雷公藤多苷对活动性膝骨关节炎临床疗效及血清基质金属蛋白酶-3、-9、-13的影响

Effects of Tripterygium wilfordii Hook F on Serum Matrix Metalloproteinases-3,-9,-13 in Patients with Active Knee Osteoarthritis

目的研究雷公藤多苷(Tripterygium wilfordii Hook F,Tw HF)对活动性膝骨关节炎(osteoarthritis,OA)患者的临床疗效及其对血清基质金属蛋白酶(matrix metalloproteinase,MMP)-3、-9、-13的影响。方法采用临床随机对照试验研究Tw HF的临床疗效,60例活动性膝OA患者分为治疗组和对照组,分别应用Tw HF和非甾体类抗炎药(nonsteroidal anti-inflammatory drugs,NSAIDs)双氯芬酸钠缓释片(扶他林)或塞来昔布(西乐葆)共12周。采用西安大略大学和麦克马斯特大学骨关节炎(Western Ontario and Mc Master University Osteoarthritis,WOMAC)指数、疼痛评分(visual analog scale,VAS)作为观察疾病活动性及疗效判定的标准;采用酶联免疫吸附(enzyme-linked immunosorbent assay,ELISA)双抗体夹心法测定治疗前后外周血MMP-3、-9、-13的变化。探讨其作用机制,采用t检验、χ2检验、秩和检验对数据进行统计学分析。结果经Tw HF和NSAIDs治疗12周后,2组患者临床症状明显改善,治疗组和对照组总有效率分别为73.3%和63.3%,治疗组总有效率高于对照组,但差异无统计学意义(χ2=0.693,P=0.405);两组患者MMP-3、-9、-13浓度[治疗组MMP-3(259.7±144.1)ng/L、MMP-9(38.8±31.0)ng/L、MMP-13(230.6±148.9)ng/L,对照组MMP-3(274.1±149.9)ng/L、MMP-9(39.6±26.2)ng/L、MMP-13(231.3±128.6)ng/L]均高于正常人[MMP-3(137.9±70.1)ng/L、MMP-9(21.5±12.1)ng/L、MMP-13(122.5±74.6)ng/L],治疗12周MMP-3、-9、-13浓度[治疗组MMP-3(184.1±67.4)ng/L、MMP-9(25.5±14.8)ng/L、MMP-13(157.1±79.2)ng/L,对照组MMP-3(183.5±82.6)ng/L、MMP-9(26.9±15.9)ng/L、MMP-13(159.4±76.4)ng/L]较治疗前均明显下降,差异有统计学意义(P<0.01)。结论雷公藤多苷能够显著改善活动性膝骨关节炎患者的临床症状,可有效抑制OA患者外周血MMP-3、-9、-13的表达,具有良好的安全性。

Objective To study the clinical efficacy of Tripterygium wilfordii Hook F(TwHF)on patients with active knee osteoarthritis(OA)and its effect on serum matrix metalloproteinase(MMP)-3,-9,-13.Methods To evaluate the clinical effects of TwHF on patients with active knee OA in a randomized controlled clinical trial.Sixty patients with active knee OA were divided into treatment group and control group.TwHF and non-steroidal anti-inflammatory drugs(NSAIDs)were used respectively in these two groups for 12 weeks.The University of Western Ontario and the University of McMaster s Osteoarthritis(WOMAC)index and pain score(VAS)were used as the criteria for disease activity and therapy efficacy.Serum matrix metalloproteinases(MMP)-3、-9、-13 were determined by sandwich enzyme-linked immunosorbent(ELISA)before and after treatment.Results The symptoms of all patients in both of the groups improved significantly after therapy.The total effective rate of treatment group was higher than that of the control group(73.3%vs.63.3%),although there was no significant difference(χ2=0.693,P=0.405).Serum levels of MMP-3,-9 and-13 in both of these two groups were higher than those of healthy controls(P<0.05),and they decreased significantly after the treatments(P<0.05).Conclusion TwHF can effectively improve the clinical symptoms of patients with active knee OA,and inhibit the expression of MMP-3,-9,-13.