加味桃红四物汤对急性膝关节创伤性滑膜炎患者血清IL-1β、TNF-α、MMP-3的影响

Clinical Effect of Jiawei Taohong Siwu Decoction on Acute Traumatic Synovitis of Knee Joint and the Effect on Serum IL-1β,TNF-α and MMP-3

目的观察加味桃红四物汤治疗急性膝关节创伤性滑膜炎(瘀水痹阻证)的临床疗效及其对血清白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-3(MMP-3)的影响,并探讨其作用机制。方法 73例患者随机分为观察组(服用加味桃红四物汤)和对照组(服用滑膜炎颗粒),两组均治疗2周。记录两组治疗前后视觉模拟量表(VAS)评分、膝周径及骨关节炎指数(WOMAC)评分,评定最终临床疗效。在治疗前后收集患者空腹血液,用以检测IL-1β、TNF-α、MMP-3水平。结果观察组总有效率为81.08%,与对照组的77.78%差别不大(P> 0.05);两组临床疗效总体分布比较,观察组显效优于对照组(P <0.05);两组治疗后VAS评分、WOMAC评分及膝周径与治疗前比较均不同程度降低(均P <0.05);观察组WOMAC僵硬、关节功能评分低于对照组(P <0.05)。治疗后,两组IL-1β、TNF-α、MMP-3水平与治疗前比较不同程度降低(均P <0.05),观察组MMP-3指标低于对照组(P <0.05)。两组在治疗观察期间未发现与应用药物相关的不良反应。结论加味桃红四物汤治疗膝关节急性创伤性滑膜炎有较好疗效,在减轻关节僵硬程度及恢复患膝关节功能方面优于滑膜炎颗粒,其作用机制可能是通过降低关节的炎性反应状态,减少基质金属蛋白酶分泌而实现的,本法安全可靠,值得进一步研究。

Objective: To evaluate the clinical efficacy of Jiawei Taohong Siwu Decoction on acute traumatic synovitis of knee joint (stasis and water obstruction syndrome) and its effect on serum IL-1β,TNF-α and MMP-3. Methods: 73 patients were divided into the experimental group(37 patients,treated with Jiawei Taohong Siwu Decoction) and the control group(36 patients,treated with Synovitis Granule). Both groups were treated for 2 weeks. VAS pain scores,peri-knee diameter and WOMAC scores were recorded before and after treatment in both groups to evaluate the final clinical efficacy. Before and after the treatment,fasting blood was collected to detect the level of IL-1β,TNF-α and MMP-3. Results: The total effective rate of the experimental group was 81.08% and that of the control group was 77.78%,without significant difference between groups. In terms of overall clinical efficacy,the experimental group was superior to the control group(P < 0.05). There was no significant difference in VAS scores,WOMAC scores and knee circumference between the two groups before treatment(P > 0.05). After treatment,the VAS scores,WOMAC scores and the knee circumference of the two groups were significantly lower than those before treatment(P < 0.05). After treatment,WOMAC stiffness and joint function score in the experimental group were lower than those in the control group(P < 0.05),but there was no significant difference in VAS pain scores and WOMAC pain scores between the two groups after treatment(P > 0.05). Before treatment,the serum levels of IL-1β,TNF-α and MMP-3 were not significantly different between the two groups(P > 0.05). After treatment,the levels of IL-1β,TNF-α and MMP-3 in the two groups were significantly lower than those before treatment(P < 0.05). After treatment,the MMP-3 level of the experimental group was lower than that of the control group(P < 0.05). No adverse reactions were found in the two groups during the treatment period. Conclusion: Jiawei Taohong Siwu Decoction has a good curative effect on acute traumatic synovitis of knee joint. It is superior to Synovitis Granule in reducing the degree of joint stiffness and restoring the function of knee joint,and its mechanism may be related to reducing the inflammatory reaction state of the joint and the secretion of matrix metalloproteinases. It is safe and reliable,worthy of further study and application.