富血小板血浆联合曲安奈德治疗膝关节炎患者的临床研究

Clinical trial of platelet-rich plasma combined with triamcinolone acetonide in the treatment of patients with knee arthritis

目的观察富血小板血浆(PRP)联合曲安奈德治疗膝关节炎患者的短期疗效及对Toll样受体4/核因子κB(TLR4/NF-κB)信号通路的影响。方法将120例膝关节炎患者分为对照组和试验组。对照组膝关节腔内单独注射PRP 4 mL,试验组在上述基础上联合注射曲安奈德注射液20 mg,2组均每周注射1次,连续注射5周。比较2组的临床疗效、膝关节功能、疼痛、炎症因子及TLR 4/NF-κB通路mRNA表达情况。结果对照组和试验组各60例。试验组治疗总有效率为91.67%,对照组为83.33%,差异无统计学意义(P>0.05)。试验组治疗1个月、3个月的LKS评分分别为(56.67±6.92)、(61.74±6.38)分,膝关节活动度分别为(78.49±8.45)°、(92.24±6.62)°,视觉模拟疼痛评分(VAS)分别为(3.97±0.84)、(2.61±0.52)分;对照组治疗1个月、3个月的LKS评分分别为(47.51±7.45)、(53.42±5.54)分,膝关节活动度分别为(70.67±7.63)°、(76.37±5.88)°,VAS评分分别为(4.67±0.91)、(3.38±0.67)分;2组上述指标的比较,差异均有统计学意义(均P<0.05)。治疗后试验组血清前列腺素E2(PGE2)、P物质(SP)、降钙素基因相关肽(CGRP)、白细胞介素(IL)-1β、IL-8、IL-18水平和外周血单个核细胞TLR4、NF-κB mRNA表达水平明显低于对照组(均P<0.05)。结论PRP联合曲安奈德治疗膝关节炎的临床疗效良好,可能通过抑制TLR4/NF-κB信号通路降低炎症反应,改善患者膝关节功能,减轻疼痛。

Objective To explore the short-term clinical efficacy of platelet-rich plasma(PRP)combined with triamcinolone acetonide on patients with knee arthritis and their effects on Toll-like receptor 4/nuclear factorκB(TLR4/NF-κB)signaling pathways.Methods A total of 120 patients with knee arthritis treated were divided into control group and treatment group.Control group was injected with PRP 4 mL in the knee cavity alone and treatment group was injected with triamcinolone injection 20 mg on the basis of control group,once a week for consecutive 5 weeks in both groups.The clinical efficacy,knee function,pain,inflammatory factors and expressions of TLR4/NF-κB pathway mRNA in the two groups were compared.Results There were 60 cases in each group.The total effective rates of treatment group and control group were 91.67%,83.33%,without significant difference(P>0.05).At 1 month and 3 months after treatment,LKS scores in treatment group were(56.67±6.92)and(61.74±6.38)points;knee ranges of motion were(78.49±8.45)°and(92.24±6.62)°;visual analogue scales(VAS)were(3.97±0.84)and(2.61±0.52)points.In control group at 1 month and 3 months afer treatment,LKS scores were(47.51±7.45)and(53.42±5.54)points;knee ranges of motion were(70.67±7.63)°and(76.37±5.88)°;VAS were(4.67±0.91)and(3.38±0.67)points.The differences in the above indexes between the two groups were statistically significant(all P<0.05).After treatment,levels of serum prostaglandin E2(PGE2),substance P(SP),calcitonin gene-related peptide(CCRP),interleukin(IL)-1β,IL-8 and IL-18,and mRNA levels of TLR4 and NF-κB in peripheral blood mononuclear cells in treatment group were significantly lower than those in control group(all P<0.05).Conclusion PRP combined with triamcinolone acetonide has good on clinial efficacy knee arthritis,which can improve knee function and relieve pain by inhibiting TLR4/NF-κB signaling pathways and reducing inflammatory response.