中药熏蒸治疗阳虚寒凝型膝痹病的疗效及对关节滑液中炎症因子表达的影响

Effect of Traditional Chinese Medicine Fumigation on Yang Deficiency and Cold Coagulating Type of Knee Arthralgia and Its Effect on Expressions of Inflammatory Factors in Synovial Fluid

目的：探讨中药熏蒸方治疗阳虚寒凝型膝痹病（knee osteoarthritis,KOA）的应用价值。方法：80例膝痹病住院患者,按照随机原则分为观察组与对照组,每组各40例,对照组采用临床路径＋水熏治疗,观察组在临床路径治疗基础上联合中药熏蒸方熏蒸治疗,3周后观察两组患者疗效、HSS膝关节评分、视觉模拟疼痛（VAS）评分变化,并测定治疗前后关节液中C-反应蛋白（CRP）、基质金属蛋白酶-3（MMP-3）、白介素-1（IL-1）、透明质酸（HA）、肿瘤坏死因子-α（TNF-α）及白介素-6（IL-6）含量。结果：两组患者治疗前CRP、MMP-3、IL-1、TNF-α、HA及IL-6含量比较无显著性差异（P〉0.05）,治疗后,观察组CRP、MMP-3、IL-1、TNF-α及IL-6含量明显低于对照组（P〈0.05）,HA含量高于对照组（P〈0.05）。两组患者治疗前HSS各症状评分及总分、VAS评分比较差异无统计学意义（P〉0.05）;观察组治疗后HSS各症状评分及总分、VAS评分明显低于对照组（P〈0.05）。观察组治疗有效率为87.5%,对照组为67.5%,组间比较差异显著（P〈0.05）。两组均未出现明显不良反应。结论：中药熏蒸方治疗阳虚寒凝型膝痹病能显著提高其临床疗效,改善患者膝关节功能,明显缓解关节疼痛,其治疗作用机制可能与减少患者关节滑液中CRP、MMP-3、IL-1、TNF-α及IL-6水平,抑制炎症反应有关。

Objective： To study the effect of self-made Chinese herbal fumigating recipe in the treatment of Yang deficiency and cold coagulation syndrome of knee osteoarthritis and the effect on the expression of inflammatory factors in synovial fluid. Methods： According to the random principle, eighty cases of knee osteoarthritis hospitalized patients were divided into the observation group and the control group, each group 40. The control group was treated with clinical pathway and water fumigation, and the observation group was combined with the treatment of fumigation on the clinical pathway. After 3 weeks, the effect of two groups, HSS knee joint score and visual simulated pain（VAS） were observed. The C-reactive protein（CRP）,matrix metalloproteinase 3（MMP-3）,interleukin 1（IL-1）, hyaluronic acid（HA）, tumor necrosis factor alpha（TNF alpha）, interleukin 6（IL-6） contents in the joint fluid of patients before and after treatment were determined. Results： There was no significant difference in the contents of CRP, MMP-3, IL-1, TNF-alpha, HA and IL-6 in the two groups patients before treatment（P〈0.05）. After treatment, the contents of CRP, MMP-3, IL-1, TNF-alpha and IL-6 were significantly lower than those in the control group（P〈0.05）, and the HA content was higher than that of the control group（P〈0.05）. Before treatment,there was no statistically significant difference between the two groups＇ symptoms and scores of HSS and VAS（P〈0.05）. After treatment, the symptoms and scores of HSS and VAS were significantly lower than those in the control group（P〈0.05）. The effective rate of the observation group was 87.5% and that of the control group were 67.5%, and the difference between groups was significant（P〈0.05）. There was no obvious adverse reaction between the two groups. Conclusion： The self-made Chinese herbal fumigating recipe can improve the clinical curative effect of Yang deficiency and cold coagulation syndrome of knee osteoarthritis, improve the patients＇ knee joint function and obviously relieve joint pain. Its therapeutic mechanism may be related to reducing the levels of CRP, MMP-3, IL-1, TNF-alpha and IL-6 and inhibiting inflammatory response in the joint fluid of patients.