柔肝和化痰中药复方对膝骨关节炎患者关节功能及关节液软骨寡聚基质蛋白浓度的影响

Effect of nourishing liver compounds(TCD) and expelling phlegm compounds(TCD) on knee joint function and the synovial fluid concentration of cartilage oligomeric matrix protein in patients with knee osteoarthritis

目的:比较柔肝和化痰中药复方对膝骨关节炎患者膝关节功能及关节液软骨寡聚基质蛋白浓度的影响及其安全性。方法:将61例符合要求的膝骨关节炎患者随机分为2组,Ⅰ组32例,Ⅱ组29例。Ⅰ组患者口服柔肝中药复方治疗,Ⅱ组口服化痰中药复方治疗。分别于治疗前和治疗4周后采用酶联免疫吸附法测定患者膝关节液中软骨寡聚基质蛋白的浓度,并采用自拟的膝关节功能评分量表评定患者的膝关节功能,同时观察记录2组患者治疗期间的不良反应发生情况。结果:①关节液COMP浓度测定结果。治疗前2组患者膝关节液中软骨寡聚基质蛋白浓度比较,差异无统计学意义[(4.35±1.42)ng·mL-1,(4.77±1.74)ng·mL-1,t=1.437,P=0.601];治疗后2组患者膝关节滑液中软骨寡聚基质蛋白浓度均降低[(4.21±1.66)ng·mL-1,(3.51±1.25)ng·mL-1],Ⅱ组降低程度更明显[(0.35±0.12)ng·mL-1,(1.05±0.09)ng·mL-1,t=4.024,P=0.038]。②膝关节功能评定结果。治疗前2组患者膝关节功能评分比较,差异无统计学意义[(20.63±4.89)分,(19.94±4.92)分,t=1.458,P=0.546];治疗后2组患者膝关节功能评分均降低[(9.25±3.01)分,(9.13±2.83)分],2组治疗前后降低程度比较,差异无统计学意义[(10.54±4.15)分,(9.97±4.07)分,t=1.913,P=0.205]。③不良反应评定结果。2组患者治疗期间均未发生与药物相关的不良反应。结论:与柔肝中药复方相比,化痰中药复方能更好地抑制膝骨关节炎患者软骨寡聚基质蛋白分泌,但二者改善膝关节功能的作用及其安全性相当。

Objectlve：To compare nourishing liver compounds（TCD） with expelling phlegm compounds （TCD）in the safety and effect on knee joint function and the synovial fluid concentration of cartilage oligomeric matrix protein（COMP） in patients with knee osteoarthritis. Methods：Sixty-one patients with knee osteoarthritis were included into the study and were randomly divided into 2 groups,32 patients in group I were administrated with nourishing liver compounds（ TCD）, while the others in group lI were administrated with expelling phlegm compounds（TCD）. The synovial fluid concentration of COMP were detected by enzyme-linked immunosorbent assay before the treatment and 4 weeks after the treatment respectively, and the knee joint functions were evaluated according to the self-designed knee joint function scale. Meantime, the adverse reactions were observed and recorded. Results：There was no statistical difference in the concentration of COMP in synovial fluid between the 2 groups before the treatment（4.35 4/- 1.42 vs 4.77 4/- 1.74 ng/mL,t = 1. 437 ,P = 0. 601 ） ,while the COMP concentration decreased in both of the 2 groups after the treatment, and the COMP concentration decreased more significantly in the group U （0.35 4/- 0.12 vs 1.05 4/- 0.09 ng,/mL, t = 4. 024, P = 0. 038 ）. There was no statistical difference in knee joint functional scores between the 2 groups before the treatment （20.63 4/- 4.89 vs 19.94 4/- 4.92 points, t = 1. 458, P = 0. 546）, while the knee joint function scores decreased in both of the 2 groups after the treatment （9.25 ＋/-3.01 vs 9.13 4/-2.83 points）, and there was no statistical difference between the 2 groups in the degree of decrease in knee joint function scores （ 10.54 4/- 4. 15 vs 9.97 4/- 4.07 points, t = 1. 913, P = 0. 205 ）. No adverse reactions related to drugs were found during the treatment in both of the 2 groups. Conclusion：For patientswith knee osteoarthritis, nourishing liver compounds （ TCD ） and expelling phlegm compounds （ TCD ） have similar effects in improving the knee joint function, and they are similar to each other in safety, while the latter is more helpful to inhibit the secretion of COMP.