322例次膝关节Parker-Pearson针滑膜活检临床分析

Clinical analysis on 322 cases of synovial biopsy in knee by Parker-Pearson needle

目的探讨Parker-Pearson针滑膜活检的应用价值及影响其活检效果的因素。方法 295例关节病或系统性疾病伴膝关节病变患者行膝关节Parker-Pearson针滑膜活检,光镜下测量合格滑膜总面积并结合H&E染色评估Krenn's滑膜炎积分。有效活检定义为活检到合格滑膜。高效活检定义为至少3块合格滑膜,合格滑膜总面积≥2.5mm2。结果共行322例次滑膜活检,有效活检率为85%,高效活检率为63%,有效活检的合格滑膜总面积中位数为5.3mm2,合格滑膜中位数为5块。25例次重复滑膜活检的有效活检率为84%。5例滑膜见尿酸盐结晶,1例滑膜见草酸钙结晶,1例滑膜病理见结核样结节及坏死。病理呈高度滑膜炎(n=97)的患者高效活检率为89%,与低度滑膜炎者的活检率67%间有统计学差异(n=176,67%,χ2=15.469,P<0.01)。受检膝关节肿胀伴压痛的患者有效活检率为89%,与无肿胀有压痛患者间的差异有统计学意义(χ2=5.458,P<0.05),或与无肿胀、无压痛患者间的差异有统计学意义(χ2=8.906,P<0.01)。结论膝关节Parker-Pearson针滑膜活检获取的合格滑膜可满足临床滑膜病理学检查及科研需要,其中病理滑膜炎程度及受检关节肿胀程度是影响活检效果的主要因素。

Objective To investigate the application value of synovial biopsy with Parker-Pearson needle and factors affecting result. Methods 295 patients with arthropathies or systemic diseases involved knees had received synovial biopsy in knee by Parker-Pearson needle. Total area of qualified synovial membrane was measured and histological Krenn＇s synovitis score was assessed according to H＆E staining under microscope. Effective biopsy was defined as obtaining qualified synovium with intact lining and sublining layers. Highly effective biopsy was defined as obtaining at least three pieces of qualified synovium and the total area ≥2. 5 mm2. Results 322 synovial biopsies were performed. The effective biopsy rate was 85% and the highly effective biopsy rate was 63%. In effective biopsies, the median of the total area of qualified synovium was 5.3 mm2, and the median pieces of qualified synovium were five. For 25 cases of repeated synovial biopsies, the effective biopsy rate was 84%. The highly effective biopsy rate in patients with high-grade synovitis （n = 97 ） was 89%, which was significantly higher than that in patients with lowgrade synovitis （n = 176, 67%, χ2 15. 469, P 〈0. 01 ）. The effective biopsy rate in swelling knees with tenderness was 89% , which was significantly higher than that in tendered knees without swelling （ χ2 = 5.458, P 〈 0.05 ）, and also significantly higher than that in knees without swelling or tenderness （ χ2 = 8.906, P 〈0. 01 ）. Conclusions Qualified synovium obtained from Parker-Pearson needle biopsy could fulfill the need of clinical pathological examination and basic research. The degree of pathological synovitis and joint swelling is the major factors affecting the rate of effective biopsy.