放射性钐注入类风湿关节炎患者膝关节腔内的弥散状况与疗效间关系的初步探讨

目的观察^153钐-柠檬酸-羟基磷灰石（^153Sm-Citrate-HA）放射性滑膜切除术治疗类风湿关节炎（RA），分析药物在关节腔内的弥散情况与疗效关系。方法对36例RA患者56个有明显滑膜增生的膝关节行关节腔内注射^153Sm-Citrate-HA 185MBq／05～1ml，比较治疗前后关节症状（疼痛、肿胀、积液、功能活动度、上下楼及蹲站有无困难）变化情况，按优效、良效、微效、无效4级标准评判疗效，γ显像表现药物在关节腔内弥散情况分为良好、较差两种评判标准分析疗效，并对不同分期（以X线分期为标准）患者的疗效进行分析。结果治疗后6个月，药物在关节腔内弥散良好的患者优、良效率合计为81．1％，弥散较差的患者无优效，良效率为52．6％；按X线分期Ⅰ，Ⅱ期患者的优、良效率合计分别为100％，87．5％，Ⅲ期患者疗效稍差。结论采用^153Sm-Citrate-HA行滑膜切除术治疗类风湿关节炎滑膜增生性变，药物在关节腔内弥散良好的X线分期Ⅰ，Ⅱ期患者疗效显著。

Effects of 153 Sm on radiation synovectomy in 36 RA patients.

Objective To investigate the effects of radiation synovectomy with 153Sm-Citrate-HA in knees of patients with rheumatoid arthritis(RA).Methods 56 knees with thickened synovium from 36 RA patients were injected with 185MBq/0.5~1ml of 153Sm-Citrate-HA.Clinical symptoms including articular pain,edema,fluid,and activity were compared before and after injection.Efficacy was evaluated as four grades.Relationship between different X-ray grade in knees and their treatment outcome was analyzed too.Results Efficacy was observed one week after intra-articular injection and increased within 6 months.Total efficiency is 98.1%,with 100% and 91.3% in patients of I and II X-ray grades.Conclusion Radiation synovectomy with 153Sm-Citrate-HA injected into knees of patients with RA is a simple,safe and effective therapy,especially in those with I to II X-ray grade.