壳聚糖关节腔注射对骨性关节炎膝关节功能及关节液炎性因子的影响

Effect of articular cavity injection of chitosan on the knee joint function and inflammatory agents of joint fluid in osteoarthritis patients

目的:观察关节腔注射壳聚糖对膝关节骨性关节炎患者关节液炎性因子白细胞介素1、白细胞介素6、超氧化物歧化酶及丙二醛含量的变化,评估壳聚糖关节腔注射对骨性关节炎关节功能的影响。方法:选择2002-09/2004-10遂宁市人民医院骨科20例膝关节骨性关节炎患者,共26膝,其中男7例9膝,女13例17膝;年龄35～72岁;病程6个月～30年。患者均经X射线片证实为膝关节骨性关节炎且自愿参加研究。给予患者关节腔注射10g/L壳聚糖,1个月内2次为1个疗程,每次治疗间隔2周。1年内4个疗程,每个疗程间隔2个月。观察膝关节的休息痛、活动痛、压痛、肿胀和关节功能,以上评定结果(计分)之和为关节功能指数。分值越高表示功能越差。测定治疗后1,4,7,12个月关节液中白细胞介素1和白细胞介素6水平、丙二醛含量和超氧化物歧化酶活性的改变。结果:①治疗后4,7,12个月的关节功能指数(8.6±1.8),(7.3±1.7),(5.6±1.9)分明显低于治疗前(10.5±2.1)分,t=3.256,4.590,5.278,P<0.01。②治疗后1,4,7,12个月关节液白细胞介素1水平(345.9±60.4),(311.7±30.5),(273.5±20.6),(223.5±31.6)ng/L明显低于治疗前(425.3±56.3)ng/L(t=2.956～6.321,P<0.01);白细胞介素6水平(440.7±61.2),(380.7±51.4),(310.8±36.9),(240.8±29.9)

AIM:To investigate the effect of chitosan injected into articular cavity on the index changes of inflammatory agents,including the level of interleukin-1(IL-1) and interleukin-6(IL-6),the activity of superoxide dismutase(SOD) and the content of malondialdehyde(MDA) of joint fluid and on the joint function of knee osteoarthritis(OA) patients. METHODS:Twenty patients(26 knees,9 knees in 7 males and 17 in 13 females) suffering from knee OA for 6 moths to 30 years aged from 35 to 72 years old were selected from Suining People's Hospital from September 2002 to October 2004.Having been finally diagnosed with knee OA by X-ray pictures,all of them were voluntary to attend this study.Chitosan 10 g/L was injected into the articular cavity of patients once for twice within one month as a course.Every treatment was performed every 2 weeks.Four courses were done every 3 months within 1 year.Knee joint rest pain,active pain,tenderness,swelling and joint function grading of the patients were assessed,and the total of above assessed results (scoring)were the indices of joint function.The higher the scores were,the worse the joint function was.The changes of level of IL-1 and IL-6,the activity of SOD and the content of MDA in joint fluid were detected at post-injection 1,4,7 and 12 months. RESULTS:①The indices of joint function at 4,7 and 12 months after treatment were (8.6±1.8),(7.3±1.7) and (5.6±1.9) points,significantly lower than those before treatment[(10.5±2.1) points](t=3.256,4.590,5.278,P< 0.01).②The level of IL-1 in joint fluid at 1,4,7 and 12 months after treatment[(345.9±60.4),(311.7±30.5),(273.5 ±20.6) and (223.5±31.6) ng/L] was significantly lower than that before treatment[(425.3±56.3) ng/L](t=2.956 to 6.321,P< 0.01),and so was the level of IL-6[(440.7±61.2),(380.7±51.4),(310.8 ±36.9) and (240.8±29.9) ng/L at 1,4,7 and 12 months after treatment vs (515.3±45.7) ng/L before treatment,t=3.125 to 5.236,P< 0.01]. ③The activity of SOD at the same time points as above after treatment was [(2.68±0.40),(3.68±0.51),(4.71±0.54) and (5.21±0.60) μkat/L],significantly higher than that after treatment[(1.71±0.59) μkat/L](t =3.025～5.786,P< 0.01).④The content of MDA also at the same time points after treatment[(23.8±2.6),(19.6±2.6),(16.2±2.5) and (13.2±2.5) mmol/L] was significantly lower than that before treatment(30.5±3.4) mmol/L]