经动脉微栓塞治疗难治性局限性关节炎症：类风湿关节炎个案报告
报告一例31岁女性类风湿关节炎累及肘、膝、踝关节，经选择性经动脉微栓塞（TAME）并动脉内给予亚胺培南/西司他丁，栓塞后血管造影显示血供减少，12个月内疼痛和功能改善，MRI显示滑膜增殖、关节周围水肿和骨髓水肿减轻。全身治疗方案维持不变，不良事件为一过性疼痛和局部皮肤变色。
要点
- TAME针对关节周围新生血管，用于全身治疗仍持续的局限性关节疼痛。
- 栓塞后造影显示血供减少，MRI随访显示滑膜增殖和骨髓水肿减轻。
- 不良事件为一过性操作相关疼痛和局部皮肤变色。
关键影像表现/征象
- 栓塞后血管造影显示关节周围血供减少。
- 随访MRI显示滑膜增殖、关节周围水肿和骨髓水肿减轻。
临床应用与阅片要点
- 识别关节周围新生血管可作为栓塞靶点，但需血管造影确认。
- 栓塞后应以MRI评估滑膜增殖和骨髓水肿变化。
- 注意一过性操作相关疼痛和局部皮肤变色等不良事件。
局限性
- 个案报告，结果仅为假设生成性，不能推广。
- 样本量极小，无对照，无法排除自然病程或安慰剂效应。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
Transarterial microembolization targets periarticular neovascularization in localized joint pain that persists despite systemic therapy. We report a 31-year-old woman with rheumatoid arthritis involving the elbow, knee, and ankle. The patient underwent selective transarterial microembolization, with intra-arterial imipenem/cilastatin delivered to angiographically identified neovessels. Post-embolization angiography demonstrated decreased hypervascularity. Over 12 months, pain and function improved, and magnetic resonance imaging showed reduced synovial proliferation, periarticular edema, and bone marrow edema. The systemic therapy regimen was maintained unchanged during follow-up. Adverse events were transient and limited to brief procedure-related pain and localized skin discoloration. These observations are hypothesis-generating and support prospective evaluation of TAME as a localized adjunct to systemic immunomodulation.
引用
- Lin YC, Wu JM, Lee CC, et al. Rheumatoid arthritis: transarterial microembolization for refractory localized joint inflammation. Skeletal Radiol. 2026. PMID: 42149217. doi:10.1007/s00256-026-05249-5
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。