〔摘要〕　目的：通过检测关节内紊乱症(TMJID)患者关节滑液中PGE2的水平变化，研究PGE2与TMJID的关系并探讨皮质激素药物关节腔内注射治疗的作用机理和利弊。方法：对16例疼痛性TMJID患者关节腔内醋酸强的松龙注射治疗，采用放免法检测治疗前后关节滑液中PGE2的含量并作对比研究。结果：注药后3周和9周的滑液中PGE2含量较注药前有显著下降，有高度统计学差异(P＜0.01)，同时关节疼痛症状明显改善。注药后9周与3周相比有部分患者的疼痛症状有复发趋势，同时伴有PGE2含量的回升。结论：PGE2水平变化与关节内紊乱症的疼痛症状密切相关，PGE2可作为判定TMJID滑膜炎的一个重要指标。皮质激素类药物关节腔内注射对缓解疼痛是一种有效但可能是短期的保守疗法。

The change of PGE2 level in synovial fluid of TMJID patients following intra-articular prednisone acetate injection

Hu Jing, Jiao Yantao, Wang Dazhang.

　　College of Stomatology, West China University of Medical Sciences, Chengdu 610041

　　〔Abstract〕Objective: To observe the change of PGE2 level in synovial fluid(SF) of TMJID patients and to evaluate the effects of intra-articular prednisone acetate injection.Methods:16 cases of painful TMJID patients were treated with intra-articular injection of prednisone acetate. The concentrations of PGE2 in SF before and after the injection were measured using RIA.Results:The levels of PGE2 in SF before and 3 weeks after intra-articular injection of prednisone acetate were 611.1 ng/L and 221.9 ng/L respectively (P＜0.01), accompanying evident relief of TMJ pain. However, 9 weeks after the injection, there was a tendency of recurrance of the pain in TMJ and elevation of PGE2 concentration in 5 cases(P＜0.01).Conculusion:PGE2 is closely related to the degree of pain in TMJID patients. PGE2 level in SF can be regarded as an index of severity of secondary synovitis in TMJID. Prednisone acetate injection is effective in controling inflammation and alleviating the symptoms, but its effect may be of short term.

　　Key words　Temporomadibular joint diseases; Prednisone; Intra-articular injetions; Synovial fluid; Prostaglandins E

　　以颞下颌关节盘移位、变形、破损和盘—突结构紊乱为基础的关节内紊乱症(TMJ internal derangement.TMJID)是口腔科的常见多发症，临床表现主要是关节的弹响、疼痛和运动受限。近年的研究证实TMJID患者存在不同程度的滑膜炎症，鉴于前列腺素E2(PGE2)在炎症反应、疼痛发生中的重要作用，本文通过检测一组疼痛性TMJID患者关节滑液中的PGE2含量，并比较其在关节腔内注射醋酸强的松龙前后的变化情况，旨在了解PGE2与TMJID的关系，进而探讨皮质激素类药物关节腔内注射的作用机理和利弊。

　　1　材料和方法

　　1.1病例　收集来我院就诊的，经临床和X线检查证实的疼痛性TMJID患者16例，其中男5例，女11例，年龄25～46岁，平均37岁。纳入样本排除感染性关节炎史、急性损伤史；风湿、类风湿及其他全身系统病史。所有患者未接受过任何形式的关节腔内穿刺、注药及手术；近一月内也未曾接受过抗炎及抗风湿治疗。

　　1.2关节滑液的抽取及关节腔内注药　方法同常规TMJ上腔注射法，先注入生理盐水1.5ml，反复回抽，注入共3遍后，尽量将液体抽出并注入经高压消毒的塑料离心管中，离心后封盖冷冻保存(-20℃)备测。随后一次性在关节腔内注入12.5mg醋酸强的松龙悬浊液加5g/L布比卡因1.5ml。关节腔内注药后3周及9周用同样的方法分别抽取关节滑液备测。

责任编辑：韩晓炜