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发表于 2008-12-16 10:27:52
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31-3-第三节 小 结
滑液分析是一种快速、有效的临床辅助检查手段,对关节炎的诊断和鉴别诊断具有特殊意义。滑液的细菌培养和晶体识别可以为诊断提供特殊线索,而滑液的大体检查、某些实验室检查,例如,白细胞计数与分类、总蛋白和补体检测、血清-滑液的葡萄糖浓度比等为诊断提供了辅助资料。客观依据的分析和实践表明,如果有足够的滑液,如0.5ml或者更多,滑液的镜下分析应该是首选的。在很多情况下,这是惟一需要进行的分析手段。而且,滑液的镜下分析是惟一广泛用于诊断从类风湿关节炎到半月板损伤,从多中心网状组织细胞增多症到化脓性关节炎,从血清阴性的脊柱关节病变到痛风等风湿病的检测手段。滑液的镜下检查对于鉴别炎性和非炎性病变,尤其在患者表现为单个关节或者寡关节病变时具有重要意义。滑液的镜下细胞学检查有利于诊断早期的关节疾患,至少在疾病的临床特征没有充分表现以前,可以帮助区分类风湿关节炎、血清阴性的脊柱关节病变和炎性关节病变。利用关节镜的镜下检查还可以快速诊断关节疾病,尤其在化脓性关节炎,预后往往与诊断早晚密切相关。滑液分析为人们提供了一些预后资料和有用的研究手段,它简单、有效,便宜而且可靠。
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$ D; O F+ z; ]/ f( X 通过对以往病例的回顾分析,某种关节疾病可能具有特异的镜下所见。在针对1000份关节滑液的研究中,双盲分析可以帮助近50%的关节疾患明确诊断,与临床其他资料结合可以提供 46%的诊断和预后资料。如果加上典型的临床资料,确诊率可以达到64%,但是仍然有4%的病例不能确诊。
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- U2 v- b2 c0 r5 l+ o+ A 进一步研究滑液将对风湿病产生重要的理论和实践意义。目前,滑液分析作为一种重要的诊断方法,迫切需要人们对其分析过程进行标准化,并建立独立评估的质控体系。 # S0 j* \% N3 w4 v- e
(孙铁铮)
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