活血膏外敷联合痹痛汤方口服治疗膝骨关节炎的疗效观察及对患者炎性反应、抗氧化能力的影响

Clinical efficacy of external application of Huoxue ointment combined with oral Bitong Decoction for knee osteoarthritis,and its influence on inflammatory response and antioxidant capacity

目的观察活血膏外敷联合痹痛汤方口服治疗膝骨关节炎的临床疗效,以及对患者炎性反应、抗氧化能力的影响。方法选取118例膝骨关节炎患者,按照随机数字表法分为2组,在均予常规康复治疗基础上,对照组59例予痹痛汤方口服治疗,治疗组59例在对照组基础上联合活血膏外敷治疗。2组均治疗4周后统计疗效,比较2组治疗前后中医症状(包括晨僵酸胀、跛行走痛及膝部肿胀)评分、膝关节功能[采用奎森功能演算指数(Lequesne)进行评价]、运动功能[采用Fugl-Meyer运动功能评定量表(FMA)进行评价]、疼痛程度[采用疼痛视觉模拟评分法(VAS)进行评价]、日常生活能力(采用Barthel指数进行评价)、炎症相关指标[包括Toll样受体4(TLR4)、核转录因子κB p65(NF-κB p65)、肿瘤坏死因子α(TNF-α)及白细胞介素1β(IL-1β)]及氧化应激指标[包括总抗氧化力(TAOC)及脂质过氧化物(LPO)]水平变化情况。结果治疗组总有效率94.92%(56/59),对照组总有效率83.05%(49/59),治疗组疗效优于对照组(P<0.05)。与本组治疗前比较,2组治疗后中医症状晨僵酸胀、跛行走痛及膝部肿胀评分均降低(P<0.05),且治疗组治疗后中医症状晨僵酸胀、跛行走痛及膝部肿胀评分均低于对照组(P<0.05)。与本组治疗前比较,2组治疗后Leqensne评分均降低,FMA评分均升高(P<0.05),且治疗组治疗后Leqensne评分低于对照组(P<0.05),FMA评分高于对照组(P<0.05)。与本组治疗前比较,2组治疗后疼痛VAS均降低(P<0.05),Barthel指数评分均升高(P<0.05),且治疗组治疗后疼痛VAS低于对照组(P<0.05),Barthel指数评分高于对照组(P<0.05)。与本组治疗前比较,2组治疗后炎症相关指标TLR4、NF-κB p65、TNF-α、IL-1β及氧化应激指标TAOC、LPO水平均降低(P<0.05),且治疗组治疗后炎症相关指标TLR4、NF-κB p65、TNF-α、IL-1β及氧化应激指标TAOC、LPO水平均低于对照组(P<0.05)。结论活血膏外敷联合痹痛汤方口服治疗膝骨关节炎临床疗效确切,可有效改善患者中医症状,提高膝关节功能和运动功能,减轻患者疼痛,提高日常生活能力,其作用机制可能与抑制炎性反应,提升抗氧化能力,减轻氧化应激损伤有关。

Objective To observe the clinical efficacy of external application of Huoxue ointment combined with oral Bitong Decoction for knee osteoarthritis(KOA),and its influence on inflammatory response and antioxidant capacity.Methods From October 2020 to March 2022,totally 118 KOA patients admitted to our hospital were randomly assigned into the treatment group(n=59)and the control group(n=59).Patients of the control group received routine rehabilitation treatment+oral Bitong Decoction,and those of the treatment group additionally received external application of Huoxue ointment based on the control group.Treated for 4 weeks,the knee joint function,motor function,severity of pain,activity of daily living(ADL)were evaluated by Lequesne Algofunctional index,Fugl-Meyer Assessment(FMA),Visual Analogue Scale(VAS),Barthel index,respectively.The traditional Chinese medicine(TCM)symptom(morning stiffness,soreness,lameness,walking pain and knee swelling)score,inflammation-related indicators(Toll-like receptor 4[TLR4],nuclear factor kappa B p65[NF-κB p65],tumor necrosis factor-α[TNF-α],interleukin-1β[IL-1β]),oxidative stress indexes(total antioxidant capacity[TAOC],lipid peroxide[LPO])were compared.The curative effect was assessed.Results The overall effective rate in the treatment group was significantly better than that in the control group(94.92%[56/59]vs 83.05%[49/59],[P<0.05],respectively).After treatment,TCM symptom scores in groups were significantly decreased(P<0.05),which significantly decreased in the treatment group compared with the control group(P<0.05).Significantly decreased Leqensne and VAS scores,and significantly increased FMA and Barthel index scores were detected in the two groups(all P<0.05).TLR4,NF-κB p65,TNF-α,IL-1β,TAOC,LPO in groups were decreased after treatment(P<0.05),which were significantly lower in the treatment group than in the control group(P<0.05).Conclusion For KOA patients,external application of Huoxue ointment combined with oral Bitong Decoction has definite clinical curative effect,which can effectively improve TCM symptoms,improve knee joint function and motor function,relieve pain,and improve ADL by inhibiting inflammatory response,improving antioxidant capacity,and reducing oxidative stress damage.