从肾论治绝经后膝骨关节炎肝肾亏虚证的临床观察

Clinical Efficacy of Postmenopausal Knee Osteoarthritis with Liver and Kidney Deficiencies Based on Theory of Syndrome Differentiation and Treatment of Kidney

目的:评价从肾论治的左归丸加减治疗绝经后膝骨关节炎(KOA)肝肾亏虚证的临床疗效及对内分泌激素和软骨代谢的影响。方法:将140例KOA患者根据随机按数字表法分为对照组和观察组各70例。两组患者均口服予盐酸氨基葡萄糖胶囊,1粒/次,2次/d,疗程共12周,疼痛明显加用塞来昔布胶囊,0.2 g/次,1次/d,共4周。对照组口服抗骨增生丸,3 g/次,3次/d。观察组加服左归丸加减,1剂/d,两组疗程均为连续治疗12周。采用疼痛视觉模拟(VAS)评分评价治疗前后活动时和静息时疼痛程度;进行治疗前后西安大略和麦克马斯特大学骨关节炎指数可视化量表(WOMAC)评分、膝关节骨性关节炎严重性指数(ISOA),肝肾亏虚证、焦虑自评量表(SAS)和抑郁自评量表(SDS)评分;检测治疗前后血清雌二醇(E2),促卵泡生成素(FSH),促黄体生成素(LH),转化生长因子-β(TGF-β),白细胞介素-1β(IL-1β),基质金属蛋白酶-3(MMP-3),肿瘤坏死因子-α(TNF-α)水平。结果:治疗后观察组患者活动时VAS和静息时VAS均低于对照组(P<0.01);观察组WOMAC总分及疼痛、僵硬、关节功能3个因子评分均低于对照组(P<0.01);观察组患者肝肾亏虚证,SAS和SDS评分均低于对照组(P<0.01);观察组ISOA总分和症状体征、最大步行距离、日常生活3个维度评分均低于对照组(P<0.01);观察组E2水平高于对照组,FSH,LH水平均低于对照组(P<0.01);观察组患者TGF-β水平高于对照组,TNF-α,IL-1β和MMP-3水平均低于对照组(P<0.01);观察组临床总有效率分别为89.23%(58/65),高于对照组的74.60%(47/63)(χ2=4.793,P<0.05)。结论:采用左归丸加减内服从肾论治绝经后KOA肝肾亏虚证患者可明显减轻症状,改善关节功能,调节内分泌激素水平,减轻焦虑、抑郁,并可调节软骨代谢的环境,抑制炎症反应,提高了患者日常生活能力和临床疗效。

Objective: To discuss the clinical efficacy of modified Zuoguiwan on postmenopausal osteoarthritis of knee(KOA)with deficiency of liver and kidney based on theory of syndrome differentiation and treatment of kidney,and its effect on endocrine hormone and cartilage metabolism. Method: One hundred and forty patients of KOA were randomly divided into control group(70 cases)and observation group(70 cases)by random number table. Patients in two group got glucosamine hydrochloride capsule for 12 weeks,1 capsule/time,2 times/day,and those with obvious pain was added celecoxib capsules for 4 weeks,0. 2 g/time,1 time/day. The control group took Kang Zengsheng pills orally. patients in observation group was also added with modified Zuoguiwan for 12 weeks,1 dose/day. Before and after treatment,pain level during activity and rest by visual simulation of pain(VAS)were scored. And visual scale of osteoarthritis index(WOMAC)of Western Ontario and McMaster University,knee osteoarthritis severity index(ISOA),deficiency of liver and kidney,self-rating anxiety scale(SAS) and self-rating depression scale(SDS) were scored. And levels of serum estradiol(E2),follicle stimulating hormone(FSH),luteinizing hormone(LH),transforming growth factor-β(TGF-β),interleukin-1β(IL-1β),matrix metalloproteinase-3(MMP-3)and tumor necrosis factor-α(TNF-α)were scored. Result: Scores of VAS during activity and rest in observation group were lower than those in control group(P<0. 01). The total score of WOMAC,scores of pain,stiffness,joint function,deficiency of liver and kidney,SAS and SDS were all lower than those in control group(P<0. 01). Total score of ISOA,symptoms and signs,maximum walking distance,daily life were lower than those in control group(P<0. 01). Levels of E2,FSH,LH,TNF-α,IL-1β and MMP-3 were lower than those in control group(P<0. 01). Level of TGF-β was higher than that in control group(P<0. 01). And total clinical effective rate in observation group was 89. 23%(58/65),which was higher than 74. 60%(47/63)in control group(χ2=4. 793,P<0. 05). Conclusion:Modified Zuoguiwan can obviously alleviate symptoms,improve joint function,regulate the level of endocrine hormone,relieve anxiety and depression,regulate the environment of cartilage metabolism,inhibit inflammatory reaction,and improve the patients’ ability of daily life and clinical efficacy.