补肾舒筋方内服和熏洗治疗老年早中期膝骨关节炎58例临床分析

Clinical Analysis of Oral and Fumigating-washing Administration of Bushen Shujin Decoction in Treating 58 Patients with Early Metaphase Knee Osteoarthritis

目的:探讨补肾舒筋方内服和熏洗治疗早中期膝骨性关节炎(KOA)的临床疗效及对血清和关节液肿瘤坏死因子-α(TNF-α)和白细胞介素-1β(IL-1β)的影响。方法:将116例患者随机按数字表法分为观察组和对照组各58例。两组均采用膝关节腔玻璃酸钠,关节腔内注射,2 m L/次,1次/周,共5周,必要时口服塞来昔布胶囊,0.2 g/次,1次/d。对照组采用抗骨增生胶囊,5粒/次,3次/d。观察组采用补肾舒筋方内服和熏洗。进行12周的治疗和6个月的随访。分别于治疗前、治疗后12周,治疗结束后6个月(随访)进行骨关节炎指数(WOMAC)量表评分;检测治疗前后关节液和血清TNF-α和IL-1水平。结果:经Ridit分析,观察组临床疗效优于对照组(P<0.05);治疗后两组WOMAC量表疼痛、僵硬和关节功能各维度评分和总分均显著下降,观察组WOMAC各维度评分和总分均低于对照组(P<0.01);随访期两组WOMAC各维度评分和总分均较治疗结束时升高(P<0.01),但观察组WOMAC各维度评分和总分仍然低于对照组(P<0.01);治疗后两组关节液和血清TNF-α和IL-1β水平均下降,治疗后观察组关节液和血清中TNF-α和IL-1β水平低于对照组(P<0.01)。结论:补肾舒筋方内服和熏洗能进一步减轻老年早、中期KOA患者临床症状,且作用更为持久,临床疗效优于抗骨增生胶囊,其作用机制可能与降低血清和关节液TNF-α和IL-1β,抑制炎症反应有关。

Objective： To discuss the curative efficacy of Bushen Shujin decoction in treating early metaphase knee osteoarthritis after oral and fumigating-washing administration, and to investigate its influence on tumor necrosis factor-α （TNF-α） , interleukin-1β （IL-1β） in serum and synovial fluid. Method： One hundred and sixteen patients were randomly divided into the control group （56 cases） and the observation group （56 cases） by a random number table. All patients in both two groups received sodium hyaluronate through intra-articular injection once daily for 5 weeks, and 0.2 g celecoxib capsules once daily when needed. Patients in the control group added 5 Kanggu Zengsheng capsules thrice daily. Patients in the observation group added oral and fumigating-washing administration of Bushen Shujin decoction. All patients in both two groups received 12 weeks of treatment and 6 months of follow-up. Before and after treatment, and during the follow-up, the Western Ontario and McMaster Universities （WOMAC） was evaluated, levels of TNF-α and IL-1β in serum and synovial fluid were detected. Result： The clinical curative effect in the observation group was superior to that in the control group （P 〈 0.05）. The WOMAC score of each dimension including pain, stiffness, joint function and the total score in two groups went down obviously. Besides, the scores were lower in the observation group （P 〈 0.01 ）. During follow-up, WOMAC score of each dimension and the total score in both groups went up compared with before （P 〈 0.01 ） , while the results in the observation group were inferior to those in the control group （P 〈 0.01 ）. Levels ofTNF-α and IL-1β in the joint fluid and serum declined in both groups after therapy, while the results were lower in the observation group （P 〈0.01 ）. Conclusion： Bushen Shujin decoction could reduce the clinical symptoms of early metaphase KOA in elderly patients after oral and fumigating-washing administration. The clinical curative effect is better and longer than Kanggu Zengsheng capsules and last longer. Its mechanism may be related to reducing TNF-α, IL-1β in joint fluid and serum, and inhibiting the inflammatory response.