来源：风湿病与关节炎,2023,12（11）:22-27.

滑液及血液尿酸在痛风性关节炎中的诊断效能（临床研究）

庄丽花，郭庆昕，饶华春

　　【摘　要】目的：研究滑液尿酸、血液尿酸、滑液/血液尿酸比值能否区分痛风性关节炎与其他关节炎，并评估其在痛风性关节炎中的诊断效能。方法：收集188例风湿病患者，其中包括69例痛风性关节炎

（GA）、40例骨关节炎（OA）、52例类风湿关节炎（RA）、27例强直性脊柱炎（AS），回顾性分析GA患者与OA、RA、AS患者的一般资料（痛风石与否、合并症、滑液一般性状）、滑液与血液白细胞计数（WBC）、中性粒细胞/淋巴细胞比值（NLR）、单核细胞/淋巴细胞比值（MLR）、尿酸（UA）。结果：GA组在高血压病发生率、血脂异常发生率、滑液结晶检出率、浑浊度检出率方面均高于OA组、RA组、AS组（P < 0.05）。GA组血液WBC、滑液及血液NLR、滑液及血液MLR、滑液及血液UA、滑液/血液UA比值均高于OA组、RA组、AS组，其中滑液及血液中WBC、NLR、MLR、UA、滑液/血液UA比值与OA组比较，差异有统计学意义（P < 0.05）；血液WBC、滑液NLR、滑液及血液NLR、滑液及血液UA、滑液/血液UA比值与RA组比较，差异有统计学意义（P < 0.05）；血液WBC、滑液NLR及MLR、滑液及血液UA、滑液/血液UA比值与AS组比较，差异有统计学意义（P < 0.05）。GA组患者滑液NLR、MLR、UA水平与血液中比较，差异有统计学意义（P < 0.05）。ROC曲线分析结果显示，滑液UA、血液UA、滑液/血液UA及三者联合检测诊断GA患者的敏感性分别为98.3%、71.7%、66.7%、96.7%，特异性分别为90.2%、87.8%、92.7%、97.6%。结论：滑液尿酸、血液尿酸、滑液/血液尿酸比值能较好地鉴别痛风性关节炎与其他关节炎，三项指标联合检测有助于提高痛风性关节炎的诊断效能。

　　【关键词】　痛风性关节炎；尿酸；滑液；中性粒细胞/淋巴细胞比值

Diagnostic Efficacy of Synovial Fluid and Blood Uric Acid in Gouty Arthritis

ZHUANG Li-hua,GUO Qing-xin,RAO Hua-chun

　　【ABSTRACT】Objective:To investigate whether synovial uric acid,blood uric acid,and synovial/blood uric acid ratio can distinguish gouty arthritis from other types of arthritis,and to evaluate their diagnostic efficacy in gouty arthritis.Methods:One hundred and eighty-eight patients with rheumatism were collected,including 69 cases of gouty arthritis（GA）,40 cases of osteoarthritis（OA）,52 cases of rheumatoid arthritis（RA）,and 27 cases of ankylosing spondylitis（AS）.A retrospective analysis was made for the general data of GA patients and OA,RA,and AS patients（gouty stones or not,comorbidities,and general synovial characteristics）,synovial fluid to blood white blood cell count（WBC）,neutrophil/lymphocyte ratio（NLR）,Monocyte/lymphocyte ratio（MLR）,and uric acid（UA）.Results:The incidence of hypertension,abnormal blood lipids,detection of synovial fluid crystals,and turbidity in the GA group were higher than those in the OA group,RA group,and AS group（P < 0.05）.The blood WBC,synovial fluid and blood NLR,synovial fluid and blood MLR,synovial fluid and blood UA,and synovial fluid/blood UA ratio in the GA group were all higher than those in the OA group,RA group,and AS group.Among them,the synovial fluid and blood WBC,NLR,MLR,UA,and synovial fluid/blood UA ratio were statistically significant（P < 0.05）compared to the OA group;compared with the RA group,there were statistically significant differences in blood WBC,synovial fluid NLR,synovial fluid and blood NLR,synovial fluid and blood UA,and synovial fluid/blood UA ratio（P < 0.05）;compared with the AS group,there were statistically significant differences in blood WBC,synovial fluid NLR and MLR,synovial fluid and blood UA,and synovial fluid/blood UA ratio（P < 0.05）.The levels of NLR,MLR,and UA in the synovial fluid of patients in the GA group were statistically significant compared to those in the blood（P < 0.05）.The ROC curve analysis results showed that the sensitivity of synovial fluid UA,blood UA,synovial fluid/blood UA,and their combined detection for diagnosing GA patients were 98.3%,71.7%,66.7%,and 96.7%,respectively,and the specificity was 90.2%,87.8%,92.7%,and 97.6%,respectively.Conclusion:Synovial uric acid,blood uric acid,and synovial/blood uric acid ratio can effectively distinguish gouty arthritis from other arthritis.The combined detection of these three indicators can improve the diagnostic efficacy of gouty arthritis.

　　【Keywords】 gouty arthritis;uric acid;synovial fluid;neutrophil/lymphocyte ratio