重骨颗粒对膝骨关节炎IL-17、IL-35细胞因子及软骨基质代谢的影响

Effects of Chonggu granule on the metabolism of cartilage matrix and cytokines IL-17 and IL-35 in knee osteoarthritis

目的评价重骨颗粒治疗肝肾亏虚型膝骨关节炎临床疗效及对软骨基质代谢的影响。方法选取2020年12月至2021年10月住院或门诊KOA患者,将其随机分为2组,每组30例。治疗组方案为盐酸氨基葡萄糖0.75 g/次,2次/d;对照组为重骨颗粒每次10 g,每日2次,两组均连续服用12周。每组治疗前后采取视觉模拟评分法(VAS)评分、WOMAC骨关节炎评分、Lequesne指数评分、中医证候积分来评定两组疾病活动度并检测C反应蛋白(CRP)、血沉(ESR)水平,采用酶联免疫吸附测定法(ELISA)检测IL-17、IL-35水平及基质金属蛋白酶-13(MMP-13)、血清软骨寡聚基质蛋白(COMP)、骨形态发生蛋白2(BMP-2)、蛋白聚糖水平。结果治疗后各组KOA患者WOMAC评分、VAS评分、Lequesne评分、中医证侯积分等均有明显改善(P<0.01),MMP-13、COMP及IL-17、CRP、ESR水平明显下降(P<0.01);BMP-2、蛋白聚糖及IL-35水平显著上升(P<0.05或P<0.01)。组间比较发现,治疗组疾病活动度评分、MMP-13、COMP及IL-17、CRP下降趋势更显著,BMP-2、蛋白聚糖及IL-35明显升高(P<0.05或P<0.01),总有效率优于对照组,差异具有统计学意义(P<0.05)。结论重骨颗粒治疗KOA可能是通过调控细胞因子的表达,减少软骨外基质的降解和破坏,从而改善临床症状,提高患者生活质量,具有较好的临床疗效。

Objective To evaluate the clinical efficacy of Chonggu granule in the treatment of knee osteoarthritis(KOA)with liver and kidney deficiency and its influence in cartilage matrix metabolism.Methods Hospitalized or outpatient KOA patients from December 2020 to October 2021 were selected and randomly divided into 2 groups,with 30 cases in each group.Patients in the treatment group received glucosamine hydrochloride 0.75 g/time,twice a day.Patients in the control group received Chonggu granule 10 g each time,twice a day.The treatment continued for 12 weeks in both groups.Before and after the treatment,visual analogue scale(VAS)score,WOMAC osteoarthritis score,Lequesne index score,and traditional Chinese medicine syndrome score were used to evaluate the disease activity of the two groups.The levels of C-reactive protein(CRP)and erythrocyte precipitation rate(ESR)were detected.Enzyme-linked immunosorbent assay(ELISA)was used to detect IL-17 and IL-35.Serum levels of matrix metalloproteinase-13(MMP-13),cartilage oligomeric matrix protein(COMP),bone morphogenetic protein 2(BMP-2),and proteoglycan were detected.Results After the treatment,WOMAC score,VAS score,Lequesne score,and TCM syndrome score of KOA patients in each group improved significantly(P<0.01).The levels of MMP-13,COMP,IL-17,CRP,and ESR decreased significantly(P<0.01).The levels of BMP-2,proteoglycan,and IL-35 increased significantly(P<0.05 or P<0.01).Compared between the two groups,the disease activity score,MMP-13,COMP,IL-17,CRP decreased significantly in the treatment group,and BMP-2,proteoglycan and IL-35 increased significantly(P<0.05 or P<0.01).The total effective rate of the treatment group was better than that of the control group,with statistical significance(P<0.05).Conclusion Chonggu granule regulates the expression of cytokines and reduces the degradation and destruction of extrachondral matrix in the treatment of KOA,thereby relieves the clinical symptoms,improves the quality of life of patients,and has good clinical efficacy.