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[1]周江濤,趙依娜,王慶來.獨活寄生湯口服聯(lián)合玻璃酸鈉關(guān)節(jié)腔注射治療早中期膝骨關(guān)節(jié)炎[J].中醫(yī)正骨,2019,31(02):18-21.
　ZHOU Jiangtao,ZHAO Yina,WANG Qinglai.Oral application of Duhuo Jisheng Tang(獨活寄生湯)combined with intra-articular injection of sodium hyaluronate for treatment of early-middle knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(02):18-21.
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獨活寄生湯口服聯(lián)合玻璃酸鈉關(guān)節(jié)腔注射治療早中期膝骨關(guān)節(jié)炎()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年02期
頁碼:
18-21
欄目:
臨床研究
出版日期:
2019-02-20

文章信息/Info

Title:
Oral application of Duhuo Jisheng Tang(獨活寄生湯)combined with intra-articular injection of sodium hyaluronate for treatment of early-middle knee osteoarthritis
作者:
周江濤; 趙依娜; 王慶來
(溫州市中醫(yī)院,浙江 溫州 325000)
Author(s):
ZHOU Jiangtao; ZHAO Yina; WANG Qinglai
Wenzhou Hospital of Traditional Chinese Medicine,Wenzhou 325000,Zhejiang,China
關(guān)鍵詞:
骨關(guān)節(jié)炎; 膝;  獨活寄生湯;  透明質(zhì)酸;  氧化應(yīng)激;  臨床試驗
Keywords:
osteoarthritis; knee;  Duhuo Jisheng Tang;  hyaluronic acid;  oxidative stress;  clinical trial
摘要:
目的:觀察獨活寄生湯口服聯(lián)合玻璃酸鈉關(guān)節(jié)腔注射治療早中期膝骨關(guān)節(jié)炎(knee osteoarthritis,KOA)的臨床療效及對氧化應(yīng)激指標(biāo)的影響。方法:將106例符合要求的早中期KOA患者隨機分為2組。聯(lián)合組(54例)采用獨活寄生湯口服聯(lián)合玻璃酸鈉關(guān)節(jié)腔注射治療,玻璃酸鈉組(52例)采用玻璃酸鈉關(guān)節(jié)腔注射治療。獨活寄生湯水煎服,每日1劑,連續(xù)治療5周; 玻璃酸鈉關(guān)節(jié)腔注射治療每周1次,連續(xù)治療5周。評定患者的骨關(guān)節(jié)炎嚴(yán)重性指數(shù)(index of severity for osteoarthritis,ISOA)、膝關(guān)節(jié)疼痛視覺模擬量表(visual analogue scale,VAS)評分及總體療效,測定血清超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛、谷胱甘肽(glutathione,GSH)水平及總抗氧化能力(total antioxidant capacity,T-AOC)。結(jié)果:①臨床療效。治療前2組患者的ISOA比較,差異無統(tǒng)計學(xué)意義(t=0.397,P=0.692); 治療結(jié)束后2組患者的ISOA均較治療前降低[(6.38±1.48)分,(1.42±0.39)分,t=23.814,P=0.000;(6.49±1.37)分,(2.11±0.56)分,t=21.340,P=0.000],聯(lián)合組的ISOA低于玻璃酸鈉組(t=7.384,P=0.000)。治療前2組患者的膝關(guān)節(jié)疼痛VAS評分比較,差異無統(tǒng)計學(xué)意義(t=0.303,P=0.763); 治療結(jié)束后2組患者的膝關(guān)節(jié)疼痛VAS評分均較治療前降低[(6.10±1.21)分,(2.05±0.64)分,t=21.742,P=0.000;(6.03±1.17)分,(2.95±0.83)分,t=15.483,P=0.000],聯(lián)合組的膝關(guān)節(jié)疼痛VAS評分低于玻璃酸鈉組(t=6.226,P=0.000)。聯(lián)合組的總體療效優(yōu)于玻璃酸鈉組((-overR)聯(lián)合組=47.37,(-overR)玻璃酸鈉組=59.87,Z=-2.205,P=0.027)。②氧化應(yīng)激指標(biāo)。治療前2組患者的血清SOD水平比較,差異無統(tǒng)計學(xué)意義(t=0.284,P=0.777); 治療結(jié)束后2組患者的血清SOD水平均較治療前升高[(65.37±9.33)單位·mL-1,(97.58±12.46)單位·mL-1,t=15.103,P=0.000;(64.83±10.21)單位·mL-1,(78.45±9.47)單位·mL-1,t=7.099,P=0.000],聯(lián)合組的血清SOD水平高于玻璃酸鈉組(t=8.874,P=0.000)。治療前2組患者的血清丙二醛水平比較,差異無統(tǒng)計學(xué)意義(t=0.360,P=0.720); 治療結(jié)束后2組患者的血清丙二醛水平均較治療前降低[(17.22±4.38)nmol·mL-1,(11.52±2.76)nmol·mL-1,t=8.091,P=0.000;(16.93±3.89)nmol·mL-1,(13.77±2.54)nmol·mL-1,t=4.905,P=0.000],聯(lián)合組的血清丙二醛水平低于玻璃酸鈉組(t=3.083,P=0.003)。治療前2組患者的血清GSH水平比較,差異無統(tǒng)計學(xué)意義(t=0.631,P=0.529); 治療結(jié)束后2組患者的血清GSH水平與治療前相比,差異均無統(tǒng)計學(xué)意義[(1 728.41±273.58)mg·L-1,(1 673.01±210.59)mg·L-1,t=1.179,P=0.241;(1 695.38±264.93)mg·L-1,(1 685.21±228.46)mg·L-1,t=0.210,P=0.834]。治療前2組患者的血清T-AOC比較,差異無統(tǒng)計學(xué)意義(t=0.341,P=0.734); 治療結(jié)束后2組患者的血清T-AOC均較治療前降低[(34.74±9.38)單位·L-1,(17.48±5.04)單位·L-1,t=11.911,P=0.000;(35.39±10.22)單位·L-1,(21.81±6.40)單位·L-1,t=8.121,P=0.000],聯(lián)合組的血清T-AOC低于玻璃酸鈉組(t=3.878,P=0.000)。結(jié)論:獨活寄生湯口服聯(lián)合玻璃酸鈉關(guān)節(jié)腔注射可有效減輕早中期KOA患者的膝關(guān)節(jié)疼痛程度、延緩病情進(jìn)展,升高血清SOD水平、降低血清丙二醛水平和T-AOC,其效果優(yōu)于單純玻璃酸鈉關(guān)節(jié)腔注射治療。
Abstract:
Objective:To observe the clinical curative effects of oral application of Duhuo Jisheng Tang(獨活寄生湯,DHJST)combined with intra-articular injection of sodium hyaluronate in the treatment of early-middle knee osteoarthritis(KOA)and its effects on oxidative stress indexes.Methods:One hundred and six patients with early-middle KOA were enrolled in the study and were randomly divided into combination therapy group(54 cases)and sodium hyaluronate group(52 cases),and were treated with combination therapy of oralapplication of DHJST and intra-articular injection of sodium hyaluronate and monotherapy of intra-articular injection of sodium hyaluronate respectively.The DHJST decoctions were taken one dose a day for consecutive 5 weeks.The intra-articular injections of sodium hyaluronate were performed on patients once a week for consecutive 5 weeks.The index of severity for osteoarthritis(ISOA),knee pain visual analogue scale(VAS)scores and the total curative effects were evaluated.The serum levels of superoxide dismutase(SOD),malondialdehyde(MDA)and glutathione(GSH)and the total antioxidant capacity(T-AOC)were measured.Results:There was no statistical difference in ISOA between the 2 groups before the treatment(t=0.397,P=0.692).The ISOA decreased in the 2 groups after the end of the treatment compared to pretreatment(6.38+/-1.48 vs 1.42+/-0.39 points,t=23.814,P=0.000; 6.49+/-1.37 vs 2.11+/-0.56 points,t=21.340,P=0.000),and the ISOA were lower in combination therapy group compared to sodium hyaluronate group(t=7.384,P=0.000).There was no statistical difference in knee pain VAS scores between the 2 groups before the treatment(t=0.303,P=0.763).The knee pain VAS scores decreased in the 2 groups after the end of the treatment compared to pretreatment(6.10+/-1.21 vs 2.05+/-0.64 points,t=21.742,P=0.000; 6.03+/-1.17 vs 2.95+/-0.83 points,t=15.483,P=0.000),and the knee pain VAS scores were lower in combination therapy group compared to sodium hyaluronate group(t=6.226,P=0.000).The combination therapy group surpassed the sodium hyaluronate group in the total curative effects((-overR)combination therapy group=47.37,(-overR)sodium hyaluronate group=59.87,Z=-2.205,P=0.027).There was no statistical difference in serum level of SOD between the 2 groups before the treatment(t=0.284,P=0.777).The serum level of SOD increased in the 2 groups after the end of the treatment compared to pretreatment(65.37+/-9.33 vs 97.58+/-12.46 unit/mL,t=15.103,PV=0.000; 64.83+/-10.21 vs 78.45+/-9.47 unit/mL,t=7.099,P=0.000),and the serum level of SOD was higher in combination therapy group compared to sodium hyaluronate group(t=8.874,P=0.000).There was no statistical difference in serum level of MDA between the 2 groups before the treatment(t=0.360,P=0.720).The serum level of MDA decreased in the 2 groups after the end of the treatment compared to pretreatment(17.22+/-4.38 vs 11.52+/-2.76 nmol/mL,t=8.091,P=0.000; 16.93+/-3.89 vs 13.77+/-2.54 nmol/mL,t=4.905,P=0.000),and the serum level of MDA was lower in combination therapy group compared to sodium hyaluronate group(t=3.083,P=0.003).There was no statistical difference in serum level of GSH between the 2 groups before the treatment(t=0.631,P=0.529).There was no statistical difference in serum level of GSH between pretreatment and posttreatment in the 2 groups(1 728.41+/-273.58 vs 1 673.01+/-210.59 mg/L,t=1.179,P=0.241; 1 695.38+/-264.93 vs 1 685.21+/-228.46 mg/L,t=0.210,P=0.834).There was no statistical difference in serum T-AOC between the 2 groups before the treatment(t=0.341,P=0.734).The serum T-AOC decreased in the 2 groups after the end of the treatment compared to pretreatment(34.74+/-9.38 vs 17.48+/-5.04 unit/L,t=11.911,P=0.000; 35.39+/-10.22 vs 21.81+/-6.40 unit/L,t=8.121,P=0.000),and the serum T-AOC was lower in combination therapy group compared to sodium hyaluronate group(t=3.878,P=0.000).Conclusion:The combination therapy of oral application of DHJST and intra-articular injection of sodium hyaluronate can effectively relieve knee pain,postpone the progress of disease,increase serum level of SOD and decrease serum level of MDA and T-AOC of patients with early-middle KOA,and its curative effects are better than that of monotherapy of intra-articular injection of sodium hyaluronate.

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備注/Memo

備注/Memo:
基金項目:2015年浙江省中醫(yī)藥科技計劃項目(2015ZQ031) 通訊作者:周江濤 E-mail:[email protected](收稿日期:2018-10-25 本文編輯:李曉樂)
更新日期/Last Update: 2019-02-20