独活寄生汤对髌骨软化症髌骨软骨及膝关节液中IL-1,MMP-1,GAG的影响

Duhuo Jisheng Tang on Patella Cartilage of Chondromalacia of Patella and IL-1,MMP-1,GAG in Patellar Joint Fluid

目的:独活寄生汤对髌骨软化症髌骨软骨及膝关节液中白细胞介素-1(interleukin-1,IL-1),金属蛋白酶-1(metalloproteinase-1,MMP-1)及硫酸葡糖氨基聚糖(sulfate glycosaminoglycan,GAG)的影响。方法:将本院收治的86例髌骨软化症患者随机分为实验组43例和对照组43例。对照组患者行西医常规治疗,实验组患者行独活寄生汤口服及局部熏洗治疗。评价两组患者的临床治疗效果及核磁共振成像(Magnetic resonance imaging,MRI)关节软骨损害分级下各级的疗效;同时,于患者治疗前后,分别检测并对比分析患者膝关节液中IL-1,MMP-1,GAG指标水平。结果:实验组患者临床治疗的总有效率为88.37%,对照组为67.44%,两组比较,差异具有统计学意义(P<0.05)。实验组和对照组内,MRI关节软骨损害Ⅰ,Ⅱ级患者临床治疗总有效率均高于Ⅲ,Ⅳ级患者(均P<0.05)。治疗后,实验组患者关节液中IL-1,MMP-1指标水平均低于对照组(均P<0.05),平均GAG指标水平高于对照组(P<0.05)。结论:独活寄生汤治疗髌骨软化症的临床疗效较西医常规治疗显著,其可能通过对膝关节液中IL-1表达水平的调节,抑制MMP-1的激活及GAG的降解,从而起到对关节软骨的修复和保护作用。同时,MRI关节软骨损害分级下I,Ⅱ级时期为患者临床治疗的最佳时期。

Objective： To analysis the effect of Duhuo Jisheng Tang on patella cartilage of chondromalacia of patella and interleukin-1（ IL-1）,metalloproteinase-1（ MMP-1）,sulfate glycosaminoglycan（ GAG） in patellar joint fluid. Method： The eighty-six cases of patella softening of the patients treated in our hospital were divided into the observation group（ 43 cases） and the control group（ 43 cases）. The control group was treated with routine western medicines,while the observation group was treated with Duhuo Jisheng Tang for oral administration and local fumigation. The clinical therapeutic effect at all MRI grades of both groups were evaluated; at the same time,before and after the treatment,IL-1,MMP-1,GAG index levels in patients＇ patellar joint fluid were tested and analyzed. Result： The observation group showed the total effective rate of 88. 37%,while the control group was 67. 44%,with a statistically significant difference between both groups（ P〈0. 05）. In the observation group and the control group,patients with articular cartilage damage grade I and grade Ⅱ according to magnetic resonance imaging（ MRI） showed the total clinical effective rate higher than those with articular cartilage damage grade level Ⅲ and Ⅳ（ P〈0. 05）. After the treatment,the experiment group shower lower IL-1,MMP 1 indexes in joint fluid than that of the control group（ P〈0. 05）,but with the average GAG index higher than the control group（ P〈0. 05）. Conclusion： Duhuo Jisheng Tang shows a better clinical curative effect than conventional western medicines in the treatment of chondromalacia of patella. It may recover and protect patella cartilage by regulating the expression of IL-1 in patellar joint fluid and inhibiting the activation of MMP-1 and the degradation of cartilage proteoglycan. At the same time,articular cartilage damage grade class I and class Ⅱ period according to magnetic resonance imaging（ MRI） are the best period for clinical treatment.