<link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/css/video-js.min.css?v=1"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/base.css?v=5"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/index.css?v=35"><link rel="stylesheet" href="https://ysz-web.yxj.org.cn/live/dist/static/base/index.css?ysz_v=2.0"><script src="https://studioyszimg.yxj.org.cn/js/dsbridge.js?v=13" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/dsBridge/main.js?v=26" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/base/fun.js?ysz_v=3" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/js/nativeToWeb.js?v=1" type="text/javascript"></script><div id="ysz-header" style="margin:0;overflow:hidden;"><h1 style="font-size:24px;line-height:1.8;color:#333333;word-wrap:break-word;">突发多关节肿痛,竟然是假痛风</h1><h2 style="font-size:16px;color:#999999;word-wrap:break-word;"><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">2022-05-17</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">韩智杰 山东莱州市人民医院风湿免疫科</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">原创:医学界风湿免疫频道</em></h2></div><section class="xmteditor" style="display:none;"></section><section class="xmteditor" style="display:none;"></section><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; box-sizing: border-box !important; outline: none 0px !important;"><span style="font-size: 16px;">患者,男性,88岁。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">因为突发多关节肿痛5天入院。开始左肩关节肿痛,随后右肩关节、双膝、双踝、双足出现肿痛,疼痛剧烈,伴有发热,体温最高达38度。曾经自行服用过头孢类抗生素无好转,2013年有右膝骨折病史。<br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">入院查体:体温37.2℃,老年男性,痛苦貌,右手腕弥漫性肿,触痛,皮温高,活动障碍。右侧肘关节、肩关节、双侧膝关节,双踝关节肿,压痛,活动障碍。右侧足肿压疼,皮面温高,活动障碍。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">辅助检查:白细胞8X10<sup>9</sup>/L,中性79.4%,血红蛋白118g/L,血小板233X10<sup>9</sup>/L ,血沉92mm/h,尿酸158μmol/L,谷丙转氨酶86U/L,谷草转氨酶21U/L, C-反应蛋白181mg/L,类风湿因子阴性,降钙素原0.24;血培养五天无生长。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">超声检查,右手腕关节滑膜一级增厚,可见一级血流信号,内回声欠均匀,可见点片状强回声,骨皮质表面不平滑。皮下软组织,水肿增厚,可见淋巴管扩张。各肌腱韧带滑囊未见明显异常。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">右膝髌上囊,髌下深囊积液,股骨内外侧髁及胫骨外侧髁骨皮质表面不光滑,多发的骨赘,腔内有大量的强回声。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">病人的X线检查:</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><img src="https://studioyszimg.yxj.org.cn/7F000001016E03D5E258A0B17E0A0FDE.jpg" style="margin: 0px; padding: 0px; caret-color: red; max-inline-size: 100%; box-sizing: border-box ; outline: none 0px ;"/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><img src="https://studioyszimg.yxj.org.cn/7F000001016E03D5E53ACDEB640C5736.jpg" style="margin: 0px; padding: 0px; max-inline-size: 100%; box-sizing: border-box ; outline: none 0px ;"/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><img src="https://studioyszimg.yxj.org.cn/7F000001016E03D5E76802DA4D10F005.jpg" style="margin: 0px; padding: 0px; max-inline-size: 100%; box-sizing: border-box ; outline: none 0px ;"/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">入院诊断考虑晶体性关节炎,假痛风可能。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">给予复方倍他米松注射液肌注;病人很快体温下降,关节肿痛明显好转,正在住院诊疗过程中。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">假痛风又叫焦磷酸钙沉积症(<span style="color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 16px; text-align: justify; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255);">CPPD</span>),主要见于老年人,女性稍多,大于85岁者有50%可出现假性痛风,但大部分没有症状或症状轻,很少一部分发作类似于痛风。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">CPPD典型的临床表现是急性发作性关节红肿热痛,病程往往呈自限性,类似痛风发作,也被称为“假痛风”,常被误诊。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">主要原因与核苷三磷酸焦磷酸水解酶(<span style="color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 16px; text-align: justify; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255);">NTPPPH</span>)过度激活、ANKH基因(<span style="color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 16px; text-align: justify; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255);">编码焦磷酸转运通道的辅助蛋白</span>)突变等有关。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">富含糖蛋白的软骨基质可促进焦磷酸钙的成核,因此焦磷酸钙主要沉积在软骨细胞周围。超声检查沉积物位于软骨内部而不是软骨表面是CPPD与痛风的重要鉴别点。常伴发糖尿病、退行性骨关节炎、痛风、甲状旁腺功能亢进、色素沉积症等。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">临床上可以出现急性的单关节炎,也可以出现多关节炎,好发关节是膝关节、踝关节、掌指关节、腕关节、肘关节。常常伴有发热,寒战,持续数周和数月。而痛风石全好发于第一跖趾关节,持续数天或一周。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">根据临床表现将其归纳为6种类型:假痛风(<span style="color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 16px; text-align: justify; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255);">A型</span>)、假RA(<span style="color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 16px; text-align: justify; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255);">B型</span>)、假OA(<span style="color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 16px; text-align: justify; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255);">急性发作型,C型</span>)、假OA(<span style="color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 16px; text-align: justify; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255);">无炎症型,D型</span>)、无症状型(<span style="color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 16px; text-align: justify; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255);">E型</span>)、假神经营养性关节炎(<span style="color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 16px; text-align: justify; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255);">F型</span>)。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">CPPD常与痛风及OA并存,2010年EULAR提出关于CPPD的诊疗建议,将其临床类型归纳为4型:</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">①无症状性CPPD:患者无明显临床症状,多因其他原因行影像学检查时发现,表现为单纯的软骨钙化,或OA合并软骨钙化;</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;"><br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">②OA合并CPPD:关节内除CPP沉积外,还具有OA的影像学或组织学表现;</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">③急性CPP晶体关节炎:患者的关节炎呈急性发作并有自限性,关节内有CPP沉积的证据,建议用这一名称替代原来的“假痛风”;</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">④慢性CPP晶体炎性关节炎:和CPPD相关的慢性炎症性关节炎。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">其发病的危险因素有年龄、既往关节损伤病史;未发现与饮食相关。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">CPPD与年龄相关,60岁以下人群罕见。84岁以上患者行双膝、骨盆和腕关节X线,44%可见软骨钙质沉积。既往关节外伤为CPPD的危险因素,研究表现,患者行半月板切除术后随访,20%术侧膝关节出现软骨钙质沉积,而未手术侧该比例仅4%。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><strong style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(215, 0, 15);">放射学及B超检查等可辅助诊断</span></strong></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">CPPD患者关节平片常提示软骨或韧带、滑膜等钙化,并伴有关节退行性变。软骨下囊肿、骨赘形成、骨或软骨碎片是CPPD合并关节退行性变的特征性表现,其他特征性表现包括掌指关节骨边缘方形化及钩状骨赘形成、桡腕关节间隙变窄、舟月关节分离、髌股关节严重退变,CT提示骶髂关节真空现象、Crown dens综合征(<span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; box-sizing: border-box !important; outline: none 0px !important;">枢椎齿突尖出现冠状或环状钙化斑</span>)等。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;"><br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><strong style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(215, 0, 15);">膝关节软骨钙质沉积</span></strong></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><ul class="custom_macula list-paddingleft-1"><li class="list-macula list-macula-paddingleft"><p style="max-inline-size: 100%; padding: 0px; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">B超上CPPD表现为透明软骨或纤维软骨内线性密度。</span></p></li></ul><p style="max-inline-size: 100%; padding: 0px; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><ul class="custom_macula list-paddingleft-1"><li class="list-macula list-macula-paddingleft"><p style="max-inline-size: 100%; padding: 0px; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">诊断的金标准是关节穿刺液在显微镜下可以见到菱状双折光晶体。</span></p></li></ul><p style="max-inline-size: 100%; padding: 0px; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><ul class="custom_macula list-paddingleft-1"><li class="list-macula list-macula-paddingleft"><section class="_135editor" style="max-inline-size: 100%; margin: 0px; padding: 0px; border: 0px none; z-index: 0; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; white-space: normal; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important; position: relative !important;"><section class="_135editor" style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; border: 0px none; z-index: 0; position: relative !important;"><section class="_135editor" style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; border: 0px none; z-index: 0; position: relative !important;"><p style="max-inline-size: 100%; padding: 0px; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">治疗主要是应用关节腔内注射糖皮质激素,或者秋水仙碱,NSAID的药物,镇痛药物,或者白介素1β抑制剂。</span></p></section></section></section></li></ul><section class="_135editor" style="max-inline-size: 100%; margin: 0px; padding: 0px; border: 0px none; z-index: 0; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; white-space: normal; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important; position: relative !important;"><section class="_135editor" style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; border: 0px none; z-index: 0; position: relative !important;"></section><section class="_135editor" style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; border: 0px none; z-index: 0; position: relative !important;"><section class="_135editor" style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; border: 0px none; z-index: 0; position: relative !important;"></section><section class="_135editor" style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; border: 0px none; z-index: 0; position: relative !important;"></section></section></section><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">本患者属于多关节受累类型,急性病程,炎症指标明显增高;超声和x线显示典型的假痛风的超声和影像学症状;诊断明确治疗有效。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; color: rgb(0, 0, 0); font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-size: 16px; box-sizing: border-box !important; outline: none 0px !important;">本病与痛风有很多类似之处,但临床实验室检查中尿酸正常;超声显示的沉积物非沉积在软骨表面,而是沉积在软骨内部;x线片可显示明确的骨骺端有条形的高密度影。</span></p><p><br/></p><!--auditorInfo-->

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