当归拈痛汤加减内服外洗治疗膝骨性关节炎风湿热痹证的临床观察
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摘要
目的:观察当归拈痛汤加减内服外洗治疗膝骨性关节炎(KOA)风湿热痹证的近期疗效及对疾病活动性的影响。方法:将118例KOA患者随机分为对照组58例和观察组60例。对照组口服塞来昔布胶囊,0. 2 g/次,1次/d;双氯芬酸二乙胺乳胶剂,适量外用痛处,3次/d。观察组采用当归拈痛汤加减内服、外洗。两组疗程均为连续治疗2周。进行膝关节疼痛视觉模拟(VAS)评分,于治疗前、治疗后2,4,6,14 d进行评价患者的行走和静息疼痛情况;膝关节功能采用西安大略和麦马斯特大学骨关节炎指数可视化量表(WOMAC),于治疗前后各评价1次;进行治疗前后湿热痹证、日本骨科协会的膝关节功能(JOA)评分,血沉(ESR),C反应蛋白(CRP),超氧化物歧化酶(SOD),白细胞介素-1β(IL-1β),IL-6,肿瘤坏死因子-α(TNF-α)和基质金属蛋白酶-3(MMP-3)的评价。结果:观察组患者在第6,14天,行走和静息时VAS评分均低于对照组(P <0. 01);观察组WOMAC量表3个维度(疼痛、僵硬、关节功能)评分和WOMAC总分均低于对照组(P <0. 01);观察组患者风湿热痹证主要症状评分和总积分均低于对照组(P <0. 01);治疗后观察组ESR,CRP水平均低于对照组,SOD水平高于对照组(P <0. 01);治疗后观察组血清IL-1β,IL-6,TNF-α和MMP-3均低于对照组(P <0. 01)。结论:当归拈痛加减汤内服和外洗能有效减轻KOA风湿热痹型疼痛、肿胀和功能障碍等近期症状,能控制急性炎症指标,减轻病情程度,降低疾病的活动性。
Objective: To observe the short-term clinical efficacy of addition and subtraction therapy and external washing treatment of Danggui Niantongtang to knee osteoarthritis( KOA) with heumatism heat Bi syndrome and to investigate its effect on disease activity. Method: One hundred and eighteen patients with KOA were randomly divided into control group( 58 cases) and observation group( 60 cases) by random number table.Patients in control group got celecoxib capsules,0. 2 g/time,1 time/day,diclofenac diethylamine emulgel for the pain,3 times/days. Patients in observation group got addition and subtraction therapy and external washing treatment of Danggui Niantongtang. The course of treatment was 2 weeks in both groups. Before treatment and at the 2 th,4 th,6 thand 14 thweeks after treatment,scores of visual analog scale( VAS) were graded for pain in walking and tranquillization. Function of knee joint was evaluated by western Ontario and McMaster university osteoarthritis index( WOMAC) both before and after treatment. Scores of heumatism heat Bi syndrome and Japanese Orthopaedic Associate( JOA),erythrocyte sedimentation rate( ESR),C-reactive protein( CRP),superoxide dismutase( SOD),interleukin~(-1)β( IL-1β),interleukin-6,tumor necrosis factor-α( TNF-α) and matrix metalloproteinases-3( MMP-3) levels were evaluated. Result: At the 6 thand 14 thweeks after treatment,scores of VAS in observation group were lower than those in control group during walking and tranquillization time. Scores of three dimensions in WOMAC( pain,stiffness,joint function) and the total score of WOMAC in observation group were all lower than those in control group( P < 0. 01). The score of main symptoms of heumatism heat Bi syndrome and the total score in observation group were lower than those in control group( P < 0. 01). After treatment,levels of ESR,CRP,IL-1β,IL-6,TNF-α and MMP-3 were lower than those in control group,and level of SOD was higher than that in control group( P < 0. 01). Conclusion: Addition and subtraction therapy and external washing treatment of Danggui Niantongtang can relieve the pain and degree of disease caused by KOA with heumatism heat Bi syndrome,swelling and dysfunction,and can control acute inflammation index,reduce disease activity.
Objective: To observe the short-term clinical efficacy of addition and subtraction therapy and external washing treatment of Danggui Niantongtang to knee osteoarthritis( KOA) with heumatism heat Bi syndrome and to investigate its effect on disease activity. Method: One hundred and eighteen patients with KOA were randomly divided into control group( 58 cases) and observation group( 60 cases) by random number table.Patients in control group got celecoxib capsules,0. 2 g/time,1 time/day,diclofenac diethylamine emulgel for the pain,3 times/days. Patients in observation group got addition and subtraction therapy and external washing treatment of Danggui Niantongtang. The course of treatment was 2 weeks in both groups. Before treatment and at the 2 th,4 th,6 thand 14 thweeks after treatment,scores of visual analog scale( VAS) were graded for pain in walking and tranquillization. Function of knee joint was evaluated by western Ontario and McMaster university osteoarthritis index( WOMAC) both before and after treatment. Scores of heumatism heat Bi syndrome and Japanese Orthopaedic Associate( JOA),erythrocyte sedimentation rate( ESR),C-reactive protein( CRP),superoxide dismutase( SOD),interleukin~(-1)β( IL-1β),interleukin-6,tumor necrosis factor-α( TNF-α) and matrix metalloproteinases-3( MMP-3) levels were evaluated. Result: At the 6 thand 14 thweeks after treatment,scores of VAS in observation group were lower than those in control group during walking and tranquillization time. Scores of three dimensions in WOMAC( pain,stiffness,joint function) and the total score of WOMAC in observation group were all lower than those in control group( P < 0. 01). The score of main symptoms of heumatism heat Bi syndrome and the total score in observation group were lower than those in control group( P < 0. 01). After treatment,levels of ESR,CRP,IL-1β,IL-6,TNF-α and MMP-3 were lower than those in control group,and level of SOD was higher than that in control group( P < 0. 01). Conclusion: Addition and subtraction therapy and external washing treatment of Danggui Niantongtang can relieve the pain and degree of disease caused by KOA with heumatism heat Bi syndrome,swelling and dysfunction,and can control acute inflammation index,reduce disease activity.
引文
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[12]李静,孙维峰,刘颖琬,等.清热除痹方治疗湿热痹阻型风湿病的临床疗效及安全性评价[J].华南国防医学杂志,2014,28(8):750-753.
[13]匡尧,李正飞,孙鹏,等.独活寄生汤配合膝四针治疗风寒湿痹型膝骨关节炎的临床观察[J].中国实验方剂学杂志,2018,24(18):147-152.
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[15]王桂珍,刘健,黄传兵,等.中药内外合治湿热痹阻型膝骨关节炎临床疗效观察[J].安徽医药,2015(8):1581-1584.
[16]安莉萍,袁丽,傅卫燕.当归拈痛汤加味膏剂对AA大鼠抗炎镇痛作用的实验研究[J].新疆中医药,2012,30(2):3-5.
[17]袁立霞.当归拈痛汤及拆方对类风湿性关节炎大鼠血清IL-1β和TNF-β的影响[J].中华中医药学刊,2008,26(6):1213-1214.
[18]袁立霞,吴茜.当归拈痛汤及其拆方对佐剂性关节炎大鼠红细胞免疫功能的影响[J].中国中医药科技,2008,15(5):367.
[19]王景红,夏坤,张志千,等.骨关节炎相关细胞因子及生物标志物的研究进展[J].中国实验方剂学杂志,2015,21(10):225-230.
[20]邝高艳,严可,柴爽,等.加味独活寄生合剂治疗膝骨关节炎临床疗效及对关节液中IL-1,IL-6,TNF-α及NO的影响[J].中国实验方剂学杂志,2017,23(1):174-178.
[2]中华医学会骨科学分会关节外科学组.骨关节炎诊疗指南(2018年版)[J].中华骨科杂志,2018,38(12):705-715.
[3]陈庆奇,龚敬乐.基于国内外指南的适用于我国全科医疗的膝骨关节炎诊治流程[J].中国全科医学,2016,19(2):125-129.
[4]中国中西医结合学会骨伤科专业委员会关节工作委员会.膝骨关节炎中医诊疗专家共识(2015年版)[J].中医正骨,2015,27(7):4-5.
[5]刘献祥.基于陈可冀学术思想之骨性关节炎研究[J].康复学报,2016,26(1):2-5.
[6]徐莎婷,唐现莉,欧阳建军.当归拈痛汤的临床应用与实验研究[J].河南中医,2013,33(2):302-305.
[7]宗文静,刘寨华,申晓伟,等.曹洪欣应用当归拈痛汤经验[J].中国中医基础医学杂志,2016,22(7):986-987.
[8]陈志龙,李木清.当归拈痛汤治疗膝关节骨性关节炎风湿热痹证35例[J].湖南中医杂志,2016,32(6):87-88.
[9]中华医学会风湿病学分会.骨关节炎诊断及治疗指南[J].中华风湿病学杂志,2010,14(6):416-419.
[10] Bellamy N. Pain assessment in osteoarthritis:experience with the WOMAC osteoarthritis index[J]. Semin Arthritis Rheum,1989,18(Suppl2):14-17.
[11]蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:123-124.
[12]李静,孙维峰,刘颖琬,等.清热除痹方治疗湿热痹阻型风湿病的临床疗效及安全性评价[J].华南国防医学杂志,2014,28(8):750-753.
[13]匡尧,李正飞,孙鹏,等.独活寄生汤配合膝四针治疗风寒湿痹型膝骨关节炎的临床观察[J].中国实验方剂学杂志,2018,24(18):147-152.
[14]陈卫衡.探索建立系统的膝骨关节炎中医临床科研范式和理论体系[J].中医正骨,2015,27(7):1-3.
[15]王桂珍,刘健,黄传兵,等.中药内外合治湿热痹阻型膝骨关节炎临床疗效观察[J].安徽医药,2015(8):1581-1584.
[16]安莉萍,袁丽,傅卫燕.当归拈痛汤加味膏剂对AA大鼠抗炎镇痛作用的实验研究[J].新疆中医药,2012,30(2):3-5.
[17]袁立霞.当归拈痛汤及拆方对类风湿性关节炎大鼠血清IL-1β和TNF-β的影响[J].中华中医药学刊,2008,26(6):1213-1214.
[18]袁立霞,吴茜.当归拈痛汤及其拆方对佐剂性关节炎大鼠红细胞免疫功能的影响[J].中国中医药科技,2008,15(5):367.
[19]王景红,夏坤,张志千,等.骨关节炎相关细胞因子及生物标志物的研究进展[J].中国实验方剂学杂志,2015,21(10):225-230.
[20]邝高艳,严可,柴爽,等.加味独活寄生合剂治疗膝骨关节炎临床疗效及对关节液中IL-1,IL-6,TNF-α及NO的影响[J].中国实验方剂学杂志,2017,23(1):174-178.