翻译：郑晓娟博士 审校 刘湘源 摘要 目的：评估用钇90( Yttrium-90)和钐153( Samarium-153)颗粒状羟基磷灰石放射性滑膜切除术治疗伴慢性滑膜炎的类风湿关节炎的有效性和耐受性。

方法：共84例患慢性滑膜炎的类风湿关节炎（符合美国风湿病协会分类标准）的患者（90个膝关节）参与了此项随机、双盲、对照研究。患者随机分配到三个组接受关节腔注射治疗：一组接受5毫居里钇90和40mg乙曲安奈德的关节腔注射（钇90治疗组），一组接受15毫居里钐153和40mg曲安奈德的关节腔注射（钐153治疗组），另一组仅接受40mg曲安奈德的关节腔注射（对照组）。在治疗时及治疗后的第1、4、12、32和 48周 进行如下的双盲检查：关节痛或肿胀的直观量表、晨僵度、关节活动度、膝围、Likert量表、症状改善程度、斯坦福健康评价量表、Lequesne指数、非甾类抗炎药及激素使用情况、药物不良反应、给医生打电话及到医院看病的次数等。

结果：3例在注射前退出了试验。在疼痛缓解方面，第一周末，钇90治疗组的疗效要优于钐153治疗组(p=0.025)，第48周末明显好于对照组(p=0.026)。钐153治疗组有更多的不良反应(p=0.042)，但这些不良反应相对较轻且短暂。

结论：就疼痛指数改善而言，曲安奈德联合钇90放射性滑膜切除术的疗效在第一周优于曲安奈德联合钐153羟基磷灰石的放射性滑膜切除术，在第48周优于单纯曲安奈德的滑膜切除术。其他指标在三个实验组间无统计学差异。

附原文：The aim of the present study was to investigate the long-term effectiveness of and tolerance to Yttrium-90 and Samarium-153-particulate hydroxyapatite radiation synovectomy in patients with rheumatoid arthritis (RA) and chronic knee synovitis. Eight-four patients (90 knees) with chronic knee synovitis and RA (according to the American College of Rheumatology criteria) participated in a controlled, double-blinded trial. Patients were randomized to receive an intra-articular injection with either 5 mCi Yttrium-90 plus 40 mg of triamcinolone hexacetonide (Y/TH Group), 15 mCi Samarium-153 hydroxyapatite plus 40 mg of triamcinolone hexacetonide (Sm/TH Group), or 40 mg triamcinolone hexacetonide alone (Control Group). Blinded examination at baseline, 1, 4, 12, 32, and 48 weeks post-intervention included a visual analog scale for joint pain and swelling, morning stiffness, range of motion, knee circumference, Likert scale, percentage of improvement, Stanford Health Assessment Questionnaire, Lequesne index, use of non-steroidal anti-inflammatory drugs and corticosteroids, events and adverse effects, calls to the physician, and hospital visits. There were three withdrawals prior to the injections. Regarding the pain, there was a significantly better response in the Y/TH Group versus the Sm/TH Group at T1 (p=0.025) and versus TH alone at T48 (p=0.026). The Sm/TH group had more adverse effects (p=0.042), but these were mild and transitory. For the pain parameter alone, Yttrium-90 radiosynovectomy associated to TH proved superior to Samarium-153 hydroxyapatite radiosynovectomy associated to TH at T1 and to synovectomy with TH at T48. No other statistically significant inter-group differences were detected.

引自：Dos Santos MF, Furtado RN, Konai MS.Effectiveness of radiation synovectomy with Yttrium-90 and Samarium-153 particulate hydroxyapatite in rheumatoid arthritis patients with knee synovitis: a controlled, randomized, double-blinded trial. Rheumatol Int. 2010 Dec 1.