玻璃酸钠联合吲哚美辛巴布膏治疗老年KOA的临床研究

Clinical study of sodium hyaluronate combined with indomethacin ointment in treatment of senile knee osteoarthritis

目的探讨玻璃酸钠联合吲哚美辛巴布膏治疗老年膝骨性关节炎(KOA)的效果及其对关节液细胞因子的影响。方法将2019年10月至2020年3月该院收治的KOA患者141例按照随机数字表法分为A、B、C 3组,每组各47例,A组给予玻璃酸钠治疗,B组给予吲哚辛巴布膏治疗,C组给予玻璃酸钠联合吲哚美辛巴布膏治疗。记录3组患者膝关节疼痛缓解时间、膝关节活动度、膝关节肿胀程度,采用视觉模拟评分(VAS)、美国特种外科医院膝关节评分(HSS)对膝关节疼痛及功能进行评价;比较各组患者治疗前后患侧膝关节液中细胞因子表达水平。结果治疗前3组患者相关指标比较,差异均无统计学意义(P>0.05)。治疗后,C组患者关节活动度高于A、B组,肿胀程度低于A、B组,疼痛缓解时间短于A、B组,差异均有统计学意义(P<0.05);C组患者总有效率高于A、B组(93.62%vs.78.23%,P<0.05);治疗后及随访1个月,C组患者VAS及HSS得分均优于A、B组(P<0.05);C组患者患侧膝关节液白细胞介素(IL)-1β、IL-6、IL-17、肿瘤坏死因子α(TNF-α)水平及磁共振成像(MRI)T2值均低于A、B组(P<0.05);A、B组患者上述指标比较差异无统计学意义(P>0.05)。结论玻璃酸钠联合吲哚美辛巴布膏能提高KOA患者的临床疗效,可明显减轻患者疼痛及改善膝关节功能。

Objective To investigate the effect of sodium hyaluronate combined with indomethacin ointment in the treatment of senile knee osteoarthritis(KOA)and its influence on the cytokines in the articular fluid.Methods A total of 141 patients with KOA admitted to this hospital from October 2019 to March 2020 were divided into the group A,B and C according to the random number table method,47 cases in each group.The group A was given sodium hyaluronate,the B group adopted indomethacin ointment,and the group C was treated with sodium hyaluronate combined with indomethacin ointment.The knee joint pain relief time,knee joint mobility and knee joint swelling were recorded in the three groups.The pain and function of knee joint were evaluated by the VAS and HSS scores.The expression levels of cytokines in the knee joint fluid before and after treatment were compared among the groups.Results The related indexes before treatment had no statistical differences among the groups(P>0.05).After treatment,the joint activity of the group C was higher than that of the group A and B,the degree of swelling was lower than that of the group A and B,the pain relief time was shorter than that of the group A and B,the and the differences were statistically significant(P<0.05).The total effective rate of the group C was higher than that of the group A and B(93.62%vs.78.23%,P<0.05).After treatment and 1-month follow up,the VAS pain score and HSS score in the group C were better than those in the group A and B(P<0.05).After treatment,the levels of IL-1β,IL-6,IL-17,TNF-αand MRI T2 value in the group C were lower than those in the group A and B(P<0.05);there was no significant difference in the above indexes between the group A and B(P>0.05).Conclusion Sodium hyaluronate combined with indomethacin ointment can improve the clinical efficacy of the patients with KOA,significantly reduce pain and improve the knee function.