齐刺配合短波治疗膝关节骨性关节炎疗效及对关节液IL-1β、TNF-α及MMP-3的影响
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摘要
目的:观察齐刺配合短波治疗膝关节骨性关节炎(KOA)的临床疗效及对关节液中白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)和基质金属蛋白酶-3(MMP-3)的影响。方法:136例KOA患者被随机分为综合治疗组和对照组,每组各68例,对照组采用美洛昔康片和盐酸氨基葡萄糖胶囊治疗,综合治疗组采用齐刺配合短波治疗。采用视觉模拟量表(VAS)和骨性关节炎指数可视化量表(WOMAC)从疼痛和关节功能两个方面评价KOA患者症状改善情况,观察两组患者的临床疗效,并比较两组患者治疗前后关节液中IL-1β、TNF-α和MMP-3的变化。结果:两组患者治疗后VAS评分和WOMAC评分均较治疗前明显降低(P<0.01),且综合治疗组低于对照组(P<0.01)。综合治疗组总有效率为92.65%,明显高于对照组的83.82%,两组比较差异有统计学意义(P<0.05)。两组治疗后关节液中IL-1β、TNF-α及MMP-3含量均较治疗前明显下降(P<0.01),且综合治疗组较对照组下降更显著(P<0.01)。结论:齐刺配合短波可减轻KOA患者疼痛,改善膝关节功能,临床疗效显著,其作用机制可能与降低关节液中炎症因子IL-1β、TNF-α和MMP-3水平有关。
Objective: To observe the clinical effect of triple needling combined with short wave therapy in treatment of knee osteoarthritis( KOA) and its intervention on the levels of interleukin-1β( IL-1β),tumor necrosis factor-α( TNF-α) and matrix metalloproteinase-3( MMP-3) in synovial fluid. Methods: A total of136 patients with KOA were randomly divided into the comprehensive treatment group( n = 68) and the control group( n = 68). The control group was treated with Meloxicam and Glucosamine Hydrochloride,and the comprehensive treatment group was treated by triple needling combined with short wave therapy. The scores of visual analogue scale( VAS) and osteoarthritis index visual scale( WOMAC) were used to evaluate the improvement of symptoms in KOA patients from two aspects,i. e. pain relief and joint function. The clinical efficacy of the two groups was observed,and the changes of IL-1β,TNF-α and MMP-3 in synovial fluid were compared between the two groups before and after the treatment. Results: The VAS score and WOMAC score were both significantly lowered after the treatment in the two groups( P < 0. 01),of which the comprehensive treatment group was superior to the control group( P < 0. 01). The total effective rate was 92. 65% in the comprehensive treatment group,which was significantly higher than 83. 82% in the control group( P < 0. 05). The levels of IL-1β,TNF-α and MMP-3 in synovial fluid were significantly reduced after the treatment in the two groups( P < 0. 01); of which the reduction of the comprehensive treatment group was more significant than that of the control group( P < 0. 01). Conclusion: Triple needling combined with short wave therapy can alleviate pain and improve knee function in the patients with KOA,and the clinical efficacy was remarkable. The mechanism of this action may be related to the decrease of IL-1β,TNF-α and MMP-3 in synovial fluid.
Objective: To observe the clinical effect of triple needling combined with short wave therapy in treatment of knee osteoarthritis( KOA) and its intervention on the levels of interleukin-1β( IL-1β),tumor necrosis factor-α( TNF-α) and matrix metalloproteinase-3( MMP-3) in synovial fluid. Methods: A total of136 patients with KOA were randomly divided into the comprehensive treatment group( n = 68) and the control group( n = 68). The control group was treated with Meloxicam and Glucosamine Hydrochloride,and the comprehensive treatment group was treated by triple needling combined with short wave therapy. The scores of visual analogue scale( VAS) and osteoarthritis index visual scale( WOMAC) were used to evaluate the improvement of symptoms in KOA patients from two aspects,i. e. pain relief and joint function. The clinical efficacy of the two groups was observed,and the changes of IL-1β,TNF-α and MMP-3 in synovial fluid were compared between the two groups before and after the treatment. Results: The VAS score and WOMAC score were both significantly lowered after the treatment in the two groups( P < 0. 01),of which the comprehensive treatment group was superior to the control group( P < 0. 01). The total effective rate was 92. 65% in the comprehensive treatment group,which was significantly higher than 83. 82% in the control group( P < 0. 05). The levels of IL-1β,TNF-α and MMP-3 in synovial fluid were significantly reduced after the treatment in the two groups( P < 0. 01); of which the reduction of the comprehensive treatment group was more significant than that of the control group( P < 0. 01). Conclusion: Triple needling combined with short wave therapy can alleviate pain and improve knee function in the patients with KOA,and the clinical efficacy was remarkable. The mechanism of this action may be related to the decrease of IL-1β,TNF-α and MMP-3 in synovial fluid.
引文
[1]Eeva-Eerika Helminen,Sanna H Sinikallio,Anna L Valjakka,et al.Determinants of pain and functioning in knee osteoarthritis:a oneyear prospective study[J].Clin Rehabil,2016,30(9):890-900.
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[4]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.
[5]敖金波,郭俐宏,吴松.温针灸疗配合外敷自制威灵仙浸膏治疗膝骨性关节炎临床研究[J].针灸临床杂志,2017,33(6):25-29.
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[7]Tarek Boutefnouchet,Guru Puranik,Esther Holmes,et al.Hylan GF-20 Viscosupplementation in the Treatment of Symptomatic Osteoarthritis of the Knee:Clinical Effect Survivorship at 5 Years[J].Knee Surg Relat Res,2017,29(2):129-136.
[8]刚嘉鸿,宓轶群,王华敏.电针与美洛昔康治疗早中期膝骨关节炎临床疗效比较:随机对照研究[J].中国针灸,2016,36(5):467-470.
[9]芦丹,汪亚群,孙迪.独活寄生汤对膝骨性关节炎患者关节液炎症因子、疗效及膝关节功能状况的影响分析[J].中华中医药学刊,2017,35(4):78-80.
[10]冯宇,陈滨,张闽光.浮针疗法对膝骨性关节炎患者关节滑液中炎症因子IL-1β、IL-6及TNF-α的影响[J].北京中医药,2017,36(2):156-159.
[11]赵耀东,韩豆瑛,元永金,等.三才齐刺法治疗膝关节骨性关节炎30例[J].中医研究,2016,29(9):45-48.
[12]聂斌,晏艳平,张晓燕,等.齐刺滞针经筋疗法对膝骨性关节炎镇痛及改善症状研究[J].针灸临床杂志,2015,31(2):43-45.
[13]Jin-Hong Kim,Ja-Young Kim,Cheol-Min Choi,et al.The DoseRelated Effects of Extracorporeal Shock Wave Therapy for Knee Osteoarthritis[J].Ann Rehabil Med,2015,39(4):616-623.
[14]董宪传,方振伟,关雪峰.雷火灸联合超短波治疗膝关节骨关节炎临床疗效观察[J].辽宁中医药大学学报,2017,19(10):175-177.
[15]Rilong Jin,Miaoda Shen,Liedao Yu,et al.Adipose-Derived Stem Cells Suppress Inflammation Induced by IL-1βthrough Down-Regulation of P2X7R Mediated by miR-373 in Chondrocytes of Osteoarthritis[J].Mol Cells,2017,40(3):222-229.
[16]Daisuke Hamada,Robert Maynard,Eric Schott,et al.Suppressive Effects of Insulin on Tumor Necrosis Factor-Dependent Early Osteoarthritic Changes Associated With Obesity and Type 2 Diabetes Mellitus[J].Arthritis Rheumatol,2016,68(6):1392-1402.
[17]黄媛霞,徐海斌,郭春.白细胞介素-1β、肿瘤坏死因子-α及基质金属蛋白酶13在骨性关节炎中的表达及相关性[J].广东医学,2017,38(15):2301-2304.
[18]Dong-Geun Kang,Hyun Jae Lee,Kun Tae Kim,et al.Effect of oleanolic acid on the activity,secretion and gene expression of matrix metalloproteinase-3 in articular chondrocytes in vitro and the production of matrix metalloproteinase-3 in vivo[J].Korean J Physiol Pharmacol,2017,21(2):197-204.
[2]范淑敏.针刺配合电磁波照射治疗寒湿痹阻型膝关节骨性关节炎50例[J].中国针灸,2016,36(8):797-798.
[3]中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中华关节外科杂志(电子版),2007,1(4):287-291.
[4]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.
[5]敖金波,郭俐宏,吴松.温针灸疗配合外敷自制威灵仙浸膏治疗膝骨性关节炎临床研究[J].针灸临床杂志,2017,33(6):25-29.
[6]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:人民卫生出版社,2002:130-131.
[7]Tarek Boutefnouchet,Guru Puranik,Esther Holmes,et al.Hylan GF-20 Viscosupplementation in the Treatment of Symptomatic Osteoarthritis of the Knee:Clinical Effect Survivorship at 5 Years[J].Knee Surg Relat Res,2017,29(2):129-136.
[8]刚嘉鸿,宓轶群,王华敏.电针与美洛昔康治疗早中期膝骨关节炎临床疗效比较:随机对照研究[J].中国针灸,2016,36(5):467-470.
[9]芦丹,汪亚群,孙迪.独活寄生汤对膝骨性关节炎患者关节液炎症因子、疗效及膝关节功能状况的影响分析[J].中华中医药学刊,2017,35(4):78-80.
[10]冯宇,陈滨,张闽光.浮针疗法对膝骨性关节炎患者关节滑液中炎症因子IL-1β、IL-6及TNF-α的影响[J].北京中医药,2017,36(2):156-159.
[11]赵耀东,韩豆瑛,元永金,等.三才齐刺法治疗膝关节骨性关节炎30例[J].中医研究,2016,29(9):45-48.
[12]聂斌,晏艳平,张晓燕,等.齐刺滞针经筋疗法对膝骨性关节炎镇痛及改善症状研究[J].针灸临床杂志,2015,31(2):43-45.
[13]Jin-Hong Kim,Ja-Young Kim,Cheol-Min Choi,et al.The DoseRelated Effects of Extracorporeal Shock Wave Therapy for Knee Osteoarthritis[J].Ann Rehabil Med,2015,39(4):616-623.
[14]董宪传,方振伟,关雪峰.雷火灸联合超短波治疗膝关节骨关节炎临床疗效观察[J].辽宁中医药大学学报,2017,19(10):175-177.
[15]Rilong Jin,Miaoda Shen,Liedao Yu,et al.Adipose-Derived Stem Cells Suppress Inflammation Induced by IL-1βthrough Down-Regulation of P2X7R Mediated by miR-373 in Chondrocytes of Osteoarthritis[J].Mol Cells,2017,40(3):222-229.
[16]Daisuke Hamada,Robert Maynard,Eric Schott,et al.Suppressive Effects of Insulin on Tumor Necrosis Factor-Dependent Early Osteoarthritic Changes Associated With Obesity and Type 2 Diabetes Mellitus[J].Arthritis Rheumatol,2016,68(6):1392-1402.
[17]黄媛霞,徐海斌,郭春.白细胞介素-1β、肿瘤坏死因子-α及基质金属蛋白酶13在骨性关节炎中的表达及相关性[J].广东医学,2017,38(15):2301-2304.
[18]Dong-Geun Kang,Hyun Jae Lee,Kun Tae Kim,et al.Effect of oleanolic acid on the activity,secretion and gene expression of matrix metalloproteinase-3 in articular chondrocytes in vitro and the production of matrix metalloproteinase-3 in vivo[J].Korean J Physiol Pharmacol,2017,21(2):197-204.