关节内注射透明质酸治疗骨性关节炎近3年研究进展

Reaseearch progress of intraarticular injection of hyaluronic acid(HA) for osteoarthritis in recent three years

关节内注射透明质酸(HA)治疗骨性关节炎是广泛应用的方法。根据近年文献,从以下4个方面综述研究进展:①作用机制。最近研究以Realtime PCR法检测经HA处理24h的人体滑膜细胞的转移生长因子β1(TGFβ1)、血管内皮生长因子(VEGF)及结缔组织生长因子(CTGF)的基因表达均明显增高,促进基质蛋白酶抑制剂(TIMP)的分泌及合成,故减轻了滑膜炎症及软骨的破坏。②治疗方法。由于新的衍生物产品不断出现,已经有注射1次代替常规的3周或5周1个疗程的方法。为了提高疗效,还有联合用药法(非甾体抗炎药口服或加用其他药物关节内注射)。③适应证:膝关节骨性关节炎K-LⅡ～Ⅲ级为首选,但对K-LⅠ级OA,目前提倡早期应用;对K-LⅣ级,虽然不能改善关节功能,但也能缓解症状。④疗效。经双盲随机对照研究,较皮质激素疗效好、持久而无不良反应。故本法是一种安全、有效及维持长期疗效的方法,应用前景广阔。

Intra articular injection of hyaluronic acid for osteoarthritis is an old and useful method.According to recent literatures,the following four problems were reviewed in this article：①Mechanisms.Real time PCR was used to detect the transforming growth factor beta 1（TGF β1）,vascular endothelial growth factor（VEGF） and connective tissue growth factor（CTGF） gene expression,which were significantly increased,as well as promoted secretion and synthesis of the tissue inhibitors of metalloprotejnasel,thus the reaction and cartilage destruction were decreased.② Methods.Because of discovering of new HA derivants,single intra articular treatment with 6 ml hylan G-F 20 had replaced the routine method of once a week.To improve the therapeutic effectiveness,compound drags were applied,such as NSAIDs.③Indication.Knee OA（K-LⅡ-Ⅲ type） was first elected.But at present,the K-L Ⅰtype was advocated early application.While the K-L Ⅳ type,although joint function can not improve,the symptoms relieved.④Therapeatic effectiveness.The double blind place bo controlled study showed that it was better than corticoid,and persistent and no side effect.Therefore,this was a safe,persistent effective method.