中医辨证施治对膝骨关节炎关节液蛋白多糖的影响
摘要
目的:关节液中蛋白多糖的含量变化,反映了软骨的不同病变时期,采用中医辩证治疗,观察其对膝骨关节炎关节液中蛋白多糖的影响。
方法:①对象和分组:2006-12/2007-03中国中医科学院望京医院骨科门诊就诊的膝骨关节炎患者60例,随机分为对照组28例,平均年龄为48.7岁;实验组32例,平均年龄为47.1岁。又将实验组又分肝肾不足、筋脉瘀滞证组11例,脾肾两虚、湿注骨节证组13例,肝肾亏虚、痰瘀交阻证组8例。②干预:实验组予中药颗粒剂口服,1剂/d,服用3个月。肝肾不足、筋脉瘀滞证组服用六味地黄汤(熟地、淮山药、茯苓等);脾肾两虚、湿注骨节证组服用除湿通痹汤(威灵仙、鸡血藤、薏仁等);肝肾亏虚、痰瘀交阻证组服用左归汤(熟地、淮山药、山臾肉等)。对照组予盐酸氨基葡萄糖和塞来昔布口服治疗。③评估:两组随访3个月,分别于第1次及最后1次治疗时抽取关节液,行蛋白多糖检测,并行膝骨性关节炎严重性指数(ISOA)评分。
结果:60例患者进入结果分析。①实验组和对照组蛋白多糖:治疗前差异无显著性(P > 0.05),治疗后实验组蛋白多糖降低(P < 0.05)。②实验组中医3个证型蛋白多糖:治疗前后对比差异有显著性(P < 0.05),而各证型之间差异无显著性(P > 0.05)。③膝骨性关节炎严重性指数评分:两种治疗方案均能显著缓解临床症状(P < 0.05),但实验组改善程度及疗效明显优于对照组(P < 0.05)。
结论:中医辨证治疗膝骨关节炎是一种有效方法,其疗效明显优于非甾体抗炎药和氨基单糖药物治疗,而关节液中蛋白多糖是一项灵敏而客观的临床检验指标。
AIM: Level changes of proteoglycan (PG) in the synovial fluid is an indicator of cartilaginous affection by stages. This study was designed to evaluate the effect of Chinese medicine treatment according to syndrome differentiation on the PG in the synovial fluid of knee osteoarthritis.
METHODS:①From December 2006 to March 2007, sixty patients with knee osteoarthritis admitted in the Outpatient Department of Orthopaedics, Wangjing Hospital, China Academy of Chinese Medical Sciences, were divided into treatment group (n=32, mean age 47.1 years) and control group (n=28, mean age 48.7 years) by random. The treatment group was consisted by three Chinese disease models, 11 cases with deficiency of liver and kidney and stasis of tendons and vessels (model A), 13 cases with insufficiency of spleen and kidney and dampness infusion into bone and joints (model B), and 8 cases with insufficiency of liver and kidney and obstruction of channels by phlegm (model C).②The treatment group took Chinese medicine particles orally, one administration per day, totally 3 months; A model was treated with Liuwei Dihuang Tang (consisting of Shudi, Huaishanyao and Fuling, etc); B model was treated with Chushi Tongbi Tang (consisting of Weilingxian, Jixueteng and Yiren, etc); C model was treated with Zuogui Tang (consisting of Shudi, Huaishanyao and Shanyurou, etc). The control group got normal treatment as taking celecoxib and Glucosamine Hydrochloride Capsules.③Both groups were followed up 3 months. The synovial fluid was taken by the first and the last time to detect the level of PG. The patients also took the index of severity for osteoarthritis of the knee (ISOA) grades system to evaluate the treatment effect.
RESULTS: All of 60 patients were involved in the result analysis.①No significant differences were found in the PG level before treatment (P > 0.05), after the treatment, the level in the treatment group went down obviously compared with the control group (P < 0.05).②By contrasting the PG levels before and after the treatment, there was a significant difference in the treatment group (P < 0.05), while no difference among the three Chinese disease models (P > 0.05).③The ISOA grades system showed both of the two treatment methods could significantly release patients' clinical syndrome (P < 0.05), and the effect of treatment group was much better than the control group (P < 0.05).
CONCLUSION: Chinese medicine treatment according to syndrome differentiation is an efficient therapy to the knee osteoarthritis, and its effect is superior to that of non-steroidal anti-inflammatory drug and amino monosaccharides drug treatment. The PG level in the synovial fluid can be a sensitive and objective clinical guidepost.
方法:①对象和分组:2006-12/2007-03中国中医科学院望京医院骨科门诊就诊的膝骨关节炎患者60例,随机分为对照组28例,平均年龄为48.7岁;实验组32例,平均年龄为47.1岁。又将实验组又分肝肾不足、筋脉瘀滞证组11例,脾肾两虚、湿注骨节证组13例,肝肾亏虚、痰瘀交阻证组8例。②干预:实验组予中药颗粒剂口服,1剂/d,服用3个月。肝肾不足、筋脉瘀滞证组服用六味地黄汤(熟地、淮山药、茯苓等);脾肾两虚、湿注骨节证组服用除湿通痹汤(威灵仙、鸡血藤、薏仁等);肝肾亏虚、痰瘀交阻证组服用左归汤(熟地、淮山药、山臾肉等)。对照组予盐酸氨基葡萄糖和塞来昔布口服治疗。③评估:两组随访3个月,分别于第1次及最后1次治疗时抽取关节液,行蛋白多糖检测,并行膝骨性关节炎严重性指数(ISOA)评分。
结果:60例患者进入结果分析。①实验组和对照组蛋白多糖:治疗前差异无显著性(P > 0.05),治疗后实验组蛋白多糖降低(P < 0.05)。②实验组中医3个证型蛋白多糖:治疗前后对比差异有显著性(P < 0.05),而各证型之间差异无显著性(P > 0.05)。③膝骨性关节炎严重性指数评分:两种治疗方案均能显著缓解临床症状(P < 0.05),但实验组改善程度及疗效明显优于对照组(P < 0.05)。
结论:中医辨证治疗膝骨关节炎是一种有效方法,其疗效明显优于非甾体抗炎药和氨基单糖药物治疗,而关节液中蛋白多糖是一项灵敏而客观的临床检验指标。
AIM: Level changes of proteoglycan (PG) in the synovial fluid is an indicator of cartilaginous affection by stages. This study was designed to evaluate the effect of Chinese medicine treatment according to syndrome differentiation on the PG in the synovial fluid of knee osteoarthritis.
METHODS:①From December 2006 to March 2007, sixty patients with knee osteoarthritis admitted in the Outpatient Department of Orthopaedics, Wangjing Hospital, China Academy of Chinese Medical Sciences, were divided into treatment group (n=32, mean age 47.1 years) and control group (n=28, mean age 48.7 years) by random. The treatment group was consisted by three Chinese disease models, 11 cases with deficiency of liver and kidney and stasis of tendons and vessels (model A), 13 cases with insufficiency of spleen and kidney and dampness infusion into bone and joints (model B), and 8 cases with insufficiency of liver and kidney and obstruction of channels by phlegm (model C).②The treatment group took Chinese medicine particles orally, one administration per day, totally 3 months; A model was treated with Liuwei Dihuang Tang (consisting of Shudi, Huaishanyao and Fuling, etc); B model was treated with Chushi Tongbi Tang (consisting of Weilingxian, Jixueteng and Yiren, etc); C model was treated with Zuogui Tang (consisting of Shudi, Huaishanyao and Shanyurou, etc). The control group got normal treatment as taking celecoxib and Glucosamine Hydrochloride Capsules.③Both groups were followed up 3 months. The synovial fluid was taken by the first and the last time to detect the level of PG. The patients also took the index of severity for osteoarthritis of the knee (ISOA) grades system to evaluate the treatment effect.
RESULTS: All of 60 patients were involved in the result analysis.①No significant differences were found in the PG level before treatment (P > 0.05), after the treatment, the level in the treatment group went down obviously compared with the control group (P < 0.05).②By contrasting the PG levels before and after the treatment, there was a significant difference in the treatment group (P < 0.05), while no difference among the three Chinese disease models (P > 0.05).③The ISOA grades system showed both of the two treatment methods could significantly release patients' clinical syndrome (P < 0.05), and the effect of treatment group was much better than the control group (P < 0.05).
CONCLUSION: Chinese medicine treatment according to syndrome differentiation is an efficient therapy to the knee osteoarthritis, and its effect is superior to that of non-steroidal anti-inflammatory drug and amino monosaccharides drug treatment. The PG level in the synovial fluid can be a sensitive and objective clinical guidepost.
引文
1、 Lequesne M. Indice of severity and disease activity for osteoarthritis. Sentin Arthritis R heum 1991;20(Supp12):48
2、邱贵兴.骨关节流行病学和病因学新发展[J].流行病学,2005,19(7):68-69
3、卫晓恩,庄志杰,石印玉.不同年龄段骨关节炎患者关节滑液中基质蛋白多糖的变化[J].中国临床康复,2005,9(30):138-139
4、王玉泉,宋敏,柴举龙. 蛋白多糖与骨性关节炎的研究[J].中医正骨,2005,17(4):60-61
5、Legate A, Garon M, Guardo R, et al.Detection and analysis of cartilage degeneration by spatially resolved streaming potentials.J Orthop Res 2002;20(4):819-826
6、王秀华,田万斌,刘元禄. 关节软骨损伤修复的实验研究及临床应用进展[J]. 辽宁中医学院报,2001,3(1):68-69
7、张士敏,庞国勋,朱永红.非甾体抗炎药物的作用机制及进展[J]. 河北医药,2004,26(9):742
8、 贺宪,魏春山.膝骨性关节炎的病机和防治机制探讨[J].山东中医杂志,2005,24(2):73-75
9、 刘昆鹏,陈百成.关节内注射糖皮质激素对关节软骨影响的实验研究[J].中国矫形外科杂志,2001,8(7):674-677
10、张洪美,荆琳,闵重函. 关节置换围手术期 COX-2 抑制剂联合镇痛泵的疗效研究[J]. 中华临床医师杂志(电子版),2007,1(4):291-292
11、沈霖.补肾健骨汤对膝骨性关节病患者氧自由基代谢的影响[J].中国骨伤,1996,9(4):8
12、彭忠政,彭江云.膝骨关节炎中医治疗进展[J].云南中医中药杂志,2007,28(3):40-42
13、牛洁, 殷海波.中医药治疗膝骨性关节炎的临床研究[J].中医正骨,2007,19(2):66-68
14 、张信成 , 仇湘中. 中医内治法治疗膝骨性关节炎概况 [J]. 湖南中医杂志,2007,23(1),90-92
2、邱贵兴.骨关节流行病学和病因学新发展[J].流行病学,2005,19(7):68-69
3、卫晓恩,庄志杰,石印玉.不同年龄段骨关节炎患者关节滑液中基质蛋白多糖的变化[J].中国临床康复,2005,9(30):138-139
4、王玉泉,宋敏,柴举龙. 蛋白多糖与骨性关节炎的研究[J].中医正骨,2005,17(4):60-61
5、Legate A, Garon M, Guardo R, et al.Detection and analysis of cartilage degeneration by spatially resolved streaming potentials.J Orthop Res 2002;20(4):819-826
6、王秀华,田万斌,刘元禄. 关节软骨损伤修复的实验研究及临床应用进展[J]. 辽宁中医学院报,2001,3(1):68-69
7、张士敏,庞国勋,朱永红.非甾体抗炎药物的作用机制及进展[J]. 河北医药,2004,26(9):742
8、 贺宪,魏春山.膝骨性关节炎的病机和防治机制探讨[J].山东中医杂志,2005,24(2):73-75
9、 刘昆鹏,陈百成.关节内注射糖皮质激素对关节软骨影响的实验研究[J].中国矫形外科杂志,2001,8(7):674-677
10、张洪美,荆琳,闵重函. 关节置换围手术期 COX-2 抑制剂联合镇痛泵的疗效研究[J]. 中华临床医师杂志(电子版),2007,1(4):291-292
11、沈霖.补肾健骨汤对膝骨性关节病患者氧自由基代谢的影响[J].中国骨伤,1996,9(4):8
12、彭忠政,彭江云.膝骨关节炎中医治疗进展[J].云南中医中药杂志,2007,28(3):40-42
13、牛洁, 殷海波.中医药治疗膝骨性关节炎的临床研究[J].中医正骨,2007,19(2):66-68
14 、张信成 , 仇湘中. 中医内治法治疗膝骨性关节炎概况 [J]. 湖南中医杂志,2007,23(1),90-92