臭氧水注射治疗强直性脊柱炎性疼痛的临床研究

Effects of ozonated water injection for patients suffered from inflammatory pain of ankylosing spondylitis

目的 研究椎旁关节和骶髂关节注射臭氧水治疗强直性脊柱炎性疼痛的有效性和安全性.方法 2013年10月至2016年10月山西焦煤西山煤电集团职工总医院诊治的强直性脊柱炎患者40例,根据治疗方法将患者分为A组和B组,每组20例患者.A组采用椎旁关节和骶髂关节注射臭氧水,B组口服双氯芬酸钠缓释片,两组均同时给予免疫抑制剂进行治疗.评估治疗前和治疗后2个月内的镇痛效果、关节活动度Schober值、巴斯强直性脊柱炎病情活动指数（BASDAI）、CRP和ESR及不良反应.结果 A组治疗前、治疗后1周及1、2个月时VAS评分分别为（8.20±0.92）、（2.60±0.79）、（2.30±0.67）、（1.50±0.53）分,腰椎活动度检查Schober值分别为（2.55±1.62）、（3.10±1.59）、（3.35±1.99）、（4.10±1.37） cm,BASDAI值分别为6.30±0.64、2.68±0.46、2.08±0.40、1.56±0.48;B组治疗前、治疗后1周及1、2个月时VAS评分分别为（8.30±1.06）、（4.00±1.05）、（2.50±1.18） （1.80±1.03）分,Schober值分别为（2.50±1.80）、（2.85±1.49）、（3.95±1.19）、（4.05±0.89） cm,BASDAI值分别为5.64±0.47、2.98±0.29、2.20±0.37和1.70±0.45.两组患者治疗后1周及1、2个月时VAS评分和BASDAI值均明显低于治疗前（P均＜0.05）,A组治疗后1周及1、2个月和B组治疗后1、2个月的Schober值明显高于治疗前（P均＜0.05）.A组治疗后1周及1、2个月的优良率分别为80％、100％和100％,B组分另为40％、80％和90％.A组在1周和1个月时的优良率均高于B组（P均＜0.05）.A组治疗前、治疗后1周CRP值分别为（43.3±12.6）、（8.46±6.92） mg/L,ESR值分别为（38.3±9.4）、（14.2±5.5） mm/1h;B组治疗前、治疗后1周CRP值分别为（43.1±16.9）、（9.92±6.98） mg/L,ESR值分别为（32.0±10.1）、（12.8±6.5）mm/1h;两组患者治疗后CRP和ESR值与治疗前比较均降低,差异均有统计学意义（P均＜0.01）.另外,A组和B组分别有20％和55％患者出现了胃肠道不良反应,A组发生率明显低于B组（x2=5.23、P＜0.05）.结论 椎旁关节和骶髂关节注射臭氧水复合免疫抑制剂具有良好的镇痛作用、增加腰椎活动度、降低胃肠道不良反应,但其长期疗效有待进一步研究.

Objective To investigate the efficacy and safety of ozonated water injection for inflammatory pain of ankylosing spondylitis.Methods Forty patients suffered from inflammatory pain of ankylosing spondylit were admitted at the Xishan Coal Electricity Group Co.,Ltd Workers＆#39; General hospital from October 2013 to October 2016,and were randomly divided into Group A and Group B,20 cases in each group.Patients in Group A were treated with ozonated water injection into facet joint and sacroiliac joint,while patients in Group B were treated with diclofenac sodium controlled release table as control.Immunosuppressant was taken by all patients in both groups as the basic therapy.The VAS,ratio of VAS less than 3,Schober,Bath ankylosing spondylitis disease activity index（BASDAI）,CRP,ESR and side effects were evaluated before treatment and 1 week,1 and 2 months after treatment.Results Before treatment,1st week,1st and 2nd month after treatment,the VAS in group A were （8.20 ± 0.92） points,（2.60 ± 0.79） points,（2.30 ± 0.67） points,（1.50 ± 0.53） points respectively,the Schober were （2.55± 1.62） cm,（3.10± 1.59） cm,（3.35±1.99） cm,（4.10t 1.37） cm,and the BASDAI were （6.30±0.64）,（2.68±0.46）,（2.08±0.40）,（1.56±0.48）.Before treatment,1st week,1st and 2nd month after treatment,the VAS in group B were （8.30± 1.06） points,（4.00± 1.05） points,（2.50± 1.18） points,（1.80± 1.03） points,the Schober were （2.50 ± 1.80） cm,（2.85± 1.49） cm,（3.95 ± 1.19）cm,（4.05±0.89） cm,and the BASDAI were （5.64±0.47）,（2.98±0.29）,（2.20±0.37）,（1.70±0.45）.The repeated measured repeated measures analysis of variance showed that among three indexes of VAS,Schober and BASDAI,the difference within group was statistically significant （P 〈 0.05）,but there were no significant difference between groups and interaction （P 〉 0.05）.The VAS and BASDAI of patients in both groups were significantly lower at 1st week,1st and 2nd month after treatment as compared to those before treatment,and the Schober of patients in group A at 1st week,1st month,2nd month and that of patients in group B at 1st month,2nd month significantly higher as compared with that before treatment（P〈0.05）.The ratio of VAS less than 3 of patients in group A were 80%,100% and 100% at 1st week,1st and 2nd month after treatment,that in group B were 40%,80% and 90%.The ratio of VAS less than 3 of patients in group A were significant higher than that of patients in group B at 1st week,1st month after treatment（P〈0.05）.The CRP in group A were （43.3±12.6）mg/L,（8.46±6.92） mg/L before treatment,1st week after treatment,and that in group B were （43.1 ± 16.9）mg/L,（9.92±6.98） mg/L.The ESR in group A were （38.3±9.4） mm/h,（14.2±5.5） mm/h before treatment,1st week after treatment,and that in group B were （32.0± 10.1） mm/h,（12.8±6.5） mm/h.The CRP and ESR after treatment in two groups significantly lower as compared with those before treatment （P〈0.01）,but there was no significant difference between group（P〉0.05）.Four patients （20%） in group A and 11 patients（55%） in group B were suffered from gastrointestinal side effects after treatment,the ratio of group A was significant lower than that of group B （X2 =5.23,P〈 0.05）.Conclusion Ozonated water injection into facet joint and sacroiliac joint compound immunosuppressant improved pain and joint function,and exhibited a low gastrointestinal side effects.