补肾活血法治疗膝关节骨关节炎的疗效研究
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摘要
目的:观察活血通络汤在治疗膝骨关节炎中的疗效,探讨补肾活血法在膝骨关节炎中的作用。
方法:选择2008年7月至2008年12月间在我院诊断并治疗的60例原发性膝骨关节炎患者,随机分为治疗组(活血通络汤加基础治疗组)及对照组(西乐葆加基础治疗组),每组30例,疗程4周。治疗后参照改良的膝关节骨关节炎病情评分标准及疗效判定标准,从症状体征(膝部疼痛、膝部功能)及中医证候两方面进行疗效观察。疗程结束后作治疗前后的组内对比及组间对比,比较两组疗效。
结果:(1)治疗组与对照组治疗前后的所有项目积分均较自身治疗前减少,具有显著性差异P(<0.01);(2)治疗后两组患者的组间总积分比较与功能积分比较P>0.05,无显著性差异;治疗后两组患者的组间疼痛积分比较与中医证候积分比较P<0.01,具有显著性差异;(3)活血通络汤方在治疗膝骨关节炎疾病疗效上和西乐葆效果相当,而活血通络汤方在改善膝骨关节炎中医证候疗效上优于西乐葆。
结论:临床上应用补肾活血法治疗膝骨关节炎能获得良好的疗效,其主要是针对膝骨关节炎病机——肝肾不足,气血不足为本,气滞血瘀,脉络痹阻为标而辨证用药,达到标本兼治的功效。
Objective:To observe the clinical effect of activating blood and dredging collateral prescription on osteoarthritis of knee(KOA),and study the mechanism of prescriptions for KOA with nourishing kidney and activating blood.
Methods:Sixty patients who were diagnosed as osteoarthritis of knee in Foshan Hospital of TCM from July to December 2008 were randomly divided into two groups on an average:the therapeutic group was using activating blood and dredging collateral prescription and basic treatment,the control group was using celecoxib and basic treatment.Four weeks later,according to the revision classified standard of American rheumatism association' s osteoarthritis and the II issue of clinical test plan for knee osteoarthritis,the changes of main symptoms and signs(ache of the knee,function of the knee)and curative effects according to the theory of TCM were observed,using the improvement grades standard the contrasts were performed between the same group and the different groups.
Result:(1) Accumulative point of symptoms and signs decrease with remarkable difference(P<0.01) after treatment in two groups.But there is no remarkable difference among 2 groups(P>0.05).(2) The integral change of patient' s symptoms and signs and the function integral change between two groups have no remarkable difference(P>0.05),however,the ache integral change and the symptom integral change according to the theory of TCM had significant difference (P<0.05).(3)There is no remarkable difference between two groups to relieve the clinical symptoms and signs,but,the therapeutic group had certain superiority to alleviate the symptom according to the theory of TCM than that of control group.
Conclusion:In clinic,the result for treatment that using nourishing kidney and activating blood provide patients good therapeutic efficacy.The mechanism is that aim at pathogenesis of osteoarthritis of knee that asthenia of the kidney and liver,vital energy and blood deficiency is the essence,vital energy, blood,channels and collaterals blocked are the appearance.Diagnosis and treatment based on the overall analysis of symptoms and signs solve the essence and the appearance.
方法:选择2008年7月至2008年12月间在我院诊断并治疗的60例原发性膝骨关节炎患者,随机分为治疗组(活血通络汤加基础治疗组)及对照组(西乐葆加基础治疗组),每组30例,疗程4周。治疗后参照改良的膝关节骨关节炎病情评分标准及疗效判定标准,从症状体征(膝部疼痛、膝部功能)及中医证候两方面进行疗效观察。疗程结束后作治疗前后的组内对比及组间对比,比较两组疗效。
结果:(1)治疗组与对照组治疗前后的所有项目积分均较自身治疗前减少,具有显著性差异P(<0.01);(2)治疗后两组患者的组间总积分比较与功能积分比较P>0.05,无显著性差异;治疗后两组患者的组间疼痛积分比较与中医证候积分比较P<0.01,具有显著性差异;(3)活血通络汤方在治疗膝骨关节炎疾病疗效上和西乐葆效果相当,而活血通络汤方在改善膝骨关节炎中医证候疗效上优于西乐葆。
结论:临床上应用补肾活血法治疗膝骨关节炎能获得良好的疗效,其主要是针对膝骨关节炎病机——肝肾不足,气血不足为本,气滞血瘀,脉络痹阻为标而辨证用药,达到标本兼治的功效。
Objective:To observe the clinical effect of activating blood and dredging collateral prescription on osteoarthritis of knee(KOA),and study the mechanism of prescriptions for KOA with nourishing kidney and activating blood.
Methods:Sixty patients who were diagnosed as osteoarthritis of knee in Foshan Hospital of TCM from July to December 2008 were randomly divided into two groups on an average:the therapeutic group was using activating blood and dredging collateral prescription and basic treatment,the control group was using celecoxib and basic treatment.Four weeks later,according to the revision classified standard of American rheumatism association' s osteoarthritis and the II issue of clinical test plan for knee osteoarthritis,the changes of main symptoms and signs(ache of the knee,function of the knee)and curative effects according to the theory of TCM were observed,using the improvement grades standard the contrasts were performed between the same group and the different groups.
Result:(1) Accumulative point of symptoms and signs decrease with remarkable difference(P<0.01) after treatment in two groups.But there is no remarkable difference among 2 groups(P>0.05).(2) The integral change of patient' s symptoms and signs and the function integral change between two groups have no remarkable difference(P>0.05),however,the ache integral change and the symptom integral change according to the theory of TCM had significant difference (P<0.05).(3)There is no remarkable difference between two groups to relieve the clinical symptoms and signs,but,the therapeutic group had certain superiority to alleviate the symptom according to the theory of TCM than that of control group.
Conclusion:In clinic,the result for treatment that using nourishing kidney and activating blood provide patients good therapeutic efficacy.The mechanism is that aim at pathogenesis of osteoarthritis of knee that asthenia of the kidney and liver,vital energy and blood deficiency is the essence,vital energy, blood,channels and collaterals blocked are the appearance.Diagnosis and treatment based on the overall analysis of symptoms and signs solve the essence and the appearance.
引文
[1]方锐,孟庆才,王拥军,等.补肾通络方对大鼠膝关节炎软骨中半胱氨酸天冬氨酸特异性蛋白酶3的调节[J].中国临床康复,2006;10(43):67-70.
[2]安莉萍,卫荣,魏晓丽,等.益肾通痹方对膝关节骨性关节炎兔血清和膝关节腔液中炎性细胞因子和一氧化氮含量的影响[J].中国临床康复,2006;10(15):79-81.
[3]郑臣校,黄星垣,郑雨中.补肾通络活血法治疗膝关节骨性关节炎112例临床观察[J].时珍国医国药,2006;17(7):1270-1271.
[4]卢耀明,蔡阳娥,柴生廷,等.关节2号方治疗膝关节骨关节炎的临床研究[J].新中医,2007;39(4):35-36.
[5]刘伟栋.温经通络膏治疗膝关节退行性变[J].中国中医药信息杂志,2003;10(9):44-45.
[6]王友京.针灸对实验性关节炎的治疗作用及其机制的探讨[J].中国针灸,1996;16(2):51-53.
[7]王济纬,杜宁.手法治疗实验性膝骨关节炎研究[J].上海第二医科大学学报,1996;16(6):417-419.
[8]余存泰,徐中和,黄公怡.应力导致关节软骨退变机制的实验研究[J].实用骨科杂志,2004;10(5):411-414.
[9]Larsen RW.IMP with particular reference to massive diaphyheal bone necrosis .Ann Surg,1938,108:127.
[10]Uchio Y,Ochi M,Adachi N,et al.Intraosseous hypertension and venous congestion in osteonecrosis Of the knee[J].Clin Orthop,2001;384(3):217-223.
[11]Fricker C,Bucher K,Stuker G.Are degenerative joint diseases chronic compartment syndromes[J].Schweiz Arch Tierheilkd,1995;137(4):137-140.
[12]莫简,医用氧自由基生物学导论.北京:人民卫生出版社,1989,93-99.
[13]张法浩,王夔.自由基在大骨节病病理过程中的作用:Ⅳ.在自由基及黄腐酸作用[J].北京医科大学学报,1990;22(1):59-61.
[14]Regan E,Flannelly J,Bowler R,et al.Extracellular superoxide dismutase and oxidant damage in osteoarthritis[J].Arthritis Rheum,2005;11:3479-3491.
[15]Ostalowska A,Birkner E,Wiecha M,et al.Lipid peroxidation and antioxidant enzymes in synovial fluid of patients with primary and secondary osteoarthritis of the knee joint[J].Osteoarthritis Cartilage,2006;2:139-145.
[16]Pelletier JP.Martel-Pelletier J,Abramson SB.Osteoarthritis,an inflammatory disease:potential implication for the selection of new therapeutic targets[J].Arthritis Rheum,2001;44:1237-1247.
[17]毕五蝉,王亦驰.膝关节载荷传导紊乱所致关节炎关节软骨退变[J].中华骨科杂志,1991;11(4):30 3.
[18]郑清波,施杞.蛋白酶在骨关节炎软骨退变中的作用[J].中医正骨,1995;7(4):35-36.
[19]Massicotte F.Fernandes JC.Martel-Pelletier J,et al.Modulation of insulin-like growth factor 1 levels in hum an osteoarthritic subchondral bone osteoblasts[J].Bone,2006;38(3):333-341.
[20]张华金,张化东,王焕勤.玻璃酸钠治疗骨关节炎的机制[J].中国生化药物杂志,2005;26(3):190-191.
[21]陈学明,卢森桂,唐焕章.钻孔减压治疗早期退行性膝关节炎[J].中国矫形外科杂志,2000;7(2):115-116.
[22]BELLAMY N,CAMPBELL J,ROBINSON V,et al.Intraarticular corcicostemid for treatnlent Of osteoarthritis of the knee[J].Cochrane Datable Syst Rev,2005;18(2):CD005328.
[23]吕征,张中南.全膝关节表面置换治疗老年严重膝骨关节炎的临床体会[J].实用老年医学,1999;13(2):88-89.
[24]中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中国临床医生杂志,2008;36(1):28-30.
[25]JH Kellgren and Js Lawrenee.Radiological assessment of osteoarthrosis.Ann Rheum Dis,Dec 1957;16(4):494-502.
[26]高益民.膝关节骨关节炎Ⅱ期临床试验方案[J].中药新药与临床药理,1998;9(1):17-18.
[27]N Bellamy.Validation study of WOMAC.J Rheurrmtol,1988;15(12):1833.
[28]MG Leauesne,C Mery.Indexes of severity for osteoarthritis of the hip and knee[J].Scand Rheumatol suppl,1987;65:85-89.
[29]郑筱英.中药新药临床研究指导原则[M].中国医药科技出版社出版,北京:2002,第一版.
[30]Sharma L,Lou C,Cahue S,et al.The mechanism of the effect ofobesity in knee osteoarthritis:the mediating role of malalignment[J].Arthritis Rheum,2000;43:568-575.
[31]Sowers MR,Mc Connell D,Jannausch M,et al.Estradiol and itsmetabolites and their association with knee osteoarthritis[J].Arthritis Rheum,2006;54(8):2481-2487.
[32]Sandell LJ,Aigner T.Articular cartilage and changes in arthritis.Anin-troduction Cell biology of osteoarthritis[J].Arthritis Res,2001;3(2): 107-113.
[33]彭卫国,邹学农,孙材江.膝骨关节炎患者性激素水平测定及临床初步研究[J].中国现代医学杂志,1998;8(3):12-13.
[34]Siler JJ,Einhon TA.Osteoporosis and aging[J].Clin Orthop,1995;316:10-20.
[35]张毓洲 许露玫.正常与骨内高压下骨髓微循环冷冻割断扫描电镜观察[J].中华骨科杂志,1999;19(5):303-306.
[36]Elizabeth T.塞来昔布治疗疼痛及炎症临床前期及临床研究[J].中国新药杂志,2000;9(8):574-576.
[37]王永铭.临床药理学[M].上海:上海医科大学出版社,1999,10.
[38]龙启才 邱建波.威灵仙、秦艽、桑寄生醇提物体外对淋巴细胞和环氧酶的影响[J].中药药理与临床,2004;20(4):26-27.
[39]陈飞雁,王旭,黄加张,等.威灵仙注射液对骨关节炎模型动物软骨组织形态和胶原表达的影响[J].中国矫形外科杂志,2006;14(5):360-363.
[2]安莉萍,卫荣,魏晓丽,等.益肾通痹方对膝关节骨性关节炎兔血清和膝关节腔液中炎性细胞因子和一氧化氮含量的影响[J].中国临床康复,2006;10(15):79-81.
[3]郑臣校,黄星垣,郑雨中.补肾通络活血法治疗膝关节骨性关节炎112例临床观察[J].时珍国医国药,2006;17(7):1270-1271.
[4]卢耀明,蔡阳娥,柴生廷,等.关节2号方治疗膝关节骨关节炎的临床研究[J].新中医,2007;39(4):35-36.
[5]刘伟栋.温经通络膏治疗膝关节退行性变[J].中国中医药信息杂志,2003;10(9):44-45.
[6]王友京.针灸对实验性关节炎的治疗作用及其机制的探讨[J].中国针灸,1996;16(2):51-53.
[7]王济纬,杜宁.手法治疗实验性膝骨关节炎研究[J].上海第二医科大学学报,1996;16(6):417-419.
[8]余存泰,徐中和,黄公怡.应力导致关节软骨退变机制的实验研究[J].实用骨科杂志,2004;10(5):411-414.
[9]Larsen RW.IMP with particular reference to massive diaphyheal bone necrosis .Ann Surg,1938,108:127.
[10]Uchio Y,Ochi M,Adachi N,et al.Intraosseous hypertension and venous congestion in osteonecrosis Of the knee[J].Clin Orthop,2001;384(3):217-223.
[11]Fricker C,Bucher K,Stuker G.Are degenerative joint diseases chronic compartment syndromes[J].Schweiz Arch Tierheilkd,1995;137(4):137-140.
[12]莫简,医用氧自由基生物学导论.北京:人民卫生出版社,1989,93-99.
[13]张法浩,王夔.自由基在大骨节病病理过程中的作用:Ⅳ.在自由基及黄腐酸作用[J].北京医科大学学报,1990;22(1):59-61.
[14]Regan E,Flannelly J,Bowler R,et al.Extracellular superoxide dismutase and oxidant damage in osteoarthritis[J].Arthritis Rheum,2005;11:3479-3491.
[15]Ostalowska A,Birkner E,Wiecha M,et al.Lipid peroxidation and antioxidant enzymes in synovial fluid of patients with primary and secondary osteoarthritis of the knee joint[J].Osteoarthritis Cartilage,2006;2:139-145.
[16]Pelletier JP.Martel-Pelletier J,Abramson SB.Osteoarthritis,an inflammatory disease:potential implication for the selection of new therapeutic targets[J].Arthritis Rheum,2001;44:1237-1247.
[17]毕五蝉,王亦驰.膝关节载荷传导紊乱所致关节炎关节软骨退变[J].中华骨科杂志,1991;11(4):30 3.
[18]郑清波,施杞.蛋白酶在骨关节炎软骨退变中的作用[J].中医正骨,1995;7(4):35-36.
[19]Massicotte F.Fernandes JC.Martel-Pelletier J,et al.Modulation of insulin-like growth factor 1 levels in hum an osteoarthritic subchondral bone osteoblasts[J].Bone,2006;38(3):333-341.
[20]张华金,张化东,王焕勤.玻璃酸钠治疗骨关节炎的机制[J].中国生化药物杂志,2005;26(3):190-191.
[21]陈学明,卢森桂,唐焕章.钻孔减压治疗早期退行性膝关节炎[J].中国矫形外科杂志,2000;7(2):115-116.
[22]BELLAMY N,CAMPBELL J,ROBINSON V,et al.Intraarticular corcicostemid for treatnlent Of osteoarthritis of the knee[J].Cochrane Datable Syst Rev,2005;18(2):CD005328.
[23]吕征,张中南.全膝关节表面置换治疗老年严重膝骨关节炎的临床体会[J].实用老年医学,1999;13(2):88-89.
[24]中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中国临床医生杂志,2008;36(1):28-30.
[25]JH Kellgren and Js Lawrenee.Radiological assessment of osteoarthrosis.Ann Rheum Dis,Dec 1957;16(4):494-502.
[26]高益民.膝关节骨关节炎Ⅱ期临床试验方案[J].中药新药与临床药理,1998;9(1):17-18.
[27]N Bellamy.Validation study of WOMAC.J Rheurrmtol,1988;15(12):1833.
[28]MG Leauesne,C Mery.Indexes of severity for osteoarthritis of the hip and knee[J].Scand Rheumatol suppl,1987;65:85-89.
[29]郑筱英.中药新药临床研究指导原则[M].中国医药科技出版社出版,北京:2002,第一版.
[30]Sharma L,Lou C,Cahue S,et al.The mechanism of the effect ofobesity in knee osteoarthritis:the mediating role of malalignment[J].Arthritis Rheum,2000;43:568-575.
[31]Sowers MR,Mc Connell D,Jannausch M,et al.Estradiol and itsmetabolites and their association with knee osteoarthritis[J].Arthritis Rheum,2006;54(8):2481-2487.
[32]Sandell LJ,Aigner T.Articular cartilage and changes in arthritis.Anin-troduction Cell biology of osteoarthritis[J].Arthritis Res,2001;3(2): 107-113.
[33]彭卫国,邹学农,孙材江.膝骨关节炎患者性激素水平测定及临床初步研究[J].中国现代医学杂志,1998;8(3):12-13.
[34]Siler JJ,Einhon TA.Osteoporosis and aging[J].Clin Orthop,1995;316:10-20.
[35]张毓洲 许露玫.正常与骨内高压下骨髓微循环冷冻割断扫描电镜观察[J].中华骨科杂志,1999;19(5):303-306.
[36]Elizabeth T.塞来昔布治疗疼痛及炎症临床前期及临床研究[J].中国新药杂志,2000;9(8):574-576.
[37]王永铭.临床药理学[M].上海:上海医科大学出版社,1999,10.
[38]龙启才 邱建波.威灵仙、秦艽、桑寄生醇提物体外对淋巴细胞和环氧酶的影响[J].中药药理与临床,2004;20(4):26-27.
[39]陈飞雁,王旭,黄加张,等.威灵仙注射液对骨关节炎模型动物软骨组织形态和胶原表达的影响[J].中国矫形外科杂志,2006;14(5):360-363.