强力天麻杜仲丸治疗膝关节骨关节炎的机制研究

A study on the mechanism of Qiangli Tianma Duzhong Wan in treating knee osteoarthritis

目的:探讨强力天麻杜仲丸治疗风寒湿型膝关节骨关节炎的药理机制。方法:选取膝关节骨关节炎患者82例,采用随机数字表法分为对照组和治疗组(每组42例)。对照组给予硫酸氨基葡萄糖口服,治疗组给予强力天麻杜仲丸联合硫酸氨基葡萄糖口服,共治疗3个月。观察两组临床疗效和关节肿痛复发情况,对比治疗前后疼痛视觉模拟评分法(Visual Analogue Scale,VAS)评分、Lysholm膝关节评分、血清肿瘤坏死因子-α(Tumor Necrosis Factor-α,TNF-α)、白细胞介素(Interleukin,IL)-1、软骨寡聚基质蛋白(Cartilage Oligomeric Matrix Protein,COMP)、基质金属蛋白酶(Matrix Metalloproteinases,MMP)3水平。结果:对照组和治疗组总有效率分别为87.5%(35/40)、92.5%(37/40),组间差异无统计学意义(P<0.05),痊愈率、显效率分别为47.5%(19/40)、67.5%(27/40),组间差异存在统计学意义(P<0.05)。两组治疗后VAS评分均明显降低(P<0.05),组间差异无统计学意义(P>0.05)。两组治疗后Lysholm膝关节评分显著升高(P<0.05),组间差异存在统计学意义(P<0.05)。治疗后两组MMP 3、COMP、TNF-α、IL-1均明显下降(P<0.05),治疗组下降更明显(P<0.05)。结论:强力天麻杜仲丸联合硫酸氨基葡萄糖治疗膝关节骨关节炎有较好的临床疗效,能有效降低膝关节炎性反应,改善关节功能,减少关节肿痛的复发。该联合治疗方案有临床推广的价值。其作用机制可能与降调炎症细胞因子及软骨降解蛋白酶相关,相关药理研究有待进一步深入。

Objective:To explore the pharmacological mechanism of Qiangli Tianma Duzhong Wan(强力天麻杜仲丸)in treating knee osteoarthritis.Methods:Eighty-two patients with knee osteoarthritis were randomly divided into the treatment group and the control group according to random number table(with 42 patients in each group).The control group was given oral glucosamine sulfate,and the treatment group was given Qiangli Tianma Duzhong Wan plus glucosamine orally for 3 months.The clinical effects and recurrence of joint swelling and pain in the two groups were observed,the VAS score and Lysholm knee joint scores were observed,and serum TNF-α,IL-1,COMP and MMP3 levels before and after treatment were compared.Results:The study showed that after treatment,the total effective rates in the control group and the treatment group were 87.5%(35/40)and 92.5%(37/40),respectively,and there were no statistical differences between the groups(P>0.05).The healing and significant efficiency was 47.5%(19/40)and 67.5%(27/40),respectively.There were statistical differences between the groups(P<0.05).The VAS scores in both groups were significantly lower than those in the corresponding patients before treatment(P<0.05).There was no statistical difference between the two groups after treatment(P>0.05).Lysholm knee score was significantly increased in two groups after treatment(P<0.05),and there was a statistical difference between the two groups(P<0.05).After treatment,MMP 3,COMP,TNF-αand IL-1 were significantly decreased in both groups(P<0.05),and the decrease was more significant in the treatment group(P<0.05).Conclusion:Qiangli Tianma Duzhong Wan plus glucosamine sulfate has significant clinical effect on KOA,which can effectively reduce the knee arthritis injury,improve joint function,and reduce the relapse of joint swelling and pain.The combined treatment plan has clinical promotion value.The mechanism of action may be related to down-regulating inflammatory cytokines and cartilage-degrading proteases.Related pharmacological studies need to be further studied.