膝关节骨性关节炎全膝关节置换术后中医证型变化及对血清TNF-α、hs-CRP、IL-6和IL-1β水平的影响

Study on the Relationship Between Traditional Chinese Medicine Syndromes and Serum TNF-α,hs-CRP,IL-6 and IL-1β Levels after Total Knee Joint Replacement in Patients with Knee Osteoarthritis

目的:对膝关节骨性关节炎患者行全膝关节置换术后中医证型变化及中医体质关系进行研究。方法:选取2014年12月~2016年12在本院接受全膝关节置换术治疗的膝关节骨性关节炎患者100例,并记录这100名患者在手术前、手术后3天、1周、2周、1月、3月气血虚弱证、气滞血瘀证、肝肾亏虚证、寒湿痹阻证以及其他证型的分布人数和它们的变化规律,观察患者治疗前后血清TNF-α、hs-CRP、IL-6和IL-1β水平的变化情况。结果:在手术前观察的100例患者,寒湿痹阻14例、气血虚弱组15例、气滞血瘀组35例、肝肾亏虚36例,在治疗前、治疗后3天、治疗后1个月气滞血瘀组分别占总数的35%、57%、11%,可以明显观察到气滞血瘀组比例明显下降;在治疗前、治疗后1周、治疗后2周气血虚弱组分别占总数的14%、17%、28%,可观察到气血虚弱组比例明显提高,提高将近2倍;在治疗前、治疗后3天寒湿痹阻组分别占总数的15%、6%,可观察到寒湿痹阻组比例明显下降;在治疗前、治疗后1周、治疗后1个月肝肾亏虚组分别占总数的36%、18%、50%,可观察到肝肾亏虚组比例先下将后又升高保持不变。将各组证型的变化进行统计学检验,两组差异有统计学意义(P<0.05);患者手术后血清TNF-α、hs-CRP、IL-6和IL-1β都明显下降,与治疗前对比差异有统计学意义(P<0.05)。结论:膝关节骨性关节炎患者在进行全膝关节置换术后中医证型会发生一些变化,气血虚弱症在手术后2周到3个月改变明显,气滞血瘀在术后2周改变明显,肝肾亏虚在3个月后改变明显。

Objective: To study the changes of TCM syndromes and the relationship between TCM constitution after total knee arthroplasty in patients with knee osteoarthritis. Methods: From December 2014 to 2016,100 patients with knee osteoarthritis were treated with total knee arthroplasty in our hospital. The patients were recorded before operation,3 days,1 week after operation,2 weeks,1 month,3 months blood deficiency syndrome,Qi stagnation blood stasis,liver and kidney deficiency syndrome,cold dampness collapse resistance card and other syndromes of the number of distribution and their changes in the law. The levels of serum TNF-α,hs-CRP,IL-6 and IL-1β were observed before and after treatment. Results: Among the 100 patients observed before operation,there were 14 cases of cold and dampness obstruction,15 cases of Qi deficiency group,35 cases of Qi stagnation and blood stasis group,36 cases of liver and kidney deficiency,3days before treatment,3 days after treatment after 1 month of stagnation of blood stasis group accounted for 35% of the total,57%,11%,can be significantly observed Qi stagnation group decreased significantly; before treatment,1 week after treatment,2 weeks after treatment of blood weak group accounted for 14% of the total,17%,28%,can be observed in the proportion of weak blood group was significantly increased,nearly 2 times; before treatment,3 days after treatment cold dampness group accounted for 15%,6%,can be observed in the group of cold dampness group decreased significantly; before treatment,1week after treatment,1 month after treatment,liver and kidney deficiency group accounted for 36% of the total,18%,50% to the liver and kidney deficiency group before the first increase would remain unchanged.The changes of each group were statistically analyzed,the difference between the two groups was statistically significant( P <0. 05). The levels of serum TNF-α,hs-CRP,IL-6 and IL-1β were significantly decreased in the patients after operation,which were significantly different from those before treatment( P<0. 05). Conclusion: There are some changes in TCM syndromes after total knee arthroplasty in patients with osteoarthritis of the knee. Changes in blood deficiency are obvious improved from 2 weeks to 3 months after operation. Obviously,liver and kidney deficiency has changed significantly from 3 months after operation.