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目的:探讨尿酸盐结晶镜检对早期痛风性关节炎的临床诊断价值。方法:采用Olympus偏振光显微镜检测来我科就诊的首次发病、疑诊为痛风性关节炎的患者97例,对其关节积液或局部组织积液进行检查针状双折光的尿酸盐结晶体;并同时抽血化验血尿酸值。结果:97例患者中有93例抽出肿胀组织/关节积液,在积液中检出尿酸盐结晶87例(阳性率93.55%),未检出尿酸盐结晶者6例;未抽出积液4例。97例患者血尿酸升高者75例(占77.32%),血尿酸值正常22例(占22.68%);而在87例检出尿酸盐结晶的患者中血尿酸升高66例(占75.86%);未检出尿酸盐结晶的6例患者血尿酸值均升高,但5例诊断为其他风湿病,余下的1例和穿刺不成功的4例(其中3例血尿酸升高),患者因临床症状、体征、检验及治疗效果判断符合痛风性关节炎。97例中最后确诊为痛风性关节炎者共92例,以检出尿酸盐结晶确诊的阳性率为94.56%,以血尿酸值升高判断的阳性率为76.08%,两者之间有显著差异(P<0.01)。结论:无论血尿酸值是否升高,尿酸盐结晶镜检阳性对早期痛风性关节炎的诊断具有重要价值。
Objective: To investigate the value of urate crystal microscopy in the early diagnosis of gouty arthritis. Methods: Ninety-seven patients suspected to be gouty arthritis were examined with Olympus polarized light microscopy in the first visit of our department. The acupoint birefringence urate crystals were examined for joint effusion or local tissue effusion. At the same time blood test blood uric acid value. Results: Of the 97 patients, 93 cases had swollen swollen tissue / joint effusion, 87 cases of urate crystals (positive rate 93.55%) were detected in effusion, and 6 cases were not detected uric acid salt crystals; Liquid in 4 cases. Serum uric acid was elevated in 97 patients (77.32%) and normal blood uric acid in 22 patients (22.68%). Serum uric acid was increased in 87 of 87 patients (75.86%) %). Uric acid crystals were not detected in 6 cases of patients with elevated serum uric acid value, but 5 cases were diagnosed with other rheumatism, the remaining 1 case and 4 cases of unsuccessful puncture (including 3 cases of elevated serum uric acid) , Patients due to clinical symptoms, signs, tests and treatment to determine compliance with gouty arthritis. 97 cases were diagnosed as gouty arthritis in a total of 92 cases to detect the positive rate of urate crystals diagnosed as 94.56%, with a rise in serum uric acid to determine the positive rate was 76.08%, between the two significant Difference (P <0.01). CONCLUSIONS: The positive urate crystal examination is of great value in the diagnosis of early gouty arthritis, regardless of whether the serum uric acid level is elevated or not.