骨痹方治疗肾虚血瘀型膝骨关节炎的疗效观察及对软骨高频超声的影响

Efficacy Observation on Gubi Prescription for Kidney Deficiency and Blood Stasis Type Knee Osteoarthritis and Its Effect on Articular Cartilage in High Frequency Ultrasound

目的:观察骨痹方治疗肾虚血瘀型膝骨关节炎(knee osteoarthritis,KOA)的临床疗效,探讨骨痹方的软骨保护作用。方法:将2015年6月—2016年2月来自广州中医药大学第一附属医院风湿病科门诊符合要求的86例KOA患者,按随机数字表法随机分配为2组,对照组(43例)给予盐酸氨基葡萄糖胶囊口服,治疗组(43例)在对照组的基础上口服骨痹方,疗程均为12周。于治疗前及治疗后第4,8,12周,通过观察国际骨关节炎常用的评分标准Lequesne指数、膝关节运动功能测试进行患者膝关节症状、功能及生活质量评定,采用高频超声进行关节软骨、滑膜、关节积液的评估,比较两组临床疗效,记录不良反应。结果:治疗组临床有效率为95.12%,对照组为77.5%,治疗组优于对照组(P<0.05);治疗组能够较快改善患者Lequesne指数评分、膝关节功能及减轻关节滑膜厚度、积液量、血流信号强度,治疗后上述指标治疗组优于对照组(P<0.05,P<0.01);两组关节软骨厚度均无明显改善,治疗组股骨内髁负重面软骨厚度高于对照组,但差异无统计学意义。结论:骨痹方能有效改善膝骨关节炎患者的临床症状及膝关节活动功能,提高生活质量,减轻滑膜炎症,具有软骨保护作用。

Objective： To observe the clinical effect of Gubi prescription on kidney deficiency and blood stasis type knee osteoarthritis （KOA） and investigate its protective function for articular cartilage. Method： The 86 cases of KOA patients who met the requirements from the department of rheumatology outpatient clinic in the First Affiliated Hospital of Guangzhou University of Chinese Medicine since June 2015 to February 2016 were divided into 2 groups according to the random number table method. Patients in control group （43 cases） orally took glucosamine hydrochloride capsules, and patients in treatment group （43 cases） orally took Gubi prescription on the basis of the treatment in control group. The course of treatment was 12 weeks in both groups. Before treatment and 4, 8, 12 weeks after treatment, the Lequesne index and knee joint motion function tests were performed in patients to grade the knee joint symptoms, functions and quality of life, and their articular cartilage, synovial membrane and joint effusion were evaluated by high frequency ultrasound. In addition, their clinical curative effects were compared and adverse reactions were recorded. Result： The clinical efficacy was 95. 12% in treatment group, higher than 77.5% in control group （P 〈 0.05）, the treatment group could more quickly improve the Lequesne index score, knee function and reduce the joint synovial thickness, fluid volume, and blood flow signal strength, because after treatment, the above indexes in treatment group were better than those in control group （P 〈 0.05, P 〈 0.01 ）. The thickness of articular cartilage was not significantly improved in both groups, and the thickness of cartilage of medial femoral condyle in treamtnet group was larger than that in control group, but there was no significant difference between the two groups. Conclusion： Gubi prescription can effectively improve the clinical symptoms and the knee joint function of the patients with knee osteoarthritis, enhance the quality of life, reduce the inflammation of the synovial membrane, and may have a protective effect on cartilage.