透明质酸钠治疗膝骨性关节炎的临床效果及分析

STUDY ON THE EFFECT OF SODIUM HYALURONATE INTRA-ARTICULAR INJECTION ON THE TREATMENT OF KNEE OSTEOARTHRITIS

目的 观察透明质酸钠 (sodium hyaluronate,SH)关节腔内注射治疗膝骨性关节炎 (osteoarthritis,OA)的临床效果及治疗前后关节液中自由基和炎性介质含量的变化。 方法 92例 (111膝 ) OA患者 ,其中男 30例 ,女6 2例 ;年龄 2 1～ 71岁 ,平均 4 7.5岁。分轻度组 5 1膝 ,中度组 35膝 ,重度组 2 5膝。关节内每周注射 SH2 0 mg一次 ,共 5次 ,按 L ysholm膝关节功能评分比较治疗前后关节症状和功能的改善情况 ,并测定第 1、2和 5周 SH注射前和注射后 3个月抽取的关节液中一氧化氮 (nitric oxide,NO)、超氧化物歧化酶 (superoxide dismutase,SOD)、丙二醛 (malonicdialodehyde,MDA)和白细胞介素 1β(interlukin1β,IL- 1β)、肿瘤坏死因子 α(tumour necrosis factorα,TNF- α)的含量。 结果 随访 3个月 ,治疗效果优 4 2膝 ,良 38膝 ,可 2 1膝 ,差 10膝 ,优良率 72 .1%。病情越轻 ,治疗见效越早 ,疗效越好。SH治疗后轻、中度组患者关节液中 ,氧自由基含量和 IL- 1β、TNF- α含量明显下降 (P<0 .0 5 ) ,重度组变化不显著 (P>0 .0 5 ) ;SH对 NO含量影响较小 ,只有轻度组治疗后 3个月较治疗前明显减少 (P<0 .0 5 ) ,中、重度组变化不大 (P>0 .0 5 )。 结论 SH关节腔内注射治疗膝 OA,可缓解临床症状 。

Objective To investigate the effect of sodium hyaluronate (SH) intra articular injection on the treatment of knee osteoarthritis (OA), and to compare the contents of free radicals and inflammatory factors in joint fluids of pre and pro treatment as to explore the treatment mechanism of SH. Methods Ninety two patients (111 knees) with mild(51),moderate(35) and serious(25) knee OA were treated with intra articular injections of SH (20 mg once a week for 5 weeks). According to Lysholm scoring, clinical signs such as pain, swelling,and the ability to walk, squat, run, go upstairs and downstairs were assessed before and after the treatment, and the contents of nitric oxide (NO), superoxide dismutase(SOD), malonic dialdehyde(MDA) and IL 1β、TNF α in joint fluids from the OA joints before 1st,2nd, and 5th injection and 3 months after each injection were observed. Results All cases were followed up for 3 months. The improvements in the signs and function of knees were excellent in 42 knees, good in 38 knees, fair in 21 knees and poor in 10 knees, with 72.1% excellent and good results. The lighter the illness was, the better the improvement was: the rate of the excellent and good was 92.1% in mild group, 68.6% in moderate group and 42.9% in serious group. The contents of oxygen free radicals and IL 1β、TNF α of the patients with mild and moderate OA decreased markedly after being treated with SH( P <0.05), but these decreased lightly in serious OA group( P >0.05). SH had mild effect on the contents of NO. Three months after treatment, only in mild OA group the contents of NO significantly decreased( P <0.05), and no significant change in moderate and serious groups was observed( P >0.05). Conclusion SH intra articular injection has a positive effect on the relief of clinical symptoms and on the improvement of articular function of knee OA. The therapeutical effect of SH on OA is achieved possibly by decreasing the contents of free radicals especially oxygen free radicals and inflammatory factors in joint fluids.