre-and post-group comparison.Multiple comparison with variance analysis between the sample groups(F)test,do not accord with normal distribution using the median and quartiles M(P25,P75),said the group comparison between using nonparametric rank and inspection(the Mann-Whitney U),multiple comparison between sample group the Kruskal-Wallis H method,comparison before and after using the method of Wilcoxon Z,count data adoption or use the form than said,comparison between groups byχ~2 test,DECT check MSU volume parameters(cm3),blood uric acid(umol/L),urinary uric acid(umol/L),the total score of gout crystallization screening diagnosis analysis,mainly involve the Sensitivity(%),Specificity(%),Youden Index(%),positive predictive value(%)and negative predictive value(%)and receiver operating curve(ROC),area under the curve(AUC))in the evaluation,Spearman rank correlation was used to analyze the correlation between the MSU volume(cm3)and the total score.Inspection level a=0.05 and there was a statistical significance when P was less than 0.05.Results:It was no statistically significant difference in age and site distribution between the three groups of purified water,tai chi water and soda water(P>0.05).Before and after treatment,there were no statistically significant differences in DECT MSU volume(cm3),urine PH value,blood uric acid(umol/L)and urine uric acid(umol/L)between the three groups of pure water,tai chi water and soda water(P>0.05).Compared with the three groups before and after treatment,there was a statistically significant difference in the MSU crystal volume(cm~3)examined by DECT and the total score between the pure water group and tai chi water group before and after treatment(P<0.05),and the MSU crystal volume examined by DECT and the total score after treatment was significantly smaller than that before treatment.There was no significant difference in DECT MSU crystal volume(cm3)and the total score before and after treatment in the soda water group(P>0.05).There was no significant difference in urine PH value before and after treatment in pure water,tai chi water and soda water(P>0.05).The difference of serum uric acid(umol/L)between the three groups of pure water,tai chi water and soda water before and after treatment was statistically significant(P<0.05),and the serum uric acid level was lower after treatment than before treatment.There was no significant difference in urinary uric acid(umol/L)before and after treatment in pure water,tai chi water and soda water(P>0.05).Gout of crystalline and non-crystalline group age,inspection area distribution,urine PH,blood uric acid(umol/L),urinary uric acid(umol/L)no statistically significant difference were observed in the comparison between groups(P>0.05),DECT check MSU crystals(cm3),the total score is compared between group differences statistically significant(P<0.05),the crystal group DECT check MSU crystals(cm3),total volume group were significantly higher than those of crystals.The area under the curve(AUC)of the MSU crystal volume(cm3)examined by DECT in patients with gout was 0.992(P<0.01),which had statistical significance for the differential diagnosis of negative and positive crystal deposition in gout MSU.When the pointcut value of MSU crystal volume(cm3)was0.0550,the sensitivity(49.15%),specificity(100.00%),Youden index(49.15%),positive predictive value(100.00%)and negative predictive value(38.78%)were detected by DECT.The DECT MSU volume(cm~3)in the three groups of pure water,tai chi water and soda water were highly correlated with the total score,with statistically significant differences(P<0.05),and the correlation coefficient ranged from 0.629 to 0.942.Conclusion:DECT can detect and quantify sodium urate(MSU)crystal deposition with high accuracy and predict clinical efficacy by quantitatively evaluating crystal deposition before and after treatment.DECT examination of MSU volume(cm3)was statistically significant in the diagnosis of negative and positive gout crystal,that is,When the cut point value of MSU volume(cm~3)examined in DECT is 0.0550,it has a suggestive value for MSU deposition,while urine PH value,blood uric acid(umol/L)and urine uric acid(umol/L)had no statistical significance for the negative and positive gout crystal.In this study,Tai Chi water did not have the effect of alkalizing urine and promoting uric acid excretion in previous studies. |
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