疏气定痛汤对膝关节骨性关节炎急性期的疗效及对血清炎性因子和氧化应激水平的影响

Shuqi Dingtong Decoction:Effects on Acute Attack of Knee Osteoarthritis,Serum Levels of Inflammatory Cytokines,and Oxidative Stress

目的 探讨疏气定痛汤联合玻璃酸钠关节腔注射对气滞血瘀型膝关节骨性关节炎(KOA)急性发作的疗效及对血清炎性因子和氧化应激水平的影响。方法 选取2022年1月—12月我院收治的90例气滞血瘀型KOA急性发作患者,随机分为观察组和对照组各45例。对照组患者接受玻璃酸钠关节腔内注射和布洛芬治疗,观察组在对照组基础上予以疏气定痛汤治疗。比较两组患者治疗前后中医证候评分、膝关节视觉模拟评分(VAS)、西大略和麦克马斯特大学骨关节炎指数(WOMAC)评分、Lyshom评分、布洛芬片平均日剂量、不良反应发生率、血清炎性因子及氧化应激水平。结果 两组各有2例患者脱落。治疗后,观察组患者中医证候评分、VAS评分、WOMAC评分、不良反应发生率、血清白细胞介素10、白细胞介素6、肿瘤坏死因子-α和丙二醛水平低于对照组(P<0.05),而血清超氧化物歧化酶水平和膝关节Lyshom评分高于对照组(P<0.05),观察组患者给药第2、3和4周布洛芬片平均日剂量低于对照组(P<0.05)。结论 疏气定痛汤联合玻璃酸钠关节腔注射可明显改善气滞血瘀型KOA急性发作患者的膝关节功能,其主要机制可能与抑制炎性反应水平和提高机体抗氧化能力有关。

Objective To investigate the effects of Shuqi Dingtong Decoction combined with intra-articular injection of sodium hyaluronate on the acute attack of knee osteoarthritis(KOA)with the syndrome of qi stagnation and blood stasis,serum levels of inflammatory cytokines,and oxidative stress.Methods Ninety patients with acute attack of KOA(syndrome of qi stagnation and blood stasis)treated in the Juxian Hospital of Traditional Chinese Medicine from January to December in 2022 were randomized into an observation group(n=45)and a control group(n=45).The patients in the control group were treated with intra-articular injection of sodium hyaluronate and oraladministration of ibuprofen tablets,while those in the observation group were treated with Shuqi Dingtong Decoction on the basis of the therapy in the control group.The Traditional Chinese Medicine(TCM)syndrome score,Visual Analogue Scale(VAS)score of knee joint,Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score,Lyshom score,the average daily dose of ibuprofen tablets,the incidence of adverse reactions,serum levels of inflammatory cytokines,and oxidative stress were compared between the two groups before and after treatment.Results Two patients in each group dropped off.After treatment,the observation group had lower TCM syndrome score,VAS score,WOMAC score,incidence of adverse reactions,and serum levels of interleukin(IL)-10,IL-6,tumor necrosis factor-a,and malondialdehyde and higher superoxide dismutase level and Lyshom score than the control group(P<0.05).The average daily dose of ibuprofen tablets in the observation group was lower than that in the control group at weeks 2,3,and 4(P<0.05).Conclusion Shuqi Dingtong Decoction combined with intra-articular injection of sodium hyaluronate can significantly improve the knee joint function of patients with acute attack of KOA(syndrome of qi stagnation and blood stasis)by inhibiting inflammation and improving the antioxidant capacity.