摘要目的 探讨关节镜滑膜切除术(arthroscopic synovectomy，AS)对类风湿关节炎(rheumatoid arthritis，RA)患者疾病活动的影响，分析术后RA疾病活动相关因素。方法 回顾性选取2018年1月至2019年1月期间行单次AS的105例RA患者作为研究对象，男17例，女88例(83.8%)；年龄58~76岁，平均(67.57±9.09)岁；病程(17.93±12.52)年。手术部位：肘关节10例(9.5%)，膝关节73例(69.5%)，踝关节22例(21%)。采用双抗体夹心ELISA法检测血C反应蛋白(C-reactive protein，CRP)，应用基于C反应蛋白的28关节疾病活动度评分(disease activity score in 28 joints based on C-reactive protein，DAS28-CRP)的评估RA疾病活动，采用SPSS 23.0统计学软件对数据进行统计分析，并用多因素Logistic回归分析术后RA疾病活动相关因素。结果 105例均获随访，随访时间10~12个月，平均(11.2±5.9)个月。5例出现术后并发症，其中3例手术关节功能受限，2例关节内血肿；3例患者术后关节疼痛未缓解。术后患者DAS28CRP及CRP与基线时比较，差异有统计学意义(P＜0.05)。Pearson相关分析结果提示ΔDAS28CRP与病程呈正相关，与基线疾病活动度及大关节手术呈负相关( r 值分别为0.265，－0.592，－0.395，P＜0.05)。多因素logistic回归分析显示，较短病程OR＝2.781，95%CI(1.011，6.111)，大关节手术OR＝0.158，95%CI)(0.101，0.251)，较高的基线DAS28CRP评分OR＝0.098，95%CI(0.035，0.175)，具有统计学意义(P＜0.05)，是术后疾病活动降低的独立相关因素。结论 病程较短、疾病活动度较高且药物治疗效果欠佳的RA患者，行大关节的AS可能显著改善疾病活动。
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