益骨汤治疗风寒湿痹型膝骨关节炎的疗效观察及对骨代谢指标的影响

Curative Observation of Using Yigu Decoction in the Treatment of Cold Dampness Type Knee Osteoarthritis and Its Effect on Bone Metabolism

目的:观察益骨汤治疗膝骨关节炎的临床疗效,并对其相关骨代谢指标进行检测。方法:选取93例膝骨关节炎患者随机分为对照组和观察组,对照组46例,观察组47例,对照组患者口服塞来昔布胶囊0.2g,每天1次,4周为1个疗程,连续治疗2个疗程;观察组采用院内自制中药处方祛痹汤治疗,每日1剂,分早晚2次温服,4周为1个疗程,连续治疗2个疗程。检测2组患者治疗前后关节液及血清中的骨钙素(BGP)、胰岛素样生长因子1(IGF-1)、骨保护素(OPG)及核因子κB受体活化因子配基(RANKL)的含量,并进行统计分析,同时比较2组的疗效,比较2组治疗2个疗程后的膝关节功能以及临床疗效。结果:治疗后2组患者的BGP及OPG的水平明显高于治疗前(P<0.05),RANKL的水平明显低于治疗前(P<0.05),并且治疗后观察组患者的BGP、OPG及RANKL变化程度显著较对照组明显(P<0.05);对照组治疗前后IGF-1水平无显著差异(P>0.05),而观察组治疗后的IGF-1水平较治疗前显著升高(P<0.05),关节液及血清中以上指标的检测结果基本一致。治疗后2组患者的膝关节功能评分均较治疗前有很大改善(P<0.05),并且观察组的膝关节各项功能评分明显较对照组低(P<0.05)。对照组治疗总有效率为82.6%,而观察组治疗总有效率为95.7%,2组比较差异具有统计学意义(P<0.05)。结论:益骨汤治疗膝骨关节炎疗效确切,其机制可能为调节骨代谢水平有关。

Objective： To determine the clinical curative effect of using Yigu Decoction in the treatment of knee osteoarthri- tis, and to detect the related bone metabolism indexes. Methods： 93 cases of knee bone arthritis patients were randomly divided into controlled group and observation group, 46 cases in the controlled group, 47 cases in the observation group, patients in the controlled group orally took celecoxib capsules O. 2g, 1 times a day, 4 weeks for a course of treatment, continuous treatment for 2 courses of treatment ; the observation group was given Self-made Yigu Decoction in the treatment, daily 1 agent, sooner or later, 2 times a day, 4 weeks for a course of treatment, continuous treatment for 2 courses. Before and after the treatment of 2 groups were detected in synovial fluid and Serum Osteocalcin （BGP）, insulin-like growth factor 1 （IGF-1）, a bone protective hormone （OPG） and nuclear factor kappa B receptor activation factor ligand （RANKL） content, and carried on the statistical analysis, and clinical curative effect of knee function and curative effect were compared between the two groups. Results ： After treatment, patients in the two groups of BGP and OPG levels were significantly higher than those before treatment （P 〈 0. 05 ） and RANKL levels were significantly lower in the treatment （ P 〈 0. 05 ）, and after treatment, the observation group of patients with BGP, OPG and RANKL change degree was smaller than that of the controlled group （ P 〈 0. 05） ; the controlled group before and after treatment with IGF-1 levels was no significant difference （ P 〉 0. 05 ） , and IGF-1 levels were observed after the treatment group compared with those before treatment significantly increased （ P 〈 O. 05 ） , detection of serum and synovial fluid in the above in- dicators results were basically the same. The knee function scores of the 2 groups after treatment were significantly improved that compared with before treatment （ P 〈 0. 05 ）, and the score of the knee joint in the observation group was significantly lower than that in the controlled group （P 〈 0. 05）. The total effective rate of the controlled group was 82. 6%, while the total effective rate of the observation group was 95. 7% , the difference between the 2 groups was statistically significant （ P 〈 0. 05 ）. Conclu- sion ： The therapeutic effect of the decoction for treating knee osteoarthritis is definite, and its mechanism may be related to the regulation of bone metabolism.