地奥司明联合艾瑞昔布对下肢骨折患者术后炎性因子和骨代谢水平的影响

Effects of diosmin combined with imrecoxib on postoperative inflammatory factors and bone metabolism in patients with lower limb fracture

目的探讨地奥司明联合艾瑞昔布对下肢骨折患者术后炎性因子和骨代谢水平的影响。方法105例下肢骨折行切开复位内固定术患者随机分为观察组53例和对照组52例。两组术后均给予右旋糖酐40葡萄糖注射液、注射用克林霉素磷酸酯、艾瑞昔布片(0.1 g, po, bid,疗程7 d)治疗,观察组在此基础上加用地奥司明片(0.9 g, po, bid,疗程21 d)。比较治疗前后两组腓肠肌周径、疼痛视觉模拟量表(VAS)评分和血清白细胞介素(IL)-1、 IL-6、 IL-10、肿瘤坏死因子-α(TNF-α)、骨钙素(OC)、骨特异性碱性磷酸酶(BALP)、总Ⅰ型原胶原N-端前肽(tP1NP)、β-Ⅰ型胶原C-末端肽交联(β-CTX)和全段甲状旁腺激素(iPTH)水平的变化,以及深静脉血栓(DVT)发生率。结果治疗3、 7、 14 d时观察组腓肠肌周径均小于对照组(P <0.05, P <0.01),治疗21 d时两组腓肠肌周径差异无显著意义(P>0.05)。治疗3、 7 d时观察组VAS评分低于对照组(P <0.05)。对照组DVT发生率为12%(6/52),高于观察组(2%, 1/53),但组间无显著差异(P> 0.05)。治疗7、 21 d时观察组IL-1、 IL-6和TNF-α水平低于对照组, IL-10水平高于对照组(P <0.05, P <0.01)。入组90 d时观察组OC、 BALP和tP1NP水平高于对照组,β-CTX和iPTH水平低于对照组(P <0.05, P <0.01)。两组均无严重不良反应发生,各不良反应发生率无显著差异(P> 0.05)。结论地奥司明联合艾瑞昔布可发挥协同抗炎作用,促进机体骨代谢水平的恢复,有效减轻下肢骨折患者术后肿胀、疼痛程度。

AIM To explore the effects of diosmin combined with imrecoxib on postoperative inflammatory factors and bone metabolism in patients with lower limb fracture.METHODS One hundred and five patients with lower limb fracture who received open reduction and internal fixation were divided into observation group (n =53)and control group (n =52).All patients were given dextran 40 and glucose injection,clindamycin phosphate for injection and imrecoxib (0.1g,po,bid,×7d),while the observation group received diosmin (0.9g,po,bid,×21d)on basis of conventional therapy.The circumference of gastrocnemius muscle,visual analogue scale (VAS)score of pain,serum levels of interleukin (IL)-1,IL-6,IL-10,tumor necrosis factor-α (TNF-α),osteocalcin (OC),bone alkaline phosphatase (BALP),total procollagen type 1N - peptide (tPINP),beta-C-terminal telopeptide of type I collagen (β-CTX)and intact parathyroid hormone (iPTH)before and after treatment in two groups were observed.The incidence of deep venous thrombosis (DVT)was also observed.RESULTS The values of circumference of gastrocnemius muscle at 3,7and 14d after treatment in the observation group were obviously smaller than those in the control group (P <0.05,P < 0.01).There was no significant difference in circumference of gastrocnemius muscle between the two groups at 21d after treatment (P >0.05).The VAS scores at 3,7d after treatment in the observation group were obviously lower than those in the control group (P <0.05).The incidence of DVT in the control group (12%, 6/52)was higher than that in the observation group (2%,1/53),but there was no significant difference (P > 0.05).The levels of IL-1,IL-6and TNF-α in the observation group at 7,21d after treatment were obviously lower than those in the control group,while the level of IL-10 was obviously higher (P <0.05,P <0.01).The levels of OC,BALP and tP1NP in the observation 90d after enrollment,while the levels of iPTH There was no significant difference in incidence group were obviously higher than those in the control group at and β-CTX were obviously lower (P <0.05,P <0.01). of adverse reactions between the two groups (P >0.05). CONCLUSION Combination of diosmin and imrecoxib has collaborative anti-inflammatory effect to promote recovery of bone metabolism,relieve tumidness and pain degree of lower limb.