复方杜仲健骨颗粒对大骨节病患者关节功能、生命质量和炎症因子的影响

Effect of Compound Duzhong Jiangu Granules on joint function,quality of life and inflammatory factors in patients with Kashin-Beck disease

目的探讨复方杜仲健骨颗粒对大骨节病患者关节功能、生命质量和炎症因子的影响。方法选择甘肃省平凉市崇信县135例大骨节病患者,采用成组设计,按照随机、单盲原则分为干预组(100例,复方杜仲健骨颗粒治疗,12 g/袋,1袋/次,3次/日,治疗时间为1个月)和对照组(35例,布洛芬治疗,0.3 g/粒,1粒/次,2次/日,治疗时间为2周)。分析患者治疗前、治疗后1个月、治疗后3个月关节功能障碍指数评分、关节功能改善率和大骨节病生命质量量表(KBDQOL)总分及各维度得分变化情况;治疗前、治疗后1个月采集部分患者血液样本,采用酶联免疫吸附试验法检测血清炎症因子白细胞介素-6(IL-6)、核因子κB(NFκB)-p65、诱导型一氧化氮合酶(NOS2)、一氧化氮(NO)、前列腺素E2(PGE2)水平。结果干预组和对照组关节功能障碍指数综合评分之和在治疗后1个月和3个月均低于治疗前,但治疗后3个月均高于治疗后1个月(均P<0.001)。治疗后1个月,干预组、对照组关节功能改善总有效率分别为68.00%(68/100)、54.55%(18/33);治疗后3个月,干预组、对照组关节功能改善总有效率分别为36.00%(36/100)、39.39%(13/33)。KBDQOL总分及各维度得分,组别主效应均不显著(均P>0.05),时点主效应均显著(均P<0.001),均无交互效应(均P>0.05);干预组社会支持和精神状况维度得分在不同时点的两两比较差异均有统计学意义(均P<0.001);干预组总分和躯体功能、活动限制、经济、总体健康各维度得分在治疗前与治疗后1个月、治疗后1个月与治疗后3个月之间比较差异均有统计学意义(均P<0.05),而治疗前与治疗后3个月之间比较差异均无统计学意义(均P>0.05)。治疗后1个月两组患者血清PGE2水平均较低(均P<0.05),其他炎症因子在不同组别和时点上比较差异均无统计学意义(均P>0.05)。结论复方杜仲健骨颗粒能够有效抑制大骨节病患者炎症反应,促使患者关节功能改善,提高患者多方面的生命质量。

Objective To study the effect of Compound Duzhong Jiangu Granules on joint function,quality of life and inflammatory factors in patients with Kashin-Beck disease.Methods By group design,135 patients with Kashin-Beck disease in Chongxin County,Pingliang City,Gansu Province,were selected and divided into intervention group(100 cases treated with Compound Duzhong Jiangu Granules,12 g/bag,1 bag/time,3 times/day,treatment for 1 month)and control group(35 cases treated with ibuprofen,0.3 g/capsule,1 capsule/time,2 times/day,treatment for 2 weeks)according to the randomized,single-blind principle.The changes of joint dysfunction index score,joint function improvement rate,total scores of Kashin-Beck disease quality of life(KBDQOL)and scores of each dimension were analyzed before treatment,1 month and 3 months after treatment.The serum levels of interleukin-6(IL-6),nuclear factorκB(NFκB)-p65,inducible nitric oxide synthase(NOS2),nitric oxide(NO),and prostaglandin E2(PGE2)were detected by enzyme-linked immunosorbent assay before treatment and 1 month after treatment.Results The total scores of joint dysfunction index of the intervention group and the control group 1 month after treatment and 3 months after treatment were lower than those before treatment,but 3 months after treatment was higher than 1 month after treatment(P<0.001).One month after treatment,the total effective rates of joint function improvement in the intervention group and the control group were 68.00%(68/100)and 54.55%(18/33),respectively;3 months after treatment,the total effective rates of the intervention group and the control group were 36.00%(36/100)and 39.39%(13/33),respectively.The total scores and scores of each dimension of KBDQOL were not significant for the main effect of the group(P>0.05),but significant for the main effect at the time point(P<0.05),and there was no interactive effect(P>0.05).There were significant differences in the scores of social support and mental status dimensions in the intervention group at different time points(P<0.001).And in the intervention group,the total score,the scores of physical function,activity limitation,economy and overall health dimensions were statistically significant between before treatment and 1 month after treatment,1 month after treatment and 3 months after treatment(P<0.05);however,there was no significant difference between before treatment and 3 months after treatment(P>0.05).One month after treatment,the serum PGE2 levels of both groups were decreased(P<0.05),and there was no difference in other inflammatory factors at different groups and time points(P>0.05).Conclusion Compound Duzhong Jiangu Granules can effectively inhibit the inflammatory reaction of patients with Kashin-Beck disease,promote the improvement of joint function and improve the quality of life in various aspects.