土藤草汤对膝骨关节炎临床疗效及炎性因子的影响

Clinical Effects of Tutengcao Decoction in the Treatment of Knee Osteoarthritis and Its Influence on Inflammatory Factor

目的:探讨土藤草汤治疗膝骨关节炎(knee osteoarthritis,KOA)的临床疗效及对膝关节液中炎性因子水平的影响。方法:选取膝骨关节炎患者124例,按照随机数字表法分为对照组和观察组,每组62例。对照组给予氨基葡萄糖胶囊联合玻璃酸钠关节腔注射治疗,观察组在对照组治疗基础上给予土藤草汤加减治疗,共治疗6周。观察两组临床疗效、Lequesne指数,检测膝关节液中白细胞介素1β(interleukin-1β,IL-1β)含量、血管内皮生长因子(vascular endothelial growth factor,VEGF)含量、基质金属蛋白酶1(matrix metalloproteinase 1,MMP-1)阳性表达率、超氧化超歧化酶(superoxide dismutase,SOD)活性、丙二醛(malondialdehyde,MDA)水平及不良反应发生情况。结果:观察组总有效率[96.77%(60/62)]显著高于对照组[82.26%(51/62)](P<0.05)。观察组Lequesne指数中休息痛、运动痛、压痛、关节肿胀、晨僵、行走痛较治疗前降低(P<0.05),且降低幅度显著大于对照组(P<0.05)。治疗后两组关节液中IL-1β含量、VEGF含量、MMP-1阳性表达率、MDA水平均降低,SOD活性升高(P<0.05),且观察组改善程度显著高于对照组(P<0.05)。观察组不良反应的发生率[9.68%(6/62)]低于对照组[37.10%(23/62)](P<0.05)。结论:土藤草汤治疗KOA可明显提高患者治疗效果,改善临床症状,其机制可能与降低KOA患者膝关节液中IL-1β、VEGF、MMP-1水平,提高SOD活性,改善膝关节炎性状态有关。

Objective:To explore clinical effects of Tutengcao decoction in the treatment of KOA and its influence on the levels of inflammatory factor in knee joint fluid.Methods:All 124 patients were chosen,and divided into the control group and the observation group according to random number table method,with 62 cases in each group.The control group were treated by glucosamine capsule and intra articular injection of sodium hyaluronate,and the observation group by modified Tutengcao decoction based on the therapy the control group accepted.To observe therapeutic effective rate and Lequesne index between both groups,to detect the contents of IL-1βand VEGF,positive expression rate of MMP-1,the activity of SOD,the levels of MDA and the incidence of adverse reaction in knee joint fluid.Results:Total effective rate of the observation group was[96.77%(60/62)],notably higher than[82.26%(51/62)]of the control group notably(P<0.05).Among Lequesne index,the scores of rest pain,exercise pain,tenderness,joint swelling,morning stiffness and walking pain lowered before treating in the observation group(P<0.05),and the decrease was larger than that of the control group apparently(P<0.05).The contents of IL-1βand VEGF,positive expression rate of MMP-1 and the levels of MDA decreased in joint fluid in both groups after treating,while the activity of SOD rose(P<0.05),and the improvements of the observation group were higher than these of the control group remarkably(P<0.05).The incidence of adverse reaction in the observation group was[9.68%(6/62)],lower than[37.10%(23/62)]of the control group(P<0.05).Conclusion:Tutengcao decoction in treating KOA could notably raise therapeutic effects of the patients and improve clinical symptoms,and its mechanism might be related to decreasing the levels of IL-1β,VEGF and MMP-1 in knee joint fluid,raising the activity of SOD and improving inflammatory state of knee joint.