实验室多项目组合检查在关节腔积液中的应用

目的探讨关节腔积液的病因,寻找特异的诊断指标为临床和实验室工作者提供诊断依据。方法收集门诊和住院191例已明确诊断的膝关节腔积液患者,进行一般性状检查,显微镜下检查,生化、免疫、微生物检查。结果 191例引起膝关节腔积液的患者中类风湿关节炎与痛风性关节炎并列38例,居首位,各占19.90%,强直性脊柱炎31例,占16.23%;类风湿关节炎组中类风湿因子均值为568U/mL,痛风性关节炎组中尿酸均值为504μmol/L,28例痛风性关节腔积液检出尿酸盐结晶,化脓性关节炎组中白细胞数53.5×109/L,中性粒细胞0.92,葡萄糖均值1.7mmol/L。结论多项目组合检查在诊断与鉴别诊断关节腔积液的性质方面具有重要意义。     

类风湿关节炎患者关节腔积液特征分析

目的 了解类风湿关节炎(RA)患者关节腔积液的特征,为该病的诊断与治疗提供实验室依据.方法 回顾分析该院2016年1月至2020年12月170例明确诊断为RA患者的关节腔积液的一般性状、细胞学检查、生化、免疫指标,并比较患者关节腔积液与血清总蛋白、尿酸、类风湿因子水平,以及不同抗环瓜氨酸肽(CCP)抗体患者的关节腔积液与血清总蛋白、尿酸、类风湿因子水平.结果 170例患者膝关节腔积液中白细胞计数23.0(13.3,35.5)×109/L,中性粒细胞百分比80.0(64.0,86.0)％,总蛋白41.5(35.8,46.8)g/L,尿酸244.5(189.3,297.0)μmol/L,类风湿因子172.2(65.4,377.6)U/L,部分患者关节腔积液中可检出Reiter细胞、狼疮细胞及类风湿细胞等病理细胞.关节腔积液中总蛋白水平低于血清,差异有统计学意义(P<0.05).无论在关节腔积液还是血清中,抗CCP抗体阳性组的类风湿因子水平均高于抗CCP抗体阴性组,差异均有统计学意义(P<0.05).结论 RA患者关节腔积液以中性粒细胞为主的大量炎症细胞集聚,总蛋白、腺苷脱氨酶水平升高,而且抗CCP抗体阳性患者的关节腔积液及血清中类风湿因子水平较抗CCP抗体阴性者高.     

肌骨超声与能谱CT对急性痛风性关节炎首次发作尿酸盐结晶沉积的检测价值

目的 探讨肌骨超声（MSUS）与能谱CT（DECT）在急性痛风性关节炎首次发作时对发病关节内尿酸盐结晶沉积的检测价值。方法 收集首次关节肿痛发作就诊并被诊断为急性痛风性关节炎的48例患者的临床资料,比较痛风首次发作时MSUS及DECT对尿酸盐结晶的检出率,分析二者对发作关节的尿酸盐结晶沉积、骨侵蚀、关节腔积液、滑膜炎等...     

尿流式有形成分及干化学分析在尿路感染诊断中的应用评价

目的 评价尿干化学分析及UF-1000i流式尿有形成分分析单独及联合应用时在尿路感染诊断中的应用价值.方法 留取148例尿路感染(UTI)患者、284例非尿路感染患者的中段尿标本,分别用培养法做尿细菌计数和鉴定,用UF-1000i流式尿有形成分分析仪做细菌计数(BACT)、酵母样菌(YEC)、WBC检测,用URISYS 2400尿干化学分析仪做自细胞酯酶(LEU)、亚硝酸盐(NIT)检测.评价尿干化学分析、UF-1000i流式尿有形成分分析仪以及UF-1000i联合尿干化学分析与定量尿细菌培养对诊断UTI的一致程度,并评价其对UTI诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度.结果 在148例尿路感染患者中,定量尿细菌培养的检出率为73.6%(109/148),尿干化学分析LEU和NIT同时为阳性的检出率为26.4%(39/148),两种方法的检出率之间差异有统计学意义(χ2=55.68,P<0.05).UF-1000i流式尿有形成分分析BACT和WBC任意1项为阳性诊断UTI的检出率为91.2%(135/148),高于定量尿细菌培养的检出率,差异有统计学意义(χ2=14.70,P<0.05).UF-1000i流式尿有形成分分析和尿干化学分析仪联合参数BACT、WBC、LEU和NIT任意1项为阳性诊断UTI的检出率为94.6%(140/148),高于定量尿细菌培养的检出率,差异有统计学意义(χ2=20.45,P<0.05).尿干化学分析敏感度较低,为26.4%(39/148),特异度较高,为99.3%(282/284);应用UF-1000i流式尿有形成分分析BACT作为尿路感染诊断依据时的敏感度为92.6%(137/148),特异度为39.8%(113/284),阳性预测值为44.5%(137/308),阴性预测值为91.1%(113/124);尿干化学分析与UF-1000i流式尿有形成分分析联合应用时,敏感度为98.O%(145/148),阴性预测值97.1%(100/103),特异度为35.2%(100/284),阳性预测值为44.1%(145/329),准确度为56.7%(245/432).结论 联合UF-1000i流式尿有形成分分析及尿干化学分析可在早期尿路感染筛查诊断中发挥重要作用;同时对尿细菌培养为阴性的UTI患者的明确诊断具有重要价值.     

全自动尿液有形成分分析仪检测浆膜腔积液时出现“管型”信息的意义

目的探讨Sysmex UF-1000i全自动尿液有形成分分析仪检测浆膜腔积液时出现"管型"信息时的临床意义,分析该仪器对浆膜腔积液常规细胞计数的可靠性。方法分别采用UF-1000i全自动尿液有形成分分析仪和传统显微镜计数法,对215例浆膜腔积液标本的细胞成分同时进行计数,并将标本离心、涂片、染色、镜检后进行有核细胞分类,比较两种方法对红细胞和有核细胞的计数差异,计算仪器出现"管型"信息时诊断浆膜腔积液中存在肿瘤细胞的灵敏度、特异度、阳性预测值、阴性预测值。结果 215例浆膜腔积液标本中213例标本的UF-1000i红细胞计数与显微镜计数法相比差异无统计学意义(中位数分别为443.00、466.00个/μL,四分位数间距分别为2 507.00、3 053.75个/μL,Z=-1.719,P=0.086),UF-1000i对浆膜腔积液中有核细胞计数与显微镜计数法相比差异亦无统计学意义(中位数分别为122.50、126.00个/μL,四分位数间距分别为479.00、514.00个/μL,Z=-1.552,P=0.121);其余2例为脓胸标本,存在大量细菌而影响细胞计数,未纳入总体统计。46例标本离心涂片染色镜检可见胞体较大的肿瘤细胞、间皮细胞或吞噬细胞的标本中,以仪器"管型"计数≥5个/μL为阈值,诊断浆膜腔积液中含有恶性肿瘤细胞的灵敏度、特异度、阳性预测值、阴性预测值分别为77.78%、94.59%、73.68%、95.63%。结论 UF-1000i全自动尿液有形成分分析仪适用于大部分浆膜腔积液的常规细胞计数。当"管型"计数≥5个/μL时,恶性肿瘤细胞存在的可能性明显增大,提示人工镜检时必须涂片染色并仔细查找有无肿瘤细胞。     

双源CT双能量成像技术诊断痛风性关节炎的临床价值

目的:探讨双源CT(DSCT)双能量成像技术诊断痛风性关节炎的临床价值。方法:选取我院疑诊的痛风性关节炎患者156例为研究对象,均行DSCT检查,由两位副主任医师采用双盲法阅片,记录和分析尿酸盐结晶沉积部位、数量、大小及对关节的影响。以关节穿刺活检结果为诊断标准,对尿酸盐结晶诊断本病进行定量分析。结果:156例患者有96例检出尿酸盐结晶,共有386处,以双足居首位,检出率61.54%,敏感性为93.75%,特异性为90.0%。结论:在痛风性关节炎诊断过程中,DSCT检测尿酸盐结晶具有较高敏感性和特异性的诊断价值,具有广阔的临床应用前景。     

重视关节腔积液中结晶镜检在痛风性关节炎诊治中的重要性

为探讨关节腔积液结晶检查在诊治痛风性关节炎中的重要性,对2009～2011年300例在本院临床确诊的痛风性关节炎患者作关节腔积液结晶镜检,其结果报道如下. 1 资料与方法 1.1 一般资料 2009~2011年对300例在本院临床确诊为痛风性关节炎患者作关节腔积液结晶镜检. 1.2 仪器与试剂偏振光显微镜;肝素抗凝剂. 1.3 方法将抽取的关节腔积液中加入肝素抗凝剂,离心5 min,弃去上清液,将沉淀物涂于玻片上,盖上载玻片,静止5 min后显微镜镜检记录.     

多层螺旋CT与磁共振成像对膝关节隐匿性骨折的诊断价值分析

目的:本文主要探究多层螺旋CT和磁共振成像应用在膝关节隐匿性骨折中的诊断价值。方法:选取我院2018年2月—2020年3月内接收的共50例膝关节隐匿性骨折患者均分成参照组与研究组,每组25例,参照组采用多层螺旋CT(MSCT)检查,研究组采用核磁共振成像检查(MRI),统计两组临床诊断结果。结果:经统计,研究组膝关节隐匿性骨折检出准确率(96.00%)比参照组检出准确率76.00%高(P<0.05);而在各个病变检查上,研究组关节腔积液(92.00%)、韧带损伤(32.00%)、半月板损伤(36.00%)、关节面软骨损伤(28.00)与骨髓水肿(40.00%)检出率高于参照组关节腔积液(52.00)、韧带损伤(0.00)、半月板损伤(0.00)、关节面软骨损伤(0.00),均(P<0.05)。结论:多层螺旋CT与磁共振成像诊断膝关节隐匿性骨折都具有较高的检出率,两相比较磁共振成像检查检出率更高。     

肌骨超声在膝骨关节炎患者诊断中的应用效果观察

目的:观察肌骨超声在膝骨关节炎患者诊断中的应用效果。方法:采用便利抽样法,选取2022年1月—2023年8月北京市大兴区中西医结合医院收治的60例膝骨关节炎患者为观察组,同期的60例膝骨关节正常的体检者为对照组,均行肌骨超声检查,观察组另实施MRI检查。比较两组研究对象超声参数,比较肌骨超声和MRI检查的超声参数、图像特征、检出准确率和检查费用及时间。结果:观察组髌上囊滑膜厚度、髌上囊积液深度大于对照组,股骨内髁软骨厚度、股骨外髁软骨厚度小于对照组(P<0.05);肌骨超声半月板病变检出率为11.67%,关节积液检出率为66.67%,髌韧带病变检出率为13.33%,交叉韧带损伤检出率为6.67%,滑膜增生检出率为65.00%,均高于MRI检查(P<0.05);肌骨超声检查检出准确率为96.67%高于MRI的81.67%(P<0.05);肌骨超声检查费用低于MRI,检查时间短于MRI (P<0.05)。结论:肌骨超声膝骨关节炎诊断价值较高,可提升膝骨病变检出率,对膝骨关节炎做出准确鉴别。     

肌肉骨骼超声与MRI检查对类风湿膝关节炎诊断的对比研究

目的比较肌肉骨骼超声(MSUS)与MRI在膝类风湿性关节炎(RA)中的诊断价值。方法在42例单膝RA患者中,于同期行单膝关节MSUS检查及MRI检查,比较MSUS与MRI对滑膜增厚、关节腔积液、骨质改变、软骨破坏检出率的差异以及软骨破坏与超声滑膜血流分级情况。结果 MSUS对滑膜增厚、关节腔积液、骨质改变的检出率(90.48%、88.10%、71.43%)与同时期MRI(85.71%、85.71%、80.95%)比较差异均无统计学意义(P0.05);对软骨破坏检出率(61.90%)低于MRI(83.33%),差异有统计学意义(P0.05);以MRI检查为标准,MSUS检查软骨破坏检出符合率为69.05%,其中漏诊11例、误诊2例,漏诊主要集中在Ⅱ～Ⅲ级滑膜血流分级中。结论 MSUS对膝RA诊断有一定价值,可用于膝RA的筛查。     

An office technique for identifying crystal in synovial fluid.

Crystal identification is made with a polarizing, color-compensated light microscope. Most microscopes can be easily and inexpensively adapted for crystal identification. The color compensator allows differentiation between the monosodium urate crystals of gout and the crystals of pseudogout, or calcium pyrophosphate deposition disease. All synovial fluid specimens should be examined. The observation of phagocytosis of crystals establishes that they are the etiologic agent responsible for an ongoing acute attack of arthritis.     

Arthritis associated with crystals containing calcium

Varying combinations of acute inflammatory and/or chronic degenerative arthritis have been found to be associated with crystals of calcium pyrophosphate dihydrate (CPPD) and/or basic calcium phosphates (BCPs). Since the arthropathies associated with CPPDs and/or BCPs occur in older individuals, while diagnosis and treatment for monosodium urate monohydrate crystal deposition disease (gout) have become extremely precise and effective, joint problems associated with calcium crystals have become more common than those associated with monosodium urate monohydrate crystals. The classification, pathogenesis, clinical manifestations, and treatment of CPPD and BCP crystal deposition are discussed.     

Septic arthritis due to non-tuberculous mycobacterium without effusion

Septic arthritis is an important but difficult to make diagnosis that leads to significant morbidity and mortality. Joint effusion is generally accepted to be a highly sensitive finding in septic arthritis; however, final diagnosis requires synovial fluid studies. Without a significant joint effusion, it is difficult to obtain synovial fluid. In this case report, we describe the presentation and diagnosis of septic arthritis in the first MTP due to mycobacterium chelonae in a 69 year old man with a history of gout and immunosuppression due to a heart transplant. There was notably no significant effusion in the joint on clinical examination or bedside ultrasound. As the patient was immunosuppressed, arthrocentesis was performed under ultrasound guidance. A needle was clearly visualized in the joint; however, minimal synovial fluid was obtained. The fluid grew Mycobacterium chelonae in culture. Subsequent joint washout revealed purulent synovial fluid that grew out the same bacteria. This case emphasizes the importance of obtaining synovial fluid to evaluate for septic arthritis, even when joint effusion is absent. Ultrasound guidance can facilitate this.     

无症状高尿酸血症患者尿酸盐晶体致病性相关因素研究进展

无症状高尿酸血症（AH）是以血清尿酸水平升高为特征的一种代谢性疾病。当血清尿酸水平超过饱和值后,尿酸盐晶体就会析出并沉积在关节滑膜、软骨及肾脏等组织诱发急性炎性反应。尿酸盐晶体是用于诊断痛风的金标准,但并非所有尿酸盐晶体沉积的AH患者最终都会发展为痛风。尿酸盐晶体沉积最终是否会引起痛风发作取决于尿酸盐晶体相关致病性基因、机体的免疫状态、软骨损伤以及滑液环境等多重因素的共同作用。明确尿酸盐晶体在AH发展为痛风过程中的致病性相关因素及其触发机制,能为AH患者中痛风高危人群的早期筛查、分层管理及个体化治疗提供依据。     

Synovial Fluid Crystals

Synovial fluid was aspirated from the Joints of unselected groupsof patients suffering from rheumatoid arthritis (30), osteoarthritis(34), pyrophosphate arthropathy (25) and gout (six). Speciallyselected patients with osteoarthritis (10) and other miscellaneousforms of arthropathy (six) were also Included. Total and differentialcell counts were performed, and the fluids were examined bypolarized light microscopy and analytical electron microscopyto determine crystal content. fluids from patients with rheumatoid arthritis and gout hada higher total cell count, and greater proportion of polymorphonuclearcells. There was no difference in the cell content in patientswith osteoarthritis and chronic pyrophosphate arthropathy. Osteoarthriticfluids containing crystals did not have a significantly differentcell count from those without. Polarized light microscopy was confirmed as a good techniquefor differentiating urate from pyrophosphate crystals. However,pyrophosphate crystals varied greatly in appearance, and wereoccasionally too small to be visualized. Crystals thought tobe brushite, formed in some fluids after aspiration, causingconfusion on polarized light examinations, and other unidentifiedbirefringent material was often seen. Analytical and scanning electron microscopy revealed a widevariation in the morphology and elemental content of synovialfluid crystals. Hydroxyapatite crystals were identified in nineout of 34 unselected osteoarthrltlc fluids, in 10 selected cases,and six with synovitis of unknown cause. Hydroxyapatite wasseen in combination with pyro phosphate in six cases, and wasthe only crystal identified in one case of ‘pyrophosphate’nrthropathy. Small pyrophosphate crystals, not seen with thelight microscope, were identified in two cases. Other crystallineparticles containing calcium and phosphorus were seen in somecases, but could not be identified. No crystals were identifiedin rheumatoid arthritis fluids. Crystal phagocytosis was visualizedusing scanning electron microscopy. It is concluded that hydroxyapatite crystals are commonly presentin synovial fluids in chronic arthritis, with or without pyrophosphate,and that a range of other calcium phosphate salts remain tobe identified.     

DIFFERENTIAL MEMBRANOLYTIC EFFECTS OF MICROCRYSTALLINE SODIUM URATE AND CALCIUM PYROPHOSPHATE DIHYDRATE

Microcrystals of sodium urate produced direct lysis of erythrocyte membranes, as had been described previously for silica. Calcium pyrophosphate crystals induced modest erythrocyte hemolysis, also, and time-course experiments showed a markedly different reaction curve from those produced by silica and urate. Polyvinylpyridine-N-oxide, a strong hydrogen acceptor, was bound from solution to urate and silica, but not to calcium pyrophosphate crystals; this compound effectively blocked urate and silica, but not calcium pyrophosphate or control hemolysis. Dextran and heparin inhibited urate-but not silica-induced hemolysis. If erythrocyte and lysosome membranes react similarly to these particles, then the absence of phagosomes in gouty synovial fluid leukocytes, and the presence of these structures in pseudogout, may be explained.     

Gout and hyperuricemia

Gout is a condition characterized by the deposition of monosodium urate crystals in the joints or soft tissue. The four phases of gout include asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout and chronic tophaceous gout. The peak incidence occurs in patients 30 to 50 years old, and the condition is much more common in men than in women. Patients with asymptomatic hyperuricemia do not require treatment, but efforts should be made to lower their urate levels by encouraging them to make changes in diet or lifestyle. Acute gout most commonly affects the first metatarsal joint of the foot, but other joints are also commonly involved. Definitive diagnosis requires joint aspiration with demonstration of birefringent crystals in the synovial fluid under a polarized light microscope. Treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, corticosteroids and analgesics. In patients without complications, NSAID therapy is preferred.     

超声在膝关节及周围病变诊断中的应用价值

摘要目的观察膝关节及周围病变的声像图特征,探讨超声在此类疾病中的诊断价值.方法80例膝关节及周围病变,超声观察病变部位、大小、数目以及声像图改变等情况.结果80例患者中,膝关节腔积液38例,腘窝囊肿12例,半月板病变9例,膝关节韧带损伤6例,关节软骨退行性病变6例,软组织肿物3例,其他病变5例.结论超声具有方便、快捷、低廉等优点,可作为膝关节疾病的重要影像学检查方法.     

骨髓转移癌22例临床及血液学特点分析

本研究观察和分析了22例骨髓转移癌的临床及血液学特点,并对其进行骨髓细胞形态学、骨髓活检及其他辅助检查。骨髓转移癌首发或主要临床表现为：贫血17例（77.3%)。骨痛10例（45.5%),发热8例（36.4%)。出血4例（18.2%),合并溶血性贫血4例（18.2%)。经辅助检查及病理学检查确诊原发肿瘤为;胃癌6例（27%）。肺癌3例（13.6%)。卵巢癌2例（9%）,乳腺癌、前列腺癌,骨肿瘤,转移性恶性黑色素瘤各1例,原发灶未明7例（31.8%)。血液学变化特点;血红蛋白减少17例（77.3%),血小板减少16例（72.7%),白细胞增多11例（50%）,外周血涂片出现幼粒细胞14例（63.6%),出现幼红细胞9例（40.9%)。Ret增高4例（18.2%)。骨髓涂片在两侧及片尾易见转移癌细胞团,8例骨髓活检证实骨髓腔内肿瘤细胞浸润,细胞呈巢团状分布,磁共振成像（MRI）检查6例有骨质破坏,椎体破坏及异常信号灶。骨髓活检更有助于提高诊断率及确定原发肿瘤的来源,MRI在骨髓转移癌的诊断性检查中具有重要作用。