独活寄生汤治疗膝关节骨性关节炎32例临床观察

Clinical Observation of 32 Cases on Duhuo Jisheng Tang in the Treatment of Knee Osteoarthritis

目的:观察独活寄生汤治疗膝关节骨性关节炎的临床疗效。方法:将60例膝关节骨性关节炎患者随机分为对照组28例和观察组32例。对照组采用塞来昔布胶囊治疗;观察组采用独活寄生汤治疗,具体用药为:生地黄、白芍各20 g,独活15 g,甘草、杜仲、牛膝、防风、地龙、川芎、桑寄生、秦艽、防己各10 g,肉桂7 g。在此基础上辨症加减,疼痛剧烈者加川乌、制草乌、白花蛇舌草;寒邪严重者加附子、干姜;湿邪严重者去生地黄,加附子、薏苡仁、苍术;正虚不甚的患者则去生地黄。每天1剂,用水煎2次,取药汤400 mL,分早晚两次温服。两组患者均连续治疗12周。治疗后比较两组患者临床疗效,白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和白细胞介素-1(interleukin-1,IL-1)指标,各项关节指标积分和两组患者的不良反应发生率。结果:观察组有效率为96.88%,显著高于对照组的75.00%,差异有统计学意义(P<0.05);观察组患者晨僵积分、关节休息痛积分、关节压痛积分和关节肿胀积分均显著低于对照组,差异均有统计学意义(P<0.05);两组患者IL-6、TNF-α和IL-1水平均显著优于对照组,差异均有统计学意义(P<0.05);观察组患者不良反应发生率为25.00%,显著低于对照组的57.14%,差异有统计学意义(P<0.05)。结论:独活寄生汤治疗膝关节骨性关节炎疗效显著,可显著改善患者疼痛症状,治疗期间不良反应较少,安全性高,且可显著降低IL-6、TNF-α及IL-1等细胞因子水平。

Objective： To observe the clinical effect of Duhuo Jisheng Tang on knee osteoarthritis（ KOA）. Methods： 60 cases of osteoarthritis of knee joint were randomly divided into the control group of 28 cases and the observation group of 32 cases. The control group was given Celecoxib capsules treatment,and the observation group was treated with Duhuo Jisheng Tang,and the prescription： Shengdihuang（ Radix Rehmanniae） 20 g,Baishao（ Radix Paeoniae Alba） 20 g,Duhuo（ Rhizoma Araliae Cordatae） 15 g,Gancao（ liquorice） 10 g,Duzhong（ Eucommia Ulmoides） 10 g,Fangfeng（ Radix Sileris） 10 g,Dilong（ Earthworm） 10 g,Chuanxiong（ Ligusticum wallichii） 10 g,Sangjisheng（ Loranthus Parasiticus） 10 g,Qinjiao（ Radix Gentianae Macrophyllae） 10 g,Fangji（ Radix Stephaniae Tetrandrae） 10 g,Rougui（ Cinnamomum Cassia） 7 g. Patients with severe pain,addition Radix Aconiti,Processed Radix Aconiti Kusnezoffii,Hedyotis Diffusa; severe cold evil,addition Aconite,Dried Ginger; wet-pathogen severe,subtraction Radix Rehmanniae,Addition Aconite,Semen Coicis,Rhizoma Atractylodis; not obvious weakened body resistance,subtraction Radix Rehmanniae. Once daily,water decocting for twice,taking the medicine decoction of 400 mL,and warm administration in the morning and evening. Both groups were treated for 12 weeks. After treatment,clinical curative effect,interleukin-6（ IL-6）,tumor necrosis factor-α（ TNF-α） and interleukin-1（ IL-1） of the two groups were compared,and each joint index score and incidence of adverse reactions in both groups. Results： The effective rate of the observation group was 96. 88%,which was significantly higher than that of the control group 75. 00%,and the difference was statistically significant（ P〈0. 05）. The scores of morning stiffness,joint rest pain,joint tenderness and joint swelling in the observation group were significantly lower than those in the control group（ P〈0. 05）. IL-6,TNF-α and IL-1 levels of the observation group were significantly better than the control group,the differences were statistically significant（ P〈0. 05）. The incidence of adverse reactions in the observation group was 25. 00%,which was significantly lower than that of the control group 57. 14%（ P〈0. 05）. Conclusion： The curative effect of Duhuo Jisheng Tang in the treatment of KOA is significant,which can significantly improve pain symptoms,less adverse reaction during treatment,high safety,significantly reduce cytokine levels such as IL-6,TNF-α and IL-1,and so on.