盐酸氨基葡萄糖联合利塞膦酸钠对伴膝冷痛的膝骨关节炎患者疗效研究

Study on the Effect of Glucosamine Hydrochloride Combined with Risedronate in the Treatment of Knee Osteoarthritis Associated with Cold Pain of Knee

目的探讨盐酸氨基葡萄糖联合利塞膦酸钠对伴膝冷痛的膝骨关节炎患者的疗效。方法收集风湿科2015年1月-12月诊治的膝骨关节炎患者50例,其中伴有膝冷痛者25例,不伴膝冷痛者25例,记录两组患者西安大略和麦克马斯特大学骨关节炎指数(WOMAC评分)、膝冷痛评分,行远红外断层扫描成像技术(TTM)测量膝关节TTM值,测量血清护骨素、Dickkopf-1(DDK-1)、硬骨素水平,比较膝冷痛组和无膝冷痛组之间的差异,探讨其检测指标水平与膝冷痛程度相关性;膝冷痛组采用盐酸氨基葡萄糖联合利塞膦酸钠方案,随访治疗6个月后,自身配对比较治疗前后指标改善情况及安全性。结果膝冷痛组与无膝冷痛组在病程、膝前TTM记录值、ΔTTM记录值、腘窝区TTM记录值、DKK-1、硬骨素水平差异有统计学意义(P<0.05)。膝冷痛组治疗6个月后,患者在WOMAC评分、膝冷痛评分、膝前TTM、ΔTTM、腘窝区TTM、血清护骨素、DKK-1、硬骨素水平均有改善,较治疗前差异均有统计学意义(P<0.05)。结论膝冷痛作为长病程膝骨关节炎患者的主诉之一,与破骨细胞代谢活跃有关,经利塞膦酸钠联合盐酸氨基葡萄糖治疗后,膝冷痛情况可有改善。

Objective To evaluate the efficacy of the glucosamine hydrochloride combined with risedronate in the treatment of knee osteoarthritis （KOA） associated with cold pain of knee. Methods The clinical data of 50 KOA patients including 25 with cold pain and 25 without cold pain, treated in the Department of Rheumatology between January and December 2015 were collected. The clinical symptoms, Western Ontario and McMater Universities （WOMAC） index of osteoarthritis score, knee cold pain score, knee joint therml texture maps （TTM） score, serum osteoprotegerin （OPG）, Dickkopf-1 （DKK-1）, and sderostin levels （SO） were recorded for comparison between patients with and without cold pain in order to investigate the correlation between these indicators and cold pain degree. Patients in the cold pain group were treated with glucosamine hydrochloride combined with risedronate. Follow-up lasted for six months, and the improvement of above indexes and the treatment safety were analyzed. Results There were significant differences between the two groups in the disease course, TTM score of knee front and popliteal fossa, ATTM, DKK-1 and SO （P 〈 0.05）. After 6 months of treatment, patients in the cold pain group improved significantly in WOMAC score, knee cold pain score, TTM score of knee front and popliteal fossa, ATTM, OPG, DKK-1 and SO （P 〈 0.05）. Conclusions As one of the main complaints of patients with advanced OA, knee cold pain is associated with the metabolic activity of osteoclasts. It can be alleviated by the treatment with risedronate combined with glucosamine.