富血小板血浆注射联合普瑞巴林治疗膝关节骨性关节炎的疗效和安全性评价

Effect and safety of platelet-rich plasma injection combined with pregabalin in the treatment of knee osteoarthritis

目的 探讨富血小板血浆(PRP)注射联合普瑞巴林治疗膝关节骨性关节炎(KOA)对疼痛及膝关节功能的影响。方法 选取本院2020年6月~2022年4月KOA患者220例,随机分为观察组(n=110)与对照组(n=110),观察组给予PRP注射联合普瑞巴林,对照组给予透明质酸钠联合普瑞巴林,比较2组临床疗效、骨关节炎指数(WOMAC量表)、疼痛程度(VAS评分)、膝关节功能(Lysholm-Ⅱ量表、Rasmussen量表)、促修复因子[转化生长因子-β(TGF-β1)、骨形态发生蛋白4(BMP4)、胰岛素生长因子(IGF-1)]、炎性因子[白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)]、氧化应激指标[超氧化物歧化酶(SOD)、一氧化氮(NO)]、血常规[白细胞计数(WBC)、血小板计数(Plt)]水平以及不良反应发生情况。结果 观察组治疗有效率94.55%(104/110)高于对照组83.64%(92/110)(P<0.05);观察组治疗后WOMAC量表评分[(43.39±5.92)分vs(49.40±6.18)分]、VAS评分[(2.50±0.33)分vs(2.87±0.39)分)]低于对照组(P<0.05);观察组治疗后膝关节功能Rasmussen评分[(60.66±6.15)分vs(55.13±5.49)分)]、Lysholm-Ⅱ量表评分[(77.04±6.18)分vs(72.15±7.25)分)]高于对照组(P<0.05);观察组治疗后血清TGF-β1、BMP4、IGF-1水平[(944.80±54.92)ng/L、(126.79±9.81)pg/mL、(96.86±5.15)μg/L vs(901.45±46.82)ng/L、(118.44±8.45)pg/mL、(91.47±5.06)μg/L]高于对照组(P<0.05);观察组治疗后血清IL-6、TNF-α、NO水平[(124.92±20.58)pg/mL、(1.90±0.31)μg/L、(81.05±6.83)μmol/L vs(149.10±22.91)pg/mL、(2.64±0.52)μg/L、(86.22±5.84)]低于对照组,SOD水平[(109.29±10.18)NU/mL vs(102.77±9.98)NU/mL]高于对照组(P<0.05);2组治疗后外周血WBC、Plt水平无差异(P>0.05);2组不良反应发生率无差异(P>0.05)。结论 PRP注射联合普瑞巴林治疗可有效提高KOA患者膝关节功能,减轻疼痛,降低炎性因子水平,减轻氧化应激损伤,促进促修复因子表达。

Objective To explore the effects of platelet-rich plasma(PRP) injection combined with pregabalin on pain and knee function in knee osteoarthritis(KOA). Methods A total of 220 patients with KOA in our hospital, between June 2020 and April 2022, were enrolled and randomly divided into observation group(n=110) and the control(n=110). The observation group was given PRP injection combined with pregabalin, while control group was given sodium hyaluronate combined with pregabalin. The clinical curative effect, osteoarthritis index(WOMAC), pain level(VAS), knee function [Lysholm-Ⅱ scale, Rasmussen scale], levels of repair-promoting factors [transforming growth factor-β1(TGF-β1), bone morphogenetic protein 4(BMP4), insulin growth factor 1(IGF-1)], inflammatory factors [interleukin-6(IL-6), tumor necrosis factor α(TNF-α)], oxidative stress indexes [superoxide dismutase(SOD), nitric oxide(NO)] and blood routine [white blood cell count(WBC), platelet count(Plt)], and the occurrence of adverse reactions in the two groups were compared. Results The response rate of treatment was higher in observation group than control group [94.55%(104/110) vs 83.64%(92/110), P<0.05]. After treatment, scores of WOMAC and VAS were lower in observation group than the control group [points: 43.39±5.92 vs 49.40±6.18, 2.50±0.33 vs 2.87±0.39, P<0.05], and scores of Rasmussen and Lysholm-Ⅱ were higher in observation group [points 60.66±6.15 vs 55.13±5.49, 77.04±6.18 vs 72.15±7.25, P<0.05]. After treatment, levels of serum TGF-β1, BMP4 and IGF-1 were higher in observation group than control group [(944.80±54.92) ng/L vs(901.45±46.82) ng/L,(126.79±9.81) pg/mL vs(118.44±8.45) pg/mL,(96.86±5.15) μg/L vs(91.47±5.06) μg/L, P<0.05]. After treatment, levels of serum IL-6, TNF-α and NO were lower in observation group than control group [(124.92±20.58) pg/mL vs(149.10±22.91) pg/mL,(1.90±0.31) μg/L vs(2.64±0.52) μg/L,(81.05±6.83) μmol/L vs(86.22±5.84) μmol/L], while SOD was higher in observation group [(109.29±10.18) NU/mL vs(102.77±9.98) NU/mL, P<0.05)]. The levels of peripheral blood WBC and PLT in the two groups were similar after treatment(P>0.05). There was no significant difference in incidence of adverse reactions between the two groups(P>0.05). Conclusion PRP injection combined with pregabalin can effectively improve knee function, relieve pain, reduce levels of inflammatory factors and oxidative stress injury, and promote the expressions of repair-promoting factors in KOA patients.