当归通痹汤治疗膝关节滑膜炎湿热内蕴型临床研究

Clinical Study on Danggui Tongbi Tang for Gonarthromeningitis of Damp-heat Accumulation Type

目的:观察当归通痹汤对膝关节滑膜炎湿热内蕴型患者的临床疗效及滑液中基质金属蛋白酶-3(MMP-3)、基质金属蛋白酶(MMP-9)及转化生长因子-β1(TGF-β1)表达的影响。方法:将膝关节滑膜炎湿热内蕴型患者136例,采用随机数字法将其分为2组各68例。对照组仅于关节腔中注射玻璃酸钠;观察组采用关节腔中注射玻璃酸钠联合口服当归通痹汤治疗,比较2组疼痛视觉模拟评分(VAS)、美国膝关节学会评分(AKSS)并评价临床治疗效果及滑液中MMP-3、MMP-9及TGF-β1的表达情况。结果:治疗后,观察组临床疗效总有效率80.88%,高于对照组57.35%,差异均有统计学意义(P<0.05)。治疗后,观察组VAS评分低于对照组,AKSS评分高于对照组,差异均有统计学意义(P<0.05);观察组滑液中MMP-3、MMP-9含量明显低于本组治疗前及对照组治疗后,观察组滑液中TGF-β1含量则明显高于本组治疗前及对照组治疗后,差异均有统计学意义(P<0.05)。结论:当归通痹汤联合注射玻璃酸钠对膝关节滑膜炎湿热内蕴型患者相比单纯注射玻璃酸钠的患者可以有效提高治疗效果,其机制可能是抑制滑液中MMP-3、MMP-9的表达,并提高TGF-β1表达,从而使患者膝关节软骨细胞增殖,抑制炎症反应,促进恢复。

Objective:To observe the clinical effect of Danggui Tongbi tang for patients with gonarthromeningitis of dampheat accumulation type and its effect on expression of matrix metalloproteinase-3(MMP-3),matrix metalloproteinase-9(MMP-9)and transforming growth factor-β1(TGF-β1)in synovial fluid.Methods:A total of 136 cases of patients with gonarthromeningitis of damp-heat accumulation type were divided into two groups according to the random number table method,68 cases in each group.The control group was simply given injection of sodium hyaluronate into articular cavity,and the observation group was additionally given oral administration of Danggui Tongbi tang based on the treatment of the control group.The Visual Analogue Scale(VAS)scores and American knee society score(AKSS)in the two groups were compared.The clinical effect and expression of MMP-3,MMP-9 and TGF-β1 in synovial fluid were evaluated.Results:After treatment,the total effective rate of clinical effect was 80.88%in the observation group,higher than that of 57.35%in the control group,differences being significant(P<0.05).After treatment,the VAS score in the observation group was lower than that in the control group,and the AKSS was higher than that in the control group,differences being significant(P<0.05);the content of MMP-3 and MMP-9 in synovial fluid in the observation group was significantly less than that in the observation group before treatment and in the control group after treatment respectively,and the content of TGF-β1 in synovial fluid was significantly higher than that in the observation group before treatment and in the control group after treatment respectively,differences being significant(P<0.05).Conclusion:Compared with that of simple injection of sodium hyaluronate,the therapy of Danggui Tongbi tang combined with injection of sodium hyaluronate for patients with gonarthromeningitis of damp-heat accumulation type can effectively improve curative effect,whose mechanism may be the inhibition of expression of MMP-3 and MMP-9 in synovial fluid,and the increase of expression of TGF-β1,so as to enhance the proliferation of knee chondrocytes,inhibit the inflammatory response and promote recovery.