从生长分化因子-5调控关节软骨形成观察加味当归四逆汤防治膝骨关节炎临床研究

Clinical Study on Modified Dangguisini Decoction Treated with KOA on Regulating Articular Cartilage Formation by Growth Differentiation Factor-5

目的:通过观察治疗前后膝骨关节炎患者生长分化因子-5(GDF-5)、血管内皮细胞生长因子(VEGF)及临床症状计分变化,探讨加味当归四逆汤防治膝骨关节炎(KOA)的可能机制及临床效用。方法:采用随机、对照设计,选择符合诊断标准、纳入标准及排除标准的KOA患者62例,按就诊顺序1︰1随机分为两组,每组31例。治疗组予加味当归四逆汤,对照组予仙灵骨葆胶囊,连续4周。详细记录治疗前、治疗后2周及4周临床症状计分变化,应用Real-time PCR技术检测治疗前后GDF-5及VEGF表达变化。结果:治疗组临床治愈10例,显效7例,有效12例,无效2例,总有效率为93.55%;对照组临床治愈6例,显效5例,有效8例,无效12例,总有效率为61.29%,治疗组总有效率明显高于对照组,P<0.05。治疗前,两组患者临床症状计分对比,无显著性差异。治疗后2、4周,治疗组临床症状计分明显低于对照组,P<0.05。治疗后,治疗组在治疗后2周关节疼痛明显缓解,晨僵改善,关节功能部分恢复,治疗后4周,关节疼痛显著缓解,晨僵及关节活动消失。治疗前,两组患者GDF-5、VEGF表达对比无显著性差异;治疗后,两组患者GDF-5、VEGF表达上升,且治疗组上升更显著(P<0.05)。结论:加味当归四逆汤可能通过上调GDF-5及VEGF表达,发挥缓解KOA的效用,值得推广应用。

Objective： The mechanism and clinical effect of modified Dangguisini decoction treaW, d with knee osteoarthritis was investigated by observing the expression of GDF-5, VEGF and clinical symptom scoring changes. Methods： It was a randomized controlled trial. 62 Cases of KOA who conformed to the diagnostic criteria, inclusion criteria and exclusion criteria, and randomly divided into two groups according to 1：1 based on treatment sequence. The intervention group was administrated with modified Dangguisini decoction, and control group was gave Xianlinggnhao capsule. The clinical symptom scoring changes in detail were recorded before and after treatment for 2 weeks and 4 weeks. The expression of GDF-5 and VEGF were detected by Real-time PCR before and after the treatment. Results： The total curative effect in intervention group： 10 cases were cured, 7 cases had marked effect, 12 cases were effective and 2 cases were ineffective, the total effective rate was 93.54%.However,the effect rate in Control group： 6 cases were clinical cure, 5 cases had marked effect, 8 cases were effective and 12 cases were ineffective, the total effective rate was 61.29%. There was a significant difference between the two group（P〈0.05）.Before treatment, there was no significant difference in clinical symptoms scoring between two groups. After 2 weeks treatment, the arthralgia and morning stiffness in intervention group were obviously alleviate, the joint function recovered partially. After 4 weeks treatment, joint pain significantly reduced, morning stiffness and joint motion disappeared. By comparing, there were obvious differences （P〈0.05）. Before the treatment, the expression of GDF-5, VEGF in both groups were lower; but they were the increment after treatment. By comparison, there was statistical difference （P〈 0.05）.Conclusion： Modified Dangguisini decoction exerts a distinct effect on improving symptoms of KOA by enhancing the expression of （3DF-5 and VEGF. It is worthy of popularization and application.