透明质酸钠联合塞来昔布治疗骨性关节炎的效果及对TNF-α、IL-1β、PGE_2的影响

Study of Sodium Hyaluronate Combined with Celecoxib in Treatment of Osteoarthritis and Its Effect on TNF-α,IL-1β and PGE_2

目的探讨透明质酸钠联合塞来昔布治疗骨性关节炎(OA)的疗效及其对肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)、前列腺素E_2(PGE_2)的影响。方法选取2013年11月至2014年10月锦州市中心医院收治的90例OA患者作为研究对象。采用抽签法将患者分为联合治疗组、透明质酸钠组和塞来昔布组,每组30例。选择同期来医院进行健康体检的30例健康人作为健康对照组。透明质酸钠组患者行透明质酸钠膝关节腔注射,每次2 mL,每周1次,连续5次;塞来昔布组患者口服塞来昔布片25 mg,每日1次,共治疗5周。联合治疗组患者联合以上两种治疗方法。比较治疗结束后及治疗结束后90 d三组患者的疗效,比较治疗前后四组研究对象体内TNF-α、IL-1β和PGE-2水平的变化,比较不良反应发生情况。结果联合治疗组的近期有效率及优良率、远期有效率和优良率优于透明质酸钠组和塞来昔布组[近期有效率为100.0%(30/30)比80.0%(24/30)比76.6%(23/30);优良率90.0%(27/30)比43.0%(13/30)比36.6%(11/30);远期有效率100.0%(30/30)比76.7%(23/30),76.7%(23/30);优良率为73.3%(23/30)比40.0%(12/30)比36.6%(11/30)](P<0.05),但透明质酸钠组组与塞来昔布组比较,差异无统计学意义(P>0.05)。治疗后,联合治疗组、透明质酸钠组和塞来昔布组患者TNF-α、IL-1β及PGE-2[(20.7±3.8)ng/L、(26.4±6.0)ng/L、(25.0±6.3)ng/L),(57.4±7.8)ng/L、(69.3±9.0)ng/L、(74.9±10.4)ng/L,(178.3±28.2)μg/L、(259.1±30.2)μg/L、(273.0±30.9)μg/L]水平均较治疗前降低,差异有统计学意义(P<0.05),但仍然显著高于健康对照组[TNF-α(16.3±4.3)ng/L、IL-1β(48.0±8.3)ng/L、PGE_2(134.8±18.0)μg/L)](P<0.05),其中联合治疗组TNF-α、IL-1β及PGE_2水平低于透明质酸钠组和塞来昔布组(P<0.05);联合治疗组的不良反应发生率与塞来昔布组、透明质酸钠组[10.0%(3/30)比6.7%(2/30),6.7%(2/30)]比较差异无统计学意义(P>0.05)。结论透明质酸钠联合塞来昔布能显著降低OA患者体内TNF-α、IL-1β及PGE-2水平,且疗效优于单独用药,因而具有较好的临床应用及推广价值。

Objective To explore the curative effect of sodium hyaluronate combines with celecoxib treatment of osteoarthritis（OA） and its effect on tumor necrosis factor α（ TNF-α）,interleukin 1β（ IL-1β）,prostaglandin E2（ PGE2）. Methods Total of 90 OA patients treated in Jinzhou Central Hospital from Nov.2013 to Oct.2014 were included as research objects,and divided into a combined treatment group,a sodium hyaluronate group and a celecoxib group according to lottery method,30 cases each. 30 healthy persons for physical examination during the same period were included as a control group. The sodium hyaluronate group received sodium hyaluronate knee joint cavity injection,2 mL per time,once a week,five times continuously.The celecoxib group took celecoxib 25 mg by oral,once per day,for 5 weeks. The combined treatment group took both methods. The curative effect of the three groups after treatment and ninety days after treatment,the levels of TNF-α,IL-1β and PGE2,and the adverse reactions were compared. Results The short-term effective rate and excellent rate,long-term effective rate and excellent rate of the combined treatment group were better than the sodium hyaluronate group and celecoxib group[short-term effective rate: 100. 0%（ 30 /30） vs80. 0%（ 24 /30） vs 76. 6%（ 23 /30）,excellent rate: 90. 0%（ 27 /30） vs 43. 0%（ 13 /30） vs 36. 6%（ 11 /30）; long-term effective rate: 100. 0%（ 30 /30） vs 76. 7%（ 23 /30） vs 76. 7%（ 23 /30）; excellent rate:73. 3%（ 23 /30） vs 40. 0%（ 12 /30） vs 36. 6%（ 11 /30） ]（ P < 0. 05）,but there was not statistically significant difference between the sodium hyaluronate group and celecoxib group（ P > 0. 05）. After treatment,the TNF-α,IL-1β and PGE2 levels of the combined treatment group,sodium hyaluronate group and celecoxib group TNF-α,IL-1β,PGE2[（ 20. 7 ± 3. 8） ng/L,（ 26. 4 ± 6. 0） ng/L,（ 25. 0 ± 6. 3） ng/L;（ 57. 4 ±7. 8） ng / L,（ 69. 3 ± 9. 0） ng / L,（ 74. 9 ± 10. 4） ng / L;（ 178. 3 ± 28. 2） μg / L,（ 259. 1 ± 30. 2） μg / L,（ 273. 0 ± 30. 9） μg/L]were lower than before treatment,but still higher than the control group [TNF-α（ 16. 3 ± 4. 3） ng/L,IL-1β（ 48. 0 ± 8. 3） ng/L,PGE2（ 134. 8 ± 18. 0） μg/L]. Among them,TNF-α,IL-1β and PGE2 levels of the combined treatment group were lower than the sodium hyaluronate group and celecoxib group（ P < 0. 05）. The adverse reaction rate of the combined treatment group,sodium hyaluronate group and celecoxib group had no statistically significant differences[10. 0%（ 3 /30）,6. 7%（ 2 /30）,6. 7%（ 2 /30） ]（ P > 0. 05）. Conclusion Sodium hyaluronate combines with celecoxib can significantly reduce the TNF-α,IL-1β and PGE2 levels of OA patients,and its curative effect is superior to sodium hyaluronate or celecoxib alone,therefore it has good clinical application and promotional value.