补肾活血方对肾虚血瘀证膝关节骨性关节炎患者的疗效及其对血清细胞因子的影响
|
摘要
目的:研究补肾活血方对肾虚血瘀证膝关节骨性关节炎(KOA)患者的疗效及其对血清细胞因子的影响。方法:选取2016年2月至2017年11月荆州市第一人民医院收治的肾虚血瘀证KOA患者262例作为研究对象,按照随机数字表法将患者分为对照组和观察组,每组131例。对照组给予硫酸氨基葡萄糖胶囊以及塞来昔布胶囊治疗,观察组给予补肾活血方治疗,2组均治疗8周,观察2组临床疗效及不良反应,比较2组治疗前后中医症状总积分、视觉模拟评分(VAS)、WOMAC总评分、Michel Lequesen指数评分、血清细胞因子水平。结果:观察组总有效率为97. 71%,高于对照组的89. 31%(P <0. 05)。2组治疗后中医症状总积分、VAS、WOMAC总评分、Michel Lequesen指数评分、丙二醛(MDA)、白细胞介素-1(IL-1)、白细胞介素-6(IL-6)水平均明显低于治疗前(P <0. 05),且观察组较对照组更低(P <0. 05)。2组治疗后超氧化物歧化酶(SOD)、转化生长因子-β(TGF-β)、成纤维细胞生长因子-2(FGF-2)水平明显高于治疗前,且观察组较对照组更高(P <0. 05)。观察组不良反应发生率为0. 76%,低于对照组的6. 87%(P <0. 05)。结论:补肾活血方治疗肾虚血瘀证KOA患者疗效显著,可改善患者临床症状及体征,降低炎性反应因子水平,且不良反应小。
Objective: To study the effects of Bushen Huoxue recipe on knee osteoarthritis( KOA) patients with kidney deficiency and blood stasis and its influence on serum cytokines. Methods: A total of 262 KOA patients with kidney deficiency and blood stasis who were treated in the first people's Hospital of Jingzhou from February 2016 to November 2017 were selected. These patients were divided into the control group( n = 131) and the observation group( n = 131) according to random number table method. The control group was treated with glucosamine sulfate capsule and celecoxib capsule,while the observation group was treated with Bushen Huoxue recipe and the 2 groups were treated for 8 weeks. The clinical effects and adverse reactions of the 2 groups were observed. The total score of TCM symptoms,visual analogue score( VAS),WOMAC total score,Michel Lequesen index score and serum cytokine levels of the 2 groups before and after the treatment were compared. Results: The total effective rate of the observation group was 97. 71%,which was higher than 89. 31% of the control group( P < 0. 05). After treatment the total score of TCM symptoms,VAS score,WOMAC total score,Michel Lequesen index score and the levels of malondialdehyde( MDA),interleukin-1( IL-1) and interleukin-6( IL-6) in the 2 groups were significantly lower than before. Those of the observation group was lower than that of the control group( P < 0. 05). After treatment,the levels of superoxide dismutase( SOD),transforming growth factor-β( TGF-β) and fibroblast growth factor-2( FGF-2) in the 2 groups were significantly higher than before. Those of the observation group was higher than that of the control group( P < 0. 05). The incidence of adverse reactions in the observation group was 0. 76%,which was lower than 6. 87% of control group( P < 0. 05). Conclusion: Bushen Huoxue recipe has significant effects on KOA patients with kidney deficiency and blood stasis syndrome,which can improve the clinical symptoms and signs,reduce the level of inflammatory factors. Furthermore,it has little toxic side effects.
Objective: To study the effects of Bushen Huoxue recipe on knee osteoarthritis( KOA) patients with kidney deficiency and blood stasis and its influence on serum cytokines. Methods: A total of 262 KOA patients with kidney deficiency and blood stasis who were treated in the first people's Hospital of Jingzhou from February 2016 to November 2017 were selected. These patients were divided into the control group( n = 131) and the observation group( n = 131) according to random number table method. The control group was treated with glucosamine sulfate capsule and celecoxib capsule,while the observation group was treated with Bushen Huoxue recipe and the 2 groups were treated for 8 weeks. The clinical effects and adverse reactions of the 2 groups were observed. The total score of TCM symptoms,visual analogue score( VAS),WOMAC total score,Michel Lequesen index score and serum cytokine levels of the 2 groups before and after the treatment were compared. Results: The total effective rate of the observation group was 97. 71%,which was higher than 89. 31% of the control group( P < 0. 05). After treatment the total score of TCM symptoms,VAS score,WOMAC total score,Michel Lequesen index score and the levels of malondialdehyde( MDA),interleukin-1( IL-1) and interleukin-6( IL-6) in the 2 groups were significantly lower than before. Those of the observation group was lower than that of the control group( P < 0. 05). After treatment,the levels of superoxide dismutase( SOD),transforming growth factor-β( TGF-β) and fibroblast growth factor-2( FGF-2) in the 2 groups were significantly higher than before. Those of the observation group was higher than that of the control group( P < 0. 05). The incidence of adverse reactions in the observation group was 0. 76%,which was lower than 6. 87% of control group( P < 0. 05). Conclusion: Bushen Huoxue recipe has significant effects on KOA patients with kidney deficiency and blood stasis syndrome,which can improve the clinical symptoms and signs,reduce the level of inflammatory factors. Furthermore,it has little toxic side effects.
引文
[1]Iijima H,Aoyama T,Fukutani N,et al.Psychological health is associated with knee pain and physical function in patients with knee osteoarthritis:an exploratory cross-sectional study[J].BMC Psychol,2018,6(1):19.
[2]涂明琦,叶肖琳.叶新苗针药合用治疗膝骨性关节炎经验[J].中华中医药杂志,2017,32(7):3021-3023.
[3]赵晓林,吴亚鹏,王达义,等.膝关节骨性关节炎全膝关节置换术后中医证型变化及对血清TNF-α、hs-CRP、IL-6和IL-1β水平的影响[J].四川中医,2017,35(9):36-38.
[4]Matzkin EG,Curry EJ,Kong Q,et al.Efficacy and Treatment Response of Intra-articular Corticosteroid Injections in Patients With Symptomatic Knee Osteoarthritis[J].J Am Acad Orthop Surg,2017,25(10):703-714.
[5]于泉,赵云飞,王玉玲.迈之灵治疗膝关节骨性关节炎合并滑膜炎疗效分析[J].中国医药,2013,8(8):1132-1133.
[6]中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中国矫形外科杂志,2014,22(3):287-288.
[7]国家食品药品监督管理局.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:349-352.
[8]陈能.补肾活血方对膝骨关节炎疼痛及致痛因子表达的影响[D].广州:广州中医药大学,2017.
[9]畅文丽,应泽华,曾春红,等.糖皮质激素联合玻璃酸钠关节腔内注射治疗膝关节骨性关节炎的临床研究[J].现代生物医学进展,2015,15(31):6122-6124.
[10]Bhandari M,Bannuru RR,Babins EM,et al.Intra-articular hyaluronic acid in the treatment of knee osteoarthritis:a Canadian evidence-based perspective[J].Ther Adv Musculoskelet Dis,2017,9(9):231-246.
[11]张作峰,韩文朝.补肾活血汤联合关节镜治疗肾亏虚型膝关节骨性关节炎疗效观察[J].陕西中医,2017,38(10):1424-1425.
[12]李明曦,张继胜,侯秀娟,等.从炎性细胞因子与Dickkopf-1变化研究补肾活血方对绝经后膝骨关节炎的干预作用[J].世界中医药,2017,12(2):338-342.
[13]梁津喜,代玉莹,陈亮,等.补肾活血强膝方联合透明质酸钠治疗老年早中期膝骨性关节炎临床观察[J].中国中医药科技,2017,24(5):642-643.
[14]陈剑强,张小芳.补肾活血通络方加减辨治原发性膝骨性关节炎急性发作的临床研究[J].中国生化药物杂志,2017,37(10):66-68.
[15]袁家骏,罗程,黄毅,等.口服自拟补肾活血汤治疗早期膝骨关节炎的临床研究[J].中医正骨,2017,29(8):26-32.
[16]Attur M,Statnikov A,Samuels J,et al.Plasma levels of interleukin-1receptor antagonist(IL1Ra)predict radiographic progression of symptomatic knee osteoarthritis[J].Osteoarthritis Cartilage,2015,23(11):1915-1924.
[17]Azim S,Nicholson J,Rebecchi MJ,et al.Interleukin-6 and leptin levels are associated with preoperative pain severity in patients with osteoarthritis but not with acute pain after total knee arthroplasty[J].Knee,2018,25(1):25-33.
[18]傅强,牛锋,张利勇,等.骨刺消合剂对膝骨关节炎患者血清中超氧化物歧化酶、一氧化氮及肿瘤坏死因子α的影响[J].长春中医药大学学报,2015,32(6):1230-1232.
[19]于清波,邓剑锋,高大新,等.膝骨关节炎关节液中丙二醛、超氧化物歧化酶在玻璃酸钠注射前后的变化[J].中国组织工程研究,2014,17(46):7528-7532.
[20]van der Kraan PM.Differential Role of Transforming Growth Factorbeta in an Osteoarthritic or a Healthy Joint[J].J Bone Metab,2018,25(2):65-72.
[21]周舒心.特色中医手法配合温针灸对膝关节骨性关节炎患者关节功能、骨代谢的影响[J].中华全科医学,2017,15(8):1419-1421,1443.
[22]喻秋萍,唐萌芽,陈金洪,等.口服补肾活血方联合关节腔内注射玻璃酸钠治疗膝骨关节炎的临床研究[J].中医正骨,2016,28(2):23-27.
[2]涂明琦,叶肖琳.叶新苗针药合用治疗膝骨性关节炎经验[J].中华中医药杂志,2017,32(7):3021-3023.
[3]赵晓林,吴亚鹏,王达义,等.膝关节骨性关节炎全膝关节置换术后中医证型变化及对血清TNF-α、hs-CRP、IL-6和IL-1β水平的影响[J].四川中医,2017,35(9):36-38.
[4]Matzkin EG,Curry EJ,Kong Q,et al.Efficacy and Treatment Response of Intra-articular Corticosteroid Injections in Patients With Symptomatic Knee Osteoarthritis[J].J Am Acad Orthop Surg,2017,25(10):703-714.
[5]于泉,赵云飞,王玉玲.迈之灵治疗膝关节骨性关节炎合并滑膜炎疗效分析[J].中国医药,2013,8(8):1132-1133.
[6]中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中国矫形外科杂志,2014,22(3):287-288.
[7]国家食品药品监督管理局.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:349-352.
[8]陈能.补肾活血方对膝骨关节炎疼痛及致痛因子表达的影响[D].广州:广州中医药大学,2017.
[9]畅文丽,应泽华,曾春红,等.糖皮质激素联合玻璃酸钠关节腔内注射治疗膝关节骨性关节炎的临床研究[J].现代生物医学进展,2015,15(31):6122-6124.
[10]Bhandari M,Bannuru RR,Babins EM,et al.Intra-articular hyaluronic acid in the treatment of knee osteoarthritis:a Canadian evidence-based perspective[J].Ther Adv Musculoskelet Dis,2017,9(9):231-246.
[11]张作峰,韩文朝.补肾活血汤联合关节镜治疗肾亏虚型膝关节骨性关节炎疗效观察[J].陕西中医,2017,38(10):1424-1425.
[12]李明曦,张继胜,侯秀娟,等.从炎性细胞因子与Dickkopf-1变化研究补肾活血方对绝经后膝骨关节炎的干预作用[J].世界中医药,2017,12(2):338-342.
[13]梁津喜,代玉莹,陈亮,等.补肾活血强膝方联合透明质酸钠治疗老年早中期膝骨性关节炎临床观察[J].中国中医药科技,2017,24(5):642-643.
[14]陈剑强,张小芳.补肾活血通络方加减辨治原发性膝骨性关节炎急性发作的临床研究[J].中国生化药物杂志,2017,37(10):66-68.
[15]袁家骏,罗程,黄毅,等.口服自拟补肾活血汤治疗早期膝骨关节炎的临床研究[J].中医正骨,2017,29(8):26-32.
[16]Attur M,Statnikov A,Samuels J,et al.Plasma levels of interleukin-1receptor antagonist(IL1Ra)predict radiographic progression of symptomatic knee osteoarthritis[J].Osteoarthritis Cartilage,2015,23(11):1915-1924.
[17]Azim S,Nicholson J,Rebecchi MJ,et al.Interleukin-6 and leptin levels are associated with preoperative pain severity in patients with osteoarthritis but not with acute pain after total knee arthroplasty[J].Knee,2018,25(1):25-33.
[18]傅强,牛锋,张利勇,等.骨刺消合剂对膝骨关节炎患者血清中超氧化物歧化酶、一氧化氮及肿瘤坏死因子α的影响[J].长春中医药大学学报,2015,32(6):1230-1232.
[19]于清波,邓剑锋,高大新,等.膝骨关节炎关节液中丙二醛、超氧化物歧化酶在玻璃酸钠注射前后的变化[J].中国组织工程研究,2014,17(46):7528-7532.
[20]van der Kraan PM.Differential Role of Transforming Growth Factorbeta in an Osteoarthritic or a Healthy Joint[J].J Bone Metab,2018,25(2):65-72.
[21]周舒心.特色中医手法配合温针灸对膝关节骨性关节炎患者关节功能、骨代谢的影响[J].中华全科医学,2017,15(8):1419-1421,1443.
[22]喻秋萍,唐萌芽,陈金洪,等.口服补肾活血方联合关节腔内注射玻璃酸钠治疗膝骨关节炎的临床研究[J].中医正骨,2016,28(2):23-27.