类风湿关节炎患者关节腔注射曲安奈德联合甲氨喋呤治疗前后滑膜超声表现的变化  

The Change of rheumatoid arthritis patients＇ synovium by ultrasonography before and after lin- traarticular injection of triamcinolone acetonide and methotrexate

作　　者：苏敏[1] 宋书林[1] 张慧芳[1] 郭晓峰[1] 

机构地区：[1]湖北省宜昌市第一人民医院(三峡大学人民医院)风湿免疫科,443000

出　　处：《临床内科杂志》2012年第11期760-762,共3页Journal of Clinical Internal Medicine

摘　　要：目的超声检测曲安奈德联合甲氨喋呤关节腔注射前后类风湿关节炎（RA）患者滑膜的变化，并进一步明确滑膜超声影像学变化对于RA诊断及治疗的意义。方法选择以膝关节炎症状入院的RA患者222例，超声检测患者膝关节滑膜厚度及关节积液量，然后以曲安奈德（1ml：10mg）及甲氨喋呤（1ml：10mg）分别注入关节腔内，同时原口服药物方案行非甾体类抗炎药（NSAIDs）及缓解病情抗风湿药物（DMARDs）治疗，分别于注射后第7天和第14天再次行上述治疗，同时行膝关节滑膜超声检查，观察注射关节的疼痛指数、肿胀指数、压痛指数和晨僵时间。此后第2个月和6个月末再次行膝关节滑膜超声检查，并记录上述指标。结果与治疗前比较，治疗第7天、第14天及第2和第6个月末，患者膝关节滑膜厚度及关节积液量均明显下降，关节疼痛指数、肿胀指数、压痛指数、关节晨僵时间均明显减少（P〈0．01或P〈0．05），滑膜厚度及关节积液与关节疼痛指数、肿胀指数、压痛指数均分别呈正相关（P〈0．05）。结论滑膜超声改变可作为评估RA患者曲安奈德联合甲氨喋呤关节腔注射治疗疗效观察指标之一。Objective To evaluate the diversity of rheumatoid arthritis（RA） patients＇ synovium by uhrasonography before and after intraarticular injection of triamcinolone acetonide and methotrexate （MTX） , as well as to identify the significance in diagnosis and treatment at RA. Methods 222 RA pa- tients with gonarthritis as main symptom were collected from 2008 January to 2011 June. Test the thickness of synovium and extent of hydrops of the knee joint, then inject it with triamcinolone acetonide （ 1 ml：10 mg） and MTX 1 ml：10 mg, meanwhile the oral drugs （NSAID and DMARDs） were proceeded. Injection and uhrasonography were repeated again at the seventh day and fourteenth day;Soreness, engorgement, tenderness and morning stiffness were recorded. Repeat the examination and records again at the second and sixth month. Results Compared with that before treatment, the thickness of synovium and extent of hydrops of the knee joint were significantly reduced, at the same time, soreness, engorgement, tenderness and morning stiffness were decreased（P 〈 0.01 or P 〈 0.05 ）, besides the thickness of synovium and ex- tent of hydrops were positively correlated with soreness, engorgement and tenderness （ P 〈 0.05,0 〈 r 〈 1 ）. Conclusion Ultrasonography can be used as index to evaluate the intraarticular injection in RA pa- tients.

关 键 词：类风湿关节炎 滑膜 甲氨喋呤 曲安奈德 关节腔内注射 超声 

分 类 号：R593.22[医药卫生—内科学]