膝关节镜滑膜切除术对早期类风湿关节炎分类标准诊断价值的评估及疗效分析

The diagnostic value of the early rheumatoid arthritis classification criteria and clinical efficacy of knee arthroscopic synovectomy for early RA

目的 评估早期类风湿关节炎（RA）分类标准对早期RA分类诊断的价值,同时对膝关节镜滑膜切除术治疗早期RA的临床疗效进行分析.方法 对62例具有明确关节炎表现、年龄＞16岁、病程＜1年的患者行膝关节镜滑膜切除术,术后结合滑膜形态改变及病理、生化免疫学检验和影像MRI检查明确RA诊断,与术前早期RA诊断比较.于术后第3个月、1年后分两次随访,比较治疗前后HAQ评分、Lysholm评分、血沉（ESR）、C反应蛋白（CRP）等指标.结果 早期RA分类标准对RA诊断的敏感性81.58％、特异性91.67％.38例RA患者及24例非RA患者术后第3个月及1年后各项指标与术前相比均明显改善,差异有统计学意义（P＜0.01）.RA患者术后第3个月与术后1年组间所有指标差异均有统计学意义（均P＜0.01）.结论 早期RA分类标准简便、实用,有利于RA早期诊断,值得临床应用.RA诊断明确后应早期行膝关节镜滑膜切除术,可有效缓解患膝症状、改善功能,提高患者生活质量,改善全身健康状况,且能打断RA病理进程,有效维持术后疗效.

Objective To evaluate the diagnostic value of the early rheumatoid arthritis （RA） classification criteria for early RA and to assess the clinical efficacy of knee arthroscopic synovectomy for RA.Methods A total of 62 patients who had arthritic complaints with disease duration less than one year were treated with knee arthroscopic synovectomy.Patients were diagnosed as RA confirmed by changes of synoviomorphous under arthroscopy,synovial biopsy,immunological biochemical laboratory and MRI,and compared with the preoperative ERA diagnosis.The efficacy was assessed at the third months and more than 12 months after operation,including Health Assessment Questionnaire （HAQ）,Lysholm score,laboratory parameters of erythrocyte sedi-mentation rate （ESR） and C-reactive protein （CRP）.Results The sensitivity and specificity in the early RA classification criteria for RA diagnosis were 81.58% and 91.67%.38 patients diagnosed as RA and the remaining 24 patients were significantly improved of HAQ,Lysholm score,ESR,CRP compared with preoperation,showed statistical difference （P 〈 0.01）.There were still statistical differences between the follow-up results of the group of patients with RA in different period after operation （P 〈 0.01）.Conclusion The early RA classification criteria is worthy of clinical application,because it has the advantages of simple,practical,and is beneficial to early diagnosis of RA.The early RA patients should be treated with knee arthroscopic synovectomy as far as possible.It can improve not only the knee function,but also the general symptoms,and it can interrupt the RA pathological process,effective maintain curative effect after operation.