藏药联合富血小板血浆治疗退变性膝关节炎的初期临床研究

Preliminary Clinical Study of Tibetan Medicine Combined with Platelet-rich Plasma in the Treatment of Degenerative Knee Arthritis

目的探讨藏药"二十五味驴血丸"与富血小板血浆(platelet-rich plasma,PRP)联合治疗早、中期膝关节退行性关节炎的临床疗效。方法收集2018-06/2019-06月在日喀则市人民医院就诊的符合早、中期膝关节退行性关节炎的90例患者资料,按照单纯随机抽样法分为藏药组、PRP组及藏药+PRP组,每组30名。所有患者在治疗前,治疗后4、8、12周进行静脉血生化标记物检测及视觉模拟评分(visual analogue scale,VAS)、美国西安大略和麦克马斯特大学(Western Ontario and McMaster University,WOMAC)骨性关节炎指数评分。结果最后共有69例完成本次研究。生化标记物中Ⅰ型前胶原氨基端前肽(amino-terminal typeⅠprocollagen propeptide,PⅠNP)、骨保护素(osteoprotegerin,OPG)、人软骨糖蛋白39(human cartilage glycoprotein 39,YKL-40)、Ⅰ型胶原羧基端端肽2(typeⅡcollagen C-terminal telopeptide,CTX-2)在治疗后12周时均有不同程度改善,PRP组及藏药+PRP组的改善程度优于藏药组(P<0.01)。治疗后3组患者VAS评分在4周时均出现不同程度下降,PRP组及藏药+PRP组下降显著(P<0.01)。3组WOMAC骨性关节炎指数评分在治疗后均出现下降,4周后藏药组下降较慢而其余两组持续下降(P均<0.01)。结论藏药"二十五味驴血丸"和PRP均对早、中期膝关节骨性关节炎的治疗有积极作用。PRP及藏药PRP联合用药的临床效果要优于单独藏药使用。

Objective To investigate the clinical effect of Tibetan medicine‘Ershiwuwei Lvxue wan’combined with platelet-rich plasma(PRP)in the treatment of early and middle stage knee degenerative arthritis.Methods A total of 90 patients with early and middle stage knee degenerative arthritis in author’s hospital from June 2018 to June 2019 were enrolled.The patients were randomly divided into Tibetan medicine group,PRP group and Tibetan medicine combined with PRP group,each group were 30 patients.Biochemical markers in venous blood,visual analogue scale(VAS),and Western Ontario and McMaster University(WOMAC)osteoarthritis index scores were detected in all patients before treatment,4 weeks,8 weeks and 12 weeks after treatment.Results A total of 69 cases were enrolled and completed this study.Biochemical markers such as amino-terminal type I procollagen propeptide(PⅠNP),osteoprotegerin(OPG),human cartilage glycoprotein 39(YKL-40)and typeⅡcollagen C-terminal telopeptide(CTX-2)of three groups were all improved in different degrees in 12 weeks after treatment,the PRP group and Tibetan medicine combined with PRP group was better than that of Tibetan medicine group.The VAS scores of the three groups were decreased in different degrees at four weeks after treatment,while the PRP group and the Tibetan medicine combined with PRP group were decreased significantly(all P<0.01).The WOMAC osteoarthritis index scores of the three groups were decreased significantly after treatment,and the Tibetan medicine group were decreased slowly after four weeks,while the other two groups continued to decline(all P<0.01).Conclusion Tibetan medicine‘Ershiwuwei Lvxue wan’and PRP have positive effects on the treatment of early and middle stage knee degenerative osteoarthritis.The clinical results of PRP and Tibetan medicine combined with PRP are better than that of Tibetan medicine alone.