~(32)P胶体放射性滑膜切除术治疗血友病性滑膜炎的效果
摘要
目的观察应用~(32)P胶体放射性滑膜切除术治疗血友病性滑膜炎患者治疗后疗效,了解患者关节功能改善情况。方法对进行首次~(32)P胶体放射性滑膜切除术治疗的43例血友病性滑膜炎患者的45个病变关节进行回顾性分析。对治疗前后关节出血次数、疼痛程度、关节评分、关节活动度、关节滑膜MRI检查及凝血因子用量进行对比分析。结果所有患者治疗后随访26～39个月[(32.48±3.73)个月],43例患者的45个关节的平均关节腔出血频率由治疗前(18.04±7.87)次/6个月减少到治疗后(5.13±4.50)次/6个月,治疗前后差异有统计学意义(P<0.05)。43例患者治疗后关节疼痛VAS评分为(1.68±1.22)分,较治疗前疼痛评分(4.64±1.63)分明显降低(P<0.05)。关节评分由治疗前的(10.08±2.12)分降低到术后的(5.76±2.18)分,差异有统计学意义(P<0.05)。术后治疗关节功能改善个数占比为40%,2个关节活动范围减少,其余关节活动度较治疗前均无明显变化,治疗前后关节活动度差异无统计学意义(P>0.05)。所有患者凝血因子单次用量较治疗前无变化,但由于出血次数减少,因此随访期间凝血因子应用总量减少。5个被选取的膝关节治疗后MRI可见滑膜厚度较治疗前均减少。结论 ~(32)P放射性滑膜切除术治疗血友病性关节炎具有创伤小、安全有效且并发症少等优点。同时操作简单,核素获得相对容易,对于符合适应证的患者,是一种较好选择。
引文
[1] 中华医学会血液学分会血栓与止血学组,中国血友病协作组.血友病诊断与治疗中国专家共识(2017年版)[J].中华血液学杂志,2017,38(5):364-370.
[2] Manco-Johnson MJ,Abshire TC,Shapiro AD,et al.Prophylaxis versus episodic treatment to prevent joint disease in boys with severe hemophilia[J].N Engl J Med,2007,357(6):535-544.
[3] Rodriguez-Merchan EC. Musculoskeletal complications of hemophilia[J]. HSS J, 2010,6(1):37-42.
[4] Ozcan Z. Radiosynovectomy in hemophilic synovitis[J]. Mol Imaging Radionucl Ther,2014,23(1):1-4.
[5] Fernandez-Palazzi F,Rivas S,Cibeira JL,et al.Radioactive synoviorthesis in hemophilic hemarthrosis:materials,techniques and dangers[J].Clin Orthop Relat Res,1996,328:14-18.
[6] Rodriguez-Merchan EC.Methods to treat chronic haemophilic synovitis[J]. Haemophilia, 2001,7(1):1-5.
[7] TOrkmen C,Zulflkar B,Taser O,et al. Radiosynoveetomy in hemophilic synovitis:correlation of therapeutic response and blood-pool changes[J].Cancer Biother Radiopharm, 2005, 20(3): 363-370.
[8] De La Corte-Rodriguez H,Rodriguez-Merchan EC,Jimenez-Yuste V.Consecutive radiosynovectomy procedures at 6-monthly intervals behave independently in haemophilic synovitis[J].Blood Transfus,2013,11(2):254-259.
[9] Merehan EC,Magallon M,Martin-Villar J,et al.Long term follow up of haemophilic arthrepathy treated by Au-198 radiation synovectomy[J].Int Orthop,1993,17(2):120-124.
[10] Fernandez-Palazzi F,Rivas S,Viso R,et al.Synovectomy with rifampicine in haemophilic haemarthrosis[J].Haemophilia,2000,6(5):562-565.
[11] Fernandez-Palazzi F,Cedeno M,Maldonado JC,et al.Chemical synoviorthesis with oxytetracycline clorhydrate (Emicine) in recurrent haemarthrosis[J]. Haemophilia, 2008, 14(1): 21-24.
[12] Clunie G,Fischer M.EANM procedure guidelines for radiosynovectomy[J].Eur J Nucl Med Mol lmaging,2003,30(3):BP12-16.
[13] Mathew P,Talbut DC,Frogameni A,et a1.Isotopic synovectomy with P-32 in paediatric patients with haemophilia[J].Haemophilia.2000,6(5):547-555.
[14] Siegel HJ,Luck JV,Siegel ME,et al.HenuLrthrosis and synovitis associated with hemopilis:Clinical use of 32P chromic phosphate synoviorthesis for treatment[J]. Radiology,1994,190(1):257-261.
[15] Soroa VE,del HVEM,Giannone C,et al.Effects of radiosynovectomy with P-32 colloid therapy in haemophilia and rheumatoid arthritis[J].Cancer Biother Radiopharm, 2005, 20(3): 344-348.
[16] Rodriguez-Merchan EC,Goddard NJ. The technique of synoviorthesis[J].Haemophilia,2001,7(Suppl.2):11-15.
[17] Mortazavi SM,Asadollahi S,Farzan M,et al.32P colloid radiosynovectomy in treatment of chronic haemophilic synovitis:Iran experience[J].Haemophilia, 2007,13(2):182-188.
[18] Silva M,Luck JV JR,Siegel ME.32P chromic phosphate radiosynovectomy for chronic haemophilic synovitis[J].Haemophilia,2001,7(Suppl 2):40-49.
[19] 王臻,张茵,葛英辉,等.32P-胶体滑膜切除术治疗血友病性关节病326例疗效观察[J].中华血液学杂志,2017,38(1):39-43.
[20] Infante-Rivard C,Rivard G-E,Derome F,et al.A retrospective cohort study of cancer incidence among patients treated with radiosynoviorthesis[J]. Haemophilia,2012,18(5):805-809.
[21] Turkman C,Ozturk S,Unal SN,et al.Monitoring the genotoxic effects of radiosynovectomy with Re-186 in paediatric age group undergoing therapy for haemophilic synovitis[J].Haemophilia,2007,13(1):57-64.
[22] Turkman C,Ozturk S,Unal SN,et al.The genotoxic effect in ly-mphocyte cultures of children treated with radiosynovectomy by using yttrium-90 citrate colloid[J].Cancer Biother Radiopharm, 2007, 22(3):393-399.
[23] Eraghi AS, Kaseb MH, Espandar R, et al. The long-term effects of radioactive phosphorous synoviorthesis on hemophilic arthropathy[J]. Blood Cells Mol Dis,2015,55(1):68-70.
[2] Manco-Johnson MJ,Abshire TC,Shapiro AD,et al.Prophylaxis versus episodic treatment to prevent joint disease in boys with severe hemophilia[J].N Engl J Med,2007,357(6):535-544.
[3] Rodriguez-Merchan EC. Musculoskeletal complications of hemophilia[J]. HSS J, 2010,6(1):37-42.
[4] Ozcan Z. Radiosynovectomy in hemophilic synovitis[J]. Mol Imaging Radionucl Ther,2014,23(1):1-4.
[5] Fernandez-Palazzi F,Rivas S,Cibeira JL,et al.Radioactive synoviorthesis in hemophilic hemarthrosis:materials,techniques and dangers[J].Clin Orthop Relat Res,1996,328:14-18.
[6] Rodriguez-Merchan EC.Methods to treat chronic haemophilic synovitis[J]. Haemophilia, 2001,7(1):1-5.
[7] TOrkmen C,Zulflkar B,Taser O,et al. Radiosynoveetomy in hemophilic synovitis:correlation of therapeutic response and blood-pool changes[J].Cancer Biother Radiopharm, 2005, 20(3): 363-370.
[8] De La Corte-Rodriguez H,Rodriguez-Merchan EC,Jimenez-Yuste V.Consecutive radiosynovectomy procedures at 6-monthly intervals behave independently in haemophilic synovitis[J].Blood Transfus,2013,11(2):254-259.
[9] Merehan EC,Magallon M,Martin-Villar J,et al.Long term follow up of haemophilic arthrepathy treated by Au-198 radiation synovectomy[J].Int Orthop,1993,17(2):120-124.
[10] Fernandez-Palazzi F,Rivas S,Viso R,et al.Synovectomy with rifampicine in haemophilic haemarthrosis[J].Haemophilia,2000,6(5):562-565.
[11] Fernandez-Palazzi F,Cedeno M,Maldonado JC,et al.Chemical synoviorthesis with oxytetracycline clorhydrate (Emicine) in recurrent haemarthrosis[J]. Haemophilia, 2008, 14(1): 21-24.
[12] Clunie G,Fischer M.EANM procedure guidelines for radiosynovectomy[J].Eur J Nucl Med Mol lmaging,2003,30(3):BP12-16.
[13] Mathew P,Talbut DC,Frogameni A,et a1.Isotopic synovectomy with P-32 in paediatric patients with haemophilia[J].Haemophilia.2000,6(5):547-555.
[14] Siegel HJ,Luck JV,Siegel ME,et al.HenuLrthrosis and synovitis associated with hemopilis:Clinical use of 32P chromic phosphate synoviorthesis for treatment[J]. Radiology,1994,190(1):257-261.
[15] Soroa VE,del HVEM,Giannone C,et al.Effects of radiosynovectomy with P-32 colloid therapy in haemophilia and rheumatoid arthritis[J].Cancer Biother Radiopharm, 2005, 20(3): 344-348.
[16] Rodriguez-Merchan EC,Goddard NJ. The technique of synoviorthesis[J].Haemophilia,2001,7(Suppl.2):11-15.
[17] Mortazavi SM,Asadollahi S,Farzan M,et al.32P colloid radiosynovectomy in treatment of chronic haemophilic synovitis:Iran experience[J].Haemophilia, 2007,13(2):182-188.
[18] Silva M,Luck JV JR,Siegel ME.32P chromic phosphate radiosynovectomy for chronic haemophilic synovitis[J].Haemophilia,2001,7(Suppl 2):40-49.
[19] 王臻,张茵,葛英辉,等.32P-胶体滑膜切除术治疗血友病性关节病326例疗效观察[J].中华血液学杂志,2017,38(1):39-43.
[20] Infante-Rivard C,Rivard G-E,Derome F,et al.A retrospective cohort study of cancer incidence among patients treated with radiosynoviorthesis[J]. Haemophilia,2012,18(5):805-809.
[21] Turkman C,Ozturk S,Unal SN,et al.Monitoring the genotoxic effects of radiosynovectomy with Re-186 in paediatric age group undergoing therapy for haemophilic synovitis[J].Haemophilia,2007,13(1):57-64.
[22] Turkman C,Ozturk S,Unal SN,et al.The genotoxic effect in ly-mphocyte cultures of children treated with radiosynovectomy by using yttrium-90 citrate colloid[J].Cancer Biother Radiopharm, 2007, 22(3):393-399.
[23] Eraghi AS, Kaseb MH, Espandar R, et al. The long-term effects of radioactive phosphorous synoviorthesis on hemophilic arthropathy[J]. Blood Cells Mol Dis,2015,55(1):68-70.