摘要 引言 近50%的痛风首次发作位于第一跖趾关节，而整个病程中几乎100%累及该关节。为防止关节破坏和肾病，X线片示骨糜烂是降尿酸治疗的指证。几项研究显示，与常规X线片相比，超声在早期发现多种炎性关节病骨糜烂上有优势。

目的 对比超声和X线片发现痛风患者第一跖趾关节骨糜烂情况，了解超声特点与临床特征间的关系及痛风的超声特征。

方法 临床上对30例原发性痛风患者（60个第一跖趾关节）和10例年龄相配的其他炎性关节病对照组（20个第一跖趾关节）进行评价，双足行标准的背跖负重位和侧位负重位X线片。由一位独立的超声科大夫进行超声检查，了解第一跖趾关节是否存在骨糜烂、滑液、滑膜增厚、多普勒信号和高回声信号。并行统计学分析 (Spearman and Pearson相关分析, Wilcoxon和卡方检验)。

结果 总共24个第一跖趾关节有骨糜烂，其中仅超声发现者17个，X线片和超声均见骨糜烂者有7个(Z = -4.123; p = 0.000)。第一跖趾关节最突出的超声特征是强回声斑点 (X2 = 40.909; p = 0.000),其次为骨糜烂和滑液存在。

结论 超声对痛风第一跖趾关节发现骨糜烂明显多于X线，这也许对临床判断是否开始治疗有参考价值。大小、数量和方向各不相同的强回声斑点(炎性晶体) 是痛风第一跖趾关节超声的主要特点，这对某些病例(血尿酸低、无滑液或尿酸晶体存在)的诊断非常重要。

附原文 Abstract INTRODUCTION: About one half of the first gout attacks occur in the first metatarsophalangeal joint (MTPJ1); in the disease course this joint is practically inevitably affected. Radiographic evidence of bone erosions is the indication for hypouricaemic therapy in order to prevent joint destruction and nephropathy. Advantages of ultrasonography (US) comparing to conventional x-ray findings in depicting early bone erosions in various inflammatory arthropathies have been demonstrated by several studies. OBJECTIVE: The aims of this study were to compare US and x-ray findings in the detection of MTPJ1 erosions in patients with gout, to correlate sonographic and clinical features, and to detect possible characteristic sonographic features of gout. METHODS: Thirty patients (60 MTPJ1) with primary gout (ACR) and 10 age-matched control subjects (20 MTPJ1) with different inflammatory arthropathies were clinically evaluated. Standard dorsiplantar weight bearing and lateral weight bearing x-ray views of both feet were taken. US was performed and interpreted by an independent sonographer on the presence of bone erosions, synovial fluid, synovial hypertrophy, Doppler signal and hyperechoic spots. Statistical analysis was performed (Spearman and Pearson correlation coefficient, Wilcoxon and chi2 test.) RESULTS: Twenty-four studied MTPJ1 had evidence of erosions, 17 only on US and seven both on x-ray and on US (Z = -4.123; p = 0.000). US findings showed that hyperechoic spots were the most prominent feature of gouty MTPJ1 (chi2 = 40.909; p = 0.000), followed by erosions and synovial fluid presentation. CONCLUSION: US of MTPJ1 in gout discovers significantly more erosions than x-ray, which may have therapeutic implications. The evidence of hyperechoic spots (surrogate crystals) of the different size, number and orientation is a major sonographic feature of the MTPJ1 in gout, which may be of importance in the diagnosis of certain cases (low serum urate, unavailable synovial fluid or the urate crystals absence).

引自：Radak-Perovi? M, Savi? V, Milutinovi? S, Zlatkovi?-Svenda M. [Ultrasonography of the first metatarsophalangeal joint in gout]. Srp Arh Celok Lek， 2011 Mar-Apr;139(3-4):161-4.