中药硬膏热贴敷对膝骨性关节炎患者的疗效及治疗机制探讨

Therapeutic effect and mechanism of traditional Chinese medicine plaster for patients with knee osteoarthritis

目的探讨中药硬膏热贴敷对膝骨性关节炎(KOA)患者的疗效及治疗机制.方法选取2015年7月至2017年6月收治的KOA患者112例,依据随机数字表法分为两组,各56例.对照组给予双氯芬酸钠缓释片口服,观察组联合中药硬膏热贴敷,治疗4周后,比较两组临床疗效、患肢关节液内炎性因子以及基质金属蛋白酶含量,观察两组患者不良反应.结果观察组治疗总有效率94.64%(53/56),高于对照组82.14%(46/56),差异有统计学意义(P<0.05);治疗4周后,观察组IL-1β、IL-6、TNF-α分别为(0.35±0.10)μg/ml、(117.24±23.45)pg/ml、(0.45±0.11)μg/ml,均低于对照组,差异均有统计学意义(均P<0.05);治疗4周后,观察组MMP-3、MMP-9、MMP-13分别为(86.74±12.12)ng/ml、(36.12±5.25)ng/ml、(165.25±26.14)ng/ml,均低于对照组,差异均有统计学意义(均P<0.05);两组均无明显不良反应发生.结论中药硬膏热贴敷可明显提高膝骨性关节炎患者的临床疗效,可能与缓解炎症症状、抑制基质金属蛋白酶表达等因素有关.

Objective To investigate the efficacy and therapeutic mechanism of traditional Chinese medicine plaster application for patients with knee osteoarthritis(KOA).Methods 112 patients with KOA admitted to our hospital from July,2015 to June,2017 were enrolled.The patients were divided into a treatment group(56 cases)and a control group(56 cases)according to the random number table method.The control group orally took diclofenac sodium sustained-release tablets;in addition,the treatment group was treated with traditional Chinese medicine plaster.After 4 weeks’treatment,the clinical efficacy,inflammatory factors and matrix metalloproteinase levels in the joints of the affected limbs were compared.The adverse reactions of the two groups were observed.Results The total effective rate of the treatment group was 94.64%(53/56),which was significantly higher than that of the control group[82.14%(46/56)](P<0.05).The levels of interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)in the joint fluid of the affected limb in the treatment group were(0.35±0.10)μg/ml,(117.24±23.45)pg/ml,and(0.45±0.11)μg/ml,which were significantly lower than those in the control group(all P<0.05).The contents of matrix metalloproteinase-3(MMP-3),MMP-9 and MMP-13 in the joint fluid of the affected limb in the treatment group were(86.74±12.12)ng/ml,(36.12±5.25)ng/ml,(165.25±26.14)ng/ml,which were significantly lower than those in the control group(all P<0.05).No significant adverse reactions occurred in either group.Conclusion Traditional Chinese medicine plaster can significantly improve the clinical efficacy of patients with knee osteoarthritis,which may be related to the relief of inflammatory symptoms and inhibition of matrix metalloproteinase expression.