盐酸氨基葡萄糖与塞来昔布结合体外冲击波对骨性关节炎患者膝关节功能的影响

Effects of glucosamine hydrochloride and celecoxib combined with extracorporeal shock wave therapy on joint mobility in patients with knee osteoarthritis

目的探讨盐酸氨基葡萄糖与塞来昔布结合体外冲击波治疗对膝关节骨性关节炎患者关节活动功能的影响。方法94例膝关节骨性关节炎患者均分为观察组(给予盐酸氨基葡萄糖、塞来昔布结合体外冲击波治疗)和对照组(给予盐酸氨基葡萄糖联合塞来昔布治疗),于治疗前和治疗3个月时检测2组患者关节液中白细胞介素-13(IL-13)、可溶性细胞间黏附分子1(sICAM-1)、IL-1β、Diekkopf-1(DKK-1)、骨保护素(OPG)、β连环素(β-catenin)、β内啡肽(β-EP)、神经肽Y(NPY)及6-酮前列腺素E1α(6-keto-PGE1α)水平,比较2组患者治疗前和治疗3个月时的视觉模拟评分(VAS)、膝关节运动功能Lysholm量表(LKSS)评分及健康状况调查表(SF-36)评分。结果治疗前,2组患者关节液中IL-13、sICAM-1、IL-1β、DKK-1、OPG、β-catenin、β-EP、NPY、6-ketoPGE1α水平及VAS、LKSS、SF-36评分比较,差异无统计学意义(P>0.05);2组患者治疗3个月时的关节液IL-13、sICAM-1、IL-1β、β-catenin、NPY、6-keto-PGE1α水平及VAS评分水平低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05),2组患者治疗3个月时的关节液中DKK-1、OPG、β-EP水平及LKSS、SF-36评分高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论给予膝关节骨性关节炎患者盐酸氨基葡萄糖、塞来昔布结合体外冲击波治疗,可改善患者关节活动功能,其机制可能与联合治疗调节关节液中β-catenin、DKK-1、OPG等介质的水平有关。

Objective To investigate the effect of glucosamine hydrochloride and celecoxib combined with extracorporeal shock wave therapy on joint mobility in patients with knee osteoarthritis.Methods Ninety-four patients with knee osteoarthritis were evenly divided into observation group(given with glucosamine hydrochloride plus celecoxib combined with extracorporeal shock wave) and control group( given with glucosamine hydrochloride plus celecoxib). Before treatment and at 3months of treatment, interleukin-13(IL-13), soluble intercellular adhesion molecule 1(sICAM-1),IL-1β, Diekkopf-1( DKK-1), osteoprotegerin( OPG), beta-catenin( β-catenin), beta endorphin(beta-EP), neuropeptide Y(NPY), and 6-keto prostaglandin E1α(6-keto-PGE1α) were detected in the synovial fluids f two groups. Visual analogue scale(VAS), Lysholm knee scoring scale(LKSS)and health status measured by SF-36 were compared before treatment and at 3 months of treatment between two groups.Results Before treatment, there were no significant differences in the levels of IL-13, sICAM-1, IL-1β, DKK-1, OPG, β-catenin, β-EP, NPY, and 6-keto-PGE1α, VAS, LKSS,and SF-36 scores between two groups(P> 0. 05). The levels of IL-13, sICAM-1, IL-1β, β-catenin,NPY, and 6-keto-PGE1α in synovial fluid, VAS score of two groups were lower at 3 months of treatment than those before treatment, and they were lower in observation group than in control group(P< 0. 05). The levels of DKK-1, OPG, β-EP, LKSS, and SF-36 score in synovial fluid of the two groups at 3 months of treatment were higher than those before treatment, and they was higher in observation group than in control group(P< 0. 05).Conclusion Glucosamine hydrochloride and celecoxib combined with extracorporeal shock wave therapy can improve the joint mobility of the patients with knee osteoarthritis. Its mechanism may be related to regulation of the levels of β-catenin,DKK-1, OPG, and other mediators in synovial fluid.