桂枝芍药知母汤加减对风寒湿痹型膝骨关节炎患者疗效及炎性细胞因子的影响

Effect of Guizhi Shaoyao Zhimu Decoction on Curative Efficacy and Inflammatory Cytokines in Patients with Knee Osteoarthritis Differentiated as Wind-cold-damp Arthralgia

【目的】观察桂枝芍药知母汤加减对风寒湿痹型膝骨关节炎患者疗效及炎性细胞因子水平的影响。【方法】将90例风寒湿痹型膝骨关节炎患者随机分为观察组和对照组,每组各45例。对照组给予双氯芬酸钠缓释片治疗,观察组给予桂枝芍药知母汤加减联合双氯芬酸钠治疗,疗程为6周。观察2组患者治疗前后疼痛视觉模拟量表(VAS)评分、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)和血清炎性细胞因子[肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)、白细胞介素6(IL-6)]水平的变化情况,并评价2组患者的临床疗效及安全性。【结果】(1)治疗6周后,观察组的总有效率为93.3%(42/45),对照组为68.9%(31/45),观察组的疗效明显优于对照组,差异有统计学意义(P<0.05)。(2)治疗后,2组患者的VAS评分和WOMAC评分均较治疗前明显降低(P<0.05),且观察组对VAS评分和WOMAC评分的降低作用均明显优于对照组,差异均有统计学意义(P<0.05)。(3)治疗后,2组患者的血清TNF-α、IL-1β、IL-6水平均较治疗前明显降低(P<0.05),且观察组对血清TNF-α、IL-1β、IL-6水平的降低作用均明显优于对照组,差异均有统计学意义(P<0.05)。(4)观察组的不良反应发生率为2.2%(1/45),明显低于对照组的17.8%(8/45),差异有统计学意义(P<0.05)。【结论】桂枝芍药知母汤加减联合双氯芬酸钠治疗风寒湿痹型膝骨关节炎患者疗效显著,可有效缓解患者疼痛程度,改善患者膝关节功能,降低患者血清炎性细胞因子水平,且不良反应较少,其疗效优于单纯使用双氯芬酸钠缓释片治疗。

Objective To observe the effect of Guizhi Shaoyao Zhimu Decoction on curative efficacy and inflammatory cytokines in patients with knee osteoarthritis(KOA)differentiated as wind-cold-damp arthralgia.Methods Ninety KOA patients differentiated as wind-cold-damp arthralgia were randomly divided into treatment group(n = 45)and control group(n = 45). The patients in the control group was treated with Diclofenac Sodium Controlled-release Tablets, and the patients in the treatment group were treated with Guizhi Shaoyao Zhimu Decoction combined with Diclofenac Sodium Controlled-release Tablets. The treatment for the two groups lasted for6 weeks. Before and after treatment, the VAS pain scores, the scores of Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC), and the serum levels of inflammatory cytokines such as tumor necrosis factor α(TNF-α),interleukin 1β(IL-1β)and interleukin 6(IL-6)in the two groups were observed.After treatment,the curative efficacy and safety in the two groups were evaluated. Results(1)After treatment for6 weeks,the total effective rate of the treatment group was 93.3%(42/45),while that of the control group was68.9%(31/45). The intergroup comparison showed that the clinical efficacy in the treatment group was superior to that in the control group,and the difference was statistically significant(P<0.05).(2)After treatment,the VAS pain scores and WOMAC scores in the two groups were obviously decreased in comparison with those before treatment(P<0.05), and the decrease on VAS pain scores and WOMAC scores in the treatment group was superior to that in the control group,the difference being statistically significant(P<0.05).(3)After treatment,the serum levels of TNF-α,IL-1β and IL-6 in the two groups were obviously decreased in comparison with those before treatment(P<0.05),and the decrease of serum TNF-α,IL-1β and IL-6 levels in the treatment group was superior to that in the control group,the difference being statistically significant(P<0.05).(4)The incidence of adverse reactions in the treatment group was 2.2%(1/45),and was lower than that in the control group(17.8%,8/45), the difference being statistically significant(P<0.05). Conclusion Guizhi Shaoyao Zhimu Decoction combined with Diclofenac Sodium Controlled-release Tablets is effective for the treatment of KOA patients with wind-cold-damp arthralgia. Its effect on relieving pain,improving knee joint function and decreasing the levels of serum inflammatory cytokines is superior to that of Diclofenac Sodium Controlled-release Tablets alone,and the adverse reaction is less.