膝关节腔内注射玻璃酸钠联用藤黄健骨胶囊治疗膝骨关节炎疗效及对炎症相关因子的影响

Curative effect of intra-articular injection of sodium hyaluronate combined with Tenghuang Jiangu Capsule on knee osteoarthritis and its influence on inflammation-related factors

目的探讨膝关节腔内注射玻璃酸钠联合藤黄健骨胶囊口服治疗膝骨关节炎的疗效及对炎症相关因子的影响。方法将2017年3月—2018年6月中国人民解放军陆军第八十二集团军医院治疗的76例膝骨关节炎患者随机分为对照组和观察组各38例,对照组患者给予玻璃酸钠膝关节腔内注射,1次/周;观察组患者在对照组治疗基础上联合藤黄健骨胶囊口服,4粒/次,2次/d。2组均治疗5周。观察2组患者治疗后膝关节功能(Lysholm评分)、膝关节疼痛程度(VAS评分)及膝关节液中炎症因子[透明质酸(HA)、基质金属蛋白酶-1(MMP-1)、超氧化物歧化酶(SOD)、C反应蛋白(CRP)]变化情况,评估2组临床疗效及不良反应。结果治疗后,2组患者Lysholm评分及关节液中HA、SOD水平均较治疗前明显增高(P均<0.05),VAS评分及关节液中MMP-1、CRP水平均较治疗前明显降低(P均<0.05);且患者Lysholm评分及关节液中HA、SOD水平均明显高于对照组(P均<0.05),VAS评分及关节液中MMP-1、CRP水平均明显低于对照组(P均<0.05)。治疗5周后,观察组治疗总有效率为97.4%(37/38),不良反应发生率为13.2%(5/38),对照组治疗总有效率和不良反应发生率分别为86.8%(33/38)和15.8%(6/38),2组总有效率比较差异有统计学意义(P<0.05),2组不良反应发生率比较差异无统计学意义(P>0.05)。结论膝关节腔内注射玻璃酸钠联合藤黄健骨胶囊口服治疗膝骨关节炎,能明显减轻疼痛,显著改善膝关节功能,作用机制可能与减轻炎症反应及脂质过氧化反应有关。

Objective It is to investigate the efficacy of intra-articular injection of sodium hyaluronate combined with Tenghuang Jiangu capsules on knee osteoarthritis and its influence on inflammation-related factors.Methods Seventy-six patients with knee osteoarthritis treated in the 82nd Army Hospital of PLA from March 2017 to June 2018 were randomly divided into a control group and an observation group with 38 cases in each group.The control group was given sodium hyaluronate by knee intra-articular injection,once per week;the patients in the observation group were treated with Tenghuang Jiangu Capsule by oral administration on the basis of the treatment of the control group,4 capsules/time,2 times/d.Both groups were treated for 5 weeks.The changes of knee joint function(Lysholm score),knee joint pain(VAS score)and inflammatory factors in knee joint fluid[hyaluronic acid(HA),matrix metalloproteinase-1(MMP-1),superoxide dismutase(SOD)and C-reactive protein(CRP)]were observed before and after treatment in the two groups,the clinical efficacy and adverse reactions of the two groups were evaluated.Results After treatment,the Lysholm score and the levels of HA and SOD in the joint fluid of the two groups were significantly increased(P<0.05),and the VAS score and the levels of MMP-1 and CRP in the joint fluid were significantly reduced compared with before treatment(P<0.05),and the Lysholm scores and HA and SOD levels in the synovial fluid in the treatment group were significantly higher than those in the control group(P<0.05),and the VAS score and the levels of MMP-1 and CRP in the synovial fluid were significantly lower than those in the control group(P<0.05).After 5 weeks of treatment,the total effective rate of treatment in the observation group was 97.4%(37/38),the incidence of adverse reactions was 13.2%(5/38),and those in the control group were 86.8%(33/38)and 15.8%(6/38),there was significant difference in the total effective rate(P,0.05),and no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Intra-articular injection of sodium hyaluronate combined with Tenghuang Jiangu Capsule by oral administration can significantly reduce pain and significantly improve knee joint function in the treatment of knee osteoarthritis.The mechanism of action may be related to reducing inflammation and lipid peroxidation.