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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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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。 + t4 T# T4 k5 {$ R
, G( n+ f7 g% N I U0 L 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。
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( j: x. ~- x6 ]" Z 参考文献:
3 D, l9 }4 S" q, p& E/ g
: Y: i8 f; ]9 l% L7 m9 ~ Aman S, Risteli J, Luukkainen R, et al. The value of syn-ovial fluid analysis in the assessment of knee joint destruction inarthritis in a three year follow up study. Ann Rheum Dis, 1999.58:559一562
4 U" U) C8 [* ?; H$ V5 q' E
3 C! F* P3 C% G5 B* m Braun J, Tuszewski M, Eggens U, et al. Nested poly-merase chain reaction strategy simultaneously targeting DNA se-quences of multiple bacterial species in inflammatory joint disease.1. Screening of synovial fluid samples of patients with spondy-loarthropathies and other arthritides. J Rheumatol, 1997. 24:1092一1100
; z" f2 [8 ~# N# g4 Y& ~+ c7 x/ B8 S n# h) Y U
Cunningham T, Vebelhant D, Very JM, et al. Synovial flu-id hydroxyapatite crystals: detection threshold of two methods.Ann Rheu Dis, 1989.48:829一831
# N3 l0 k- o# ^, { ]9 }; }1 A# m) d& W4 Y6 T/ |5 E
Dieppe P, Swan A. Identification of crystals in synovial flu-id. Ann Rheum Dis, 1999.58:261一263
1 H* b5 x" e* e& c" y8 ` a8 t& F* r) u; z1 z
Dieppe P, Pascal E, Swan A. The identificationin synovial fluids; the EULAR quality control initiative.tology in Europe. 1997.26:74一75。4 U) Y) C0 Q$ g9 A5 @9 S
* j! h* o8 z- z0 u3 z: T/ Q
Duff GP, Lachiewicz PF, Kelley SS. Aspiration of the kneejoint before revision arthroplasty. Clin Orthop, 1996.331:132一139 8 j# @/ H+ e/ L' e' B! |8 u) R- ?
0 k5 @3 i j/ I Fiechtner JJ, Simkin PA. Urate spherulites in gouty synovi-a. JAMA. 1981.245:1533一1536
' T C; e! }2 ^0 i1 x( N7 Y6 L+ F+ {% V/ Z5 U
Freemont AL Denton J, Chuck A, et al. Diagnostic value ofsynovialRheu Dismicroscopy: a reassessment and rationalization. Ann1991.50:101一107# K ?6 ^( S, M5 [& y( } ]
; x, j4 p# y4 |) }
Freemont AJ. Microscopic analysis of synovial fluid-the per-fect diagnostic test? Ann Rheum Dis. 1996. 55:695一697 3 Q& e8 B/ I, o
0 V) @2 h9 F7 F) H0 f& W# b9 {' _2 y
Galvez J, Sola J, Ortuno, G, et al. Microscopic rice bodiesin the rheumatoid synovial fluid sediments nearly specific for RA.J Rheumatol 1992.19:1851一1858
9 ^- }; f% d+ d. {9 @& P7 o7 @! J7 s- j5 W4 g0 J
Gatter RA, Schumacher HR. A practical handbook of jointfluid analysis. 2nd ed. Philadelphia: Lea&Febiger.1991
3 p9 }# E. }2 Q, P
6 z' b3 [* ^0 z M+ C2 ]9 B Ghosh P. The role of hyaluronic acid in health and disease:interactions with cells, cartilage and components of synovial fluid.Clin Exp Rheumatol, 1994.12:75一82 " J* m1 } _/ z& o7 l
" Y6 y* c4 Y9 r! P5 K: Y: f& @, o/ W
Lazavevic MB, Skosey, LL, Vitic J, et al. Cholesterolcrystals in synovial and bursal fluid. Semin Arthritis Rheum,1993.23:99一103
4 G6 X0 M( l2 Z/ ^* |. v7 \: v# `" G# t- V0 d
Lazcano O, Chin-Yang LI, Pierre RV, et al. Clinical utilityof the Alizarin Red S stain on permenant preparations to detectcalcium-containing compounds in synovial fluids. Arme J ClinPath, 1993.99:90一96
% E, d- T3 \2 W8 N" x B' G' N; {7 [1 }" C0 S! Y
Mann D, Schmuacher HR. Pseudosepsis in rheumatoidarthritis due to cellular and lipid abnormalities in synovial fluid. BrJ Rheumatol 1995.31:625一626
; m6 M( |% X+ A" t* p: l, m' Y) X# t% u- k
McCarty DJ. Synovial fluid. In: Koopman WJ,eds. Arthri-tis and allied conditions. Th ed. Lea&Febiger, 1997: 81一99 $ r6 p; z+ V4 I6 z+ @9 t' n
: M5 I4 v0 u2 [+ u7 e4 C1 g Muroz-Gomez J, et al. Synovial fluid examination for the di-agnosis of synovial amyloidosis in patients with chronic renal fail-ure undergoing hemodialysis. Ann Rheum Dis, 1987.324: 3一26
; B3 M* l: p5 E- r; D: o
' D% J) m4 n* |1 p4 U0 y- I Padeh S. High synovial immunoglobin E levels ineosinophilic synovitis. J Pediat 1992. 121:417一419
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2 G0 F9 p" R Y5 _& c Pal B, Nash EJ, Oppenheim B, et al. Routine synovial fluidculture: is it necessary? Lesson from an audit. British J Rheuma-tol. 1997.36:1116一1117 |
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