The Application Value And Progress Of Ultrasound In The Diagnosis And Treatment Of Hyperuricemia

OBJECTIVE:To investigate and compare the musculoskeletal ultrasound features in patients with gouty arthritis and asymptomatic hyperuricemia.METHODS:From July 2015 to May 2017,31 patients with hyperuricemia in our hospital were randomly divided into 15 cases with gouty arthritis and 16 cases with asymptomatic hyperuricemia according to the history of acute arthritis.Using high frequency ultrasound to observerespectively the bilateral first metatarsophalangeal joint,knee joint and other seizure joints of the gouty arthritis group in two groups of subjects.Analyze the differences in the detection rate of ultrasound in each group about double contour(DC)sign,tophi,hyperechoic spots in the synovial fluid(HSSF)or hyperechoic cloudy areas(HCA),joint effusion,synovial thickening and bone erosion.The Change in related signs after uric acid treatment.And the relationship between serum uric acid concentration and the above signs.Statistically,using chi-square test to compare the distribution of lesion joints and the presence or absence of differences in ultrasound signs between the two groups,and explore the predictive value of ultrasound signs in the diagnosis of gouty arthritis,using Spearman correlation analysis of relationship between serum uric acid concentration and ultrasound Signs.P<0.05 indicates statistically significant difference.RESULTS:?The serum uric acid concentration was not significantly correlated with the presence of high-frequency ultrasound-detected DC signs,HSSFor HCA,joint effusion,synovial thickening,and bone erosion(all P>0.05),tophi was positively correlated(r=0.358,P=0.032)and was moderately correlated.?There were 60 lesions(60/69)in the gouty arthritis group,including 33(55.0%)first metatarsophalangeal joints,19 knees,4 ankle joints,3 wrist joints,and 1 proximal interphalangeal joints.There were 14 lesions in the asymptomatic hyperuricemia group(14/64),including 9 metatarsophalangeal joints(64.3%)and 5 knees.The joint lesions in both groups occurred mostly in the first metatarsophalangeal joint.There was no significant difference in the detection rate of the first metatarsophalangeal joint lesion between the two groups(?2 =0.40,P>0.05).?Ultrasonic detection rates of joint disease in gouty arthritis group and asymptomatic hyperuricemia group were 93.3%(14/15)and 37.5%(6/16),there was a statistically significant difference between the two groups(?2=10.54,P<0.05).?The detection rate of the joints in the asymptomatic hyperuricemia group under high frequency ultrasound,such as DC sign(?2 =25.99),HSSF or HCA(?2 =19.11),joint effusion(?2=5.90),synovial thickening(?2=44.68)and bone erosion(?2=10.52),were lower than that in the gouty arthritis group.There was a statistically significantdifference between the two groups(P<0.05).Asymptomatic hyperuricemia group has not detected tophi,but there were tophi and synovial blood flow rich performance in the gouty arthritis group.?After uric acid treatment for about 1 year,the signs of urate deposition of some patients with gouty arthritis and asymptomatic hyperuricemia,such as DC signs,HSSF/HCA and tophi,have a lesser extent than those before.CONCLUSIONS:High frequency ultrasound can be used as a routine screening method for screening joint disease in patients with gouty arthritis and asymptomatic hyperuricemia,early detection and intervention treatment,follow-up treatment efficacy and assessment of disease progression,has a certain clinical application value.Ultrasound detection of signs of MSU crystal deposition,such as DC sign,HSSFor HCA,tophi,and bone erosion have a greater significance for the diagnosis of gouty arthritis.The higher the serum uric acid concentration,the longer the course of disease and the higher the detection rate of the tophi signs of the diseased joints.There is no obvious correlation between other ultrasonic signs and sUA concentration.Asymptomatic hyperuricemia patients may already have joint lesions,high-frequency ultrasound can detect DC signs,HSSF/HCA,joint effusion,synovial thickening,and bone erosion.Although the detection rate is lower than that of patients with gouty arthritis,it can also be detected and intervened early through high-frequency ultrasonography.In addition,gouty arthritis and asymptomatic hyperuricemia in patients with joint lesions occur in the first metatarsophalangeal joint,may prompt the clinical for hyperuricemia patients,with or without arthritis symptoms,should routinely check the first metatarsophalangeal joint.OBJECTIVE:Usingcolor doppler ultrasonography to observe the renal morphological structure,non-alcoholic fatty liver and its degree,the change of arterial wall structure in patients with hyperuricemia.To explore the ultrasonographic characteristics of renal damage caused by hyperuricemia,the effect of the disease on non-alcoholic fatty liver,and the relationship between hyperuricemia and carotid atherosclerosis.Evaluating the value of ultrasound in comprehensive evaluation of hyperuricemia in kidney,liver and carotid artery associated disease.METHODS:From July 2015 to May 2017,48 patients with hyperuricemia in our hospital and 50 patients with normal serum uric acid concentrations were continuous collected and examined for liver and kidney function,blood lipids,and blood glucose.The color Doppler ultrasonography was used to observe the kidneys(size and morphology of the kidneys,renal blood flow),liver(liver size,non-alcoholic fatty liver,and severity),and arteries of the neck.(Accumulation of intima-media thickness of the common carotid artery,presence or absence of plaque,and its degree of stenosis).The renal,hepatic,and cervical arterial lesions were compared between the two groups.To analyze the ultrasonographic features of hyperuricemia-induced renal impairment,and the correlation of hyperuricemia on non-alcoholic fatty liver and carotid atherosclerosis.Statistically,the two-sample t-test was used to compare whether there were differences between the two groups.Chi-square test was used to compare whether the renal,hepatic,and carotid arterial images had differences between the two groups.P<0.05 indicated statistically significant difference.Pearson correlation analysis was used to analyze the relationship between serum uric acid concentration and morphological changes of the kidney structure,nonalcoholic fatty liver and carotid atherosclerosis.Logistic regression analysis was used to investigate whether hyperuricemia was risk factors of non-alcoholic fatty liver and carotid artery atherosclerosis.RESULTS:?Ultrasonic display rate of renal morphological changes caused by hyperuricemia is about 79.2%.Ultrasonography can be roughly divided into urate crystal type,urinary tract stone type,chronic renal insufficiency type,and acute renal insufficiency type.The urate crystal type is the most common,accounting for 47.9%,which is a strong echo group with scattered punctiform strong echoes or structural loosening in the kidney,and is mostly found in the renal pyramidal region.There was no significant correlation between sUA concentration and ultrasonography changes of renal damage(all P>0.05).?The incidence of non-alcoholic fatty liver disease in the hyperuricemia group was 64.6%,and most of them were moderate to severe fatty liver.SUA concentration positively correlated with the detection rate of NAFLD(r=0.874,P<0.05).Hyperuricemia is an independent risk factor for non-alcoholic fattyliver(OR=1.718,95%CI 1.622-1.820,P<0.05).?The mean thickness of the common carotid artery in the hyperuricemia group was(0.14±0.01),and the detection rate of carotid atherosclerosis was 41.7%.SUA concentration was positively correlated with intima-media thickness of the common carotid artery(r=0.897,P<0.05).Hyperuricemia is an independent risk factor for carotid atherosclerosis(OR=1.397,95%CI 1.195-1.602,P<0.05).CONCLUSIONS:The incidence of renal damage,non-alcoholic fatty liver disease,and atherosclerosis in patients with hyperuricemia was significantly increased.Color Doppler ultrasonography confirms the close relationship between hyperuricemia and nephropathy,Hyperuricemia is an independent risk factor for non-alcoholic fatty liver and carotid atherosclerosis.Color Doppler ultrasound has important diagnostic value for hyperuricemiaextra-articular organ damage.It can be used to observe various forms of renal morphological changes,especially the formation of early urate crystals.It can also diagnose fatty liver and its severity.It can also measure the common carotid artery intima-media thickness,and then evaluate the presence of atherosclerosis.In addition,color Doppler ultrasonography has practical value in the evaluation and follow-up of curative effect and lesion progression after comprehensive treatment of uric acid in patients with hyperuricemia.