氨基葡萄糖联合玻璃酸钠对大骨节病患者膝关节功能及生活质量的影响
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摘要
目的:观察软骨保护药物硫酸氨基葡萄糖联合玻璃酸钠治疗膝大骨节病关节功能、生存质量及药物安全性。方法:选取2013年2月至2016年9月,咸阳市中心医院收治的120例大骨节病患者为研究对象,随机分为观察组和对照组,每组60例。对照组仅口服硫酸氨基葡萄糖,观察组在口服硫酸氨基葡萄糖基础上联用关节腔内注射玻璃酸钠,并对治疗前、治疗后6周和6个月的结果进行比。结果:观察组的治疗总有效率(93.3%)明显高于对照组(78.3%),差异有统计学意义(P<0.05);与对照组相比,观察组的视觉模拟评分法(visual analogue score,VAS)、骨关节炎指数评分(the Western Ontario and McMaster Universities,WOMAC)较低,SF-36评分较高,差异均有统计学意义(P<0.05); 2组治疗后6周、6个月分别与治疗前相比,VAS评分、WOMAC评分和SF-36评分明显改善,差异均有统计学意义(P<0.05)。结论:软骨保护药物硫酸氨基葡萄糖联合玻璃酸钠治疗膝关节大骨节病的效果优于单用硫酸氨基葡萄糖,可以有效解除患者痛苦,提升生存质量、修复膝关节功能。
Objective:To observe the effect of cartilage protective drugs glucosamine sulfate combined with sodium hyaluronate on joint function,quality of life and drug safety of knee joint Kashin-Beck disease.Methods:120 patients with Kashin-Beck disease treated in our hospital were randomly divided into observation group and control group(n=60).The control group was treated with oral D-Glucosamine alone.D-Glucosamine sulfate was administered intraperitoneally with sodium hyaluronate,and the results were compared before treatment,6 weeks after treatment and 6 months after treatment.Results:After 6 months treatment,the effective rate(93.3%)was significantly higher in the observation group than in the control group(78.3%).Compared with the control group,the VAS and WOMAC score of the observation group was lower,but the SF-36 score were higher,the results were significantly different(P<0.05).The VAS score,WOMAC score and SF-36 were also significantly improved(P<0.05)after treatment in each group,respectively.Conclusion:Cartilage protection drug glucosamine sulfate combined with sodium hyaluronate in the treatment of knee joint Kashin-Beck disease is better than the single use of glucosamine sulfate,which can not only effectively relieve the patient suffering,but also improve the quality of life and repair knee function.
Objective:To observe the effect of cartilage protective drugs glucosamine sulfate combined with sodium hyaluronate on joint function,quality of life and drug safety of knee joint Kashin-Beck disease.Methods:120 patients with Kashin-Beck disease treated in our hospital were randomly divided into observation group and control group(n=60).The control group was treated with oral D-Glucosamine alone.D-Glucosamine sulfate was administered intraperitoneally with sodium hyaluronate,and the results were compared before treatment,6 weeks after treatment and 6 months after treatment.Results:After 6 months treatment,the effective rate(93.3%)was significantly higher in the observation group than in the control group(78.3%).Compared with the control group,the VAS and WOMAC score of the observation group was lower,but the SF-36 score were higher,the results were significantly different(P<0.05).The VAS score,WOMAC score and SF-36 were also significantly improved(P<0.05)after treatment in each group,respectively.Conclusion:Cartilage protection drug glucosamine sulfate combined with sodium hyaluronate in the treatment of knee joint Kashin-Beck disease is better than the single use of glucosamine sulfate,which can not only effectively relieve the patient suffering,but also improve the quality of life and repair knee function.
引文
[1]关哲,王文波.大骨节病发病机制研究进展[J].国际骨科学杂志,2016,37(2):89-92.
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[6]Altman R,Asch E,Bloch D,et al.Development of criteria for the classification and reporting of osteoarthritis.Classification of osteoarthritis of the knee.Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association[J].Arthritis Rheum,1986,29(8):1039-1049.
[7]Yu F F,Ping Z G,Yao C,et al.Evaluation of the sensitivity and specificity of the new clinical diagnostic and classification criteria for Kashin-Beck disease,an endemic osteoarthritis,in China[J].Biomed Environ Sci,2017,30(2):150-155.
[8]Yang P,Guo X,He X,et al.The efficacy and safety of intra-articular injection of hyaluronic acid in the knee and physical ther-apy agents to treat Kashin-Beck disease:a prospective interventional study[J].Exp Ther Med,2016,12(2):739-745.
[9]何岱平,李旗,张彦青,等.用SF-36量表评价不同方案治疗成人大骨节病效果[J].中国公共卫生管理,2016,32(4):480-482.
[10]史晓薇,郭雄.COL9A1基因多态性与儿童大骨节病的关联分析[J].中国妇幼健康研究,2016,27(5):556-557,646.
[11]Yu F F,Xia C T,Fang H,et al.Evaluation of the therapeutic effect of treatment with intra-articular hyaluronic acid in knees for Kashin-Beck disease:a meta-analysis[J].Osteoarthritis Cartilage,2014,22(6):718-725.
[12]武世勋,郭雄,张峰,等.大骨节病与骨关节病软骨组织死亡相关因子表达的比较[J].南方医科大学学报,2014,34(12):1785-1789.
[13]刘丹,王治伦,陈庆平,等.NSAIDs联合施沛特关节腔注射治疗成人大骨节病临床观察[J].中国地方病防治杂志,2012,27(1):21-22.
[14]Zhang Y X,Dong W,Liu H,et al.Effects of chondroitin sulfate and glucosamine in adult patients with Kaschin-Beck disease[J].Clin Rheumatol,2010,29(4):357-362.
[15]Liu W,Liu G,Pei F,et al.Kashin-Beck disease in Sichuan,report of a pilot open therapeutic trial[J].J Clin Rheumatol,2012,18(1):8-14.
[16]Tang X,Pei F X,Zhou Z K,et al.A randomized,single-blind comparison of the efficacy and tolerability of hyaluronate acid and meloxicam in adult patients with Kashin-Beck disease of the knee[J].Clin Rheumatol,2012,31(7):1079-1086.
[17]高宗强,郭雄,陈君长,等.大骨节病、骨关节炎软骨细胞分泌IL-1β、TNF-α及透明质酸对其影响实验研究[J].陕西医学杂志,2015,44(7):774-778.
[18]Xia C T,Yu F F,Ren F L,et al.Hyaluronic acid and glucosamine sulfate for adult Kashin-Beck disease:a cluster-randomized,placebo-controlled study[J].Clin Rheumatol,2016,35(5):1263-1270.
[2]黄强,周宗科,马俊,等.WOMAC用于阿坝州成年大骨节病患者关节病损评价的研究[J/CD].中华关节外科杂志(电子版),2013,7(5):683-688.
[3]Wu C,Zheng J,Yao X,et al.Defective autophagy in chondrocytes with Kashin-Beck disease but higher than osteoarthritis[J].Osteoarthritis Cartilage,2014,22(11):1936-1946.
[4]Li S,Cao J,Caterson B,et al.Proteoglycan metabolism,cell death and Kashin-Beck disease[J].Glycoconj J,2012,29(5-6):241-248.
[5]Yue J,Yang M,Yi S,et al.Chondroitin sulfate and/or glucosamine hydrochloride for Kashin-Beck disease:a cluster-randomized,placebo-controlled study[J].Osteoarthritis Cartilage,2012,20(7):622-629.
[6]Altman R,Asch E,Bloch D,et al.Development of criteria for the classification and reporting of osteoarthritis.Classification of osteoarthritis of the knee.Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association[J].Arthritis Rheum,1986,29(8):1039-1049.
[7]Yu F F,Ping Z G,Yao C,et al.Evaluation of the sensitivity and specificity of the new clinical diagnostic and classification criteria for Kashin-Beck disease,an endemic osteoarthritis,in China[J].Biomed Environ Sci,2017,30(2):150-155.
[8]Yang P,Guo X,He X,et al.The efficacy and safety of intra-articular injection of hyaluronic acid in the knee and physical ther-apy agents to treat Kashin-Beck disease:a prospective interventional study[J].Exp Ther Med,2016,12(2):739-745.
[9]何岱平,李旗,张彦青,等.用SF-36量表评价不同方案治疗成人大骨节病效果[J].中国公共卫生管理,2016,32(4):480-482.
[10]史晓薇,郭雄.COL9A1基因多态性与儿童大骨节病的关联分析[J].中国妇幼健康研究,2016,27(5):556-557,646.
[11]Yu F F,Xia C T,Fang H,et al.Evaluation of the therapeutic effect of treatment with intra-articular hyaluronic acid in knees for Kashin-Beck disease:a meta-analysis[J].Osteoarthritis Cartilage,2014,22(6):718-725.
[12]武世勋,郭雄,张峰,等.大骨节病与骨关节病软骨组织死亡相关因子表达的比较[J].南方医科大学学报,2014,34(12):1785-1789.
[13]刘丹,王治伦,陈庆平,等.NSAIDs联合施沛特关节腔注射治疗成人大骨节病临床观察[J].中国地方病防治杂志,2012,27(1):21-22.
[14]Zhang Y X,Dong W,Liu H,et al.Effects of chondroitin sulfate and glucosamine in adult patients with Kaschin-Beck disease[J].Clin Rheumatol,2010,29(4):357-362.
[15]Liu W,Liu G,Pei F,et al.Kashin-Beck disease in Sichuan,report of a pilot open therapeutic trial[J].J Clin Rheumatol,2012,18(1):8-14.
[16]Tang X,Pei F X,Zhou Z K,et al.A randomized,single-blind comparison of the efficacy and tolerability of hyaluronate acid and meloxicam in adult patients with Kashin-Beck disease of the knee[J].Clin Rheumatol,2012,31(7):1079-1086.
[17]高宗强,郭雄,陈君长,等.大骨节病、骨关节炎软骨细胞分泌IL-1β、TNF-α及透明质酸对其影响实验研究[J].陕西医学杂志,2015,44(7):774-778.
[18]Xia C T,Yu F F,Ren F L,et al.Hyaluronic acid and glucosamine sulfate for adult Kashin-Beck disease:a cluster-randomized,placebo-controlled study[J].Clin Rheumatol,2016,35(5):1263-1270.