[1]康武林,袁普卫,李小群,等.口服蠲痹汤和盐酸氨基葡萄糖胶囊治疗膝骨关节炎的疗效观察及作用机制研究[J].中医正骨,2016,28(09):19-22.
　KANG Wulin,YUAN Puwei,LI Xiaoqun,et al.A clinical study on the curative effect and mechanism of action of oral applications of Juanbi Tang(蠲痹汤)and glucosamine hydrochloride capsules for treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(09):19-22.
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口服蠲痹汤和盐酸氨基葡萄糖胶囊治疗膝骨关节炎的疗效观察及作用机制研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期数:
2016年09期
页码:
19-22
栏目:
膝骨关节炎
出版日期:
2016-09-20

文章信息/Info

Title:
A clinical study on the curative effect and mechanism of action of oral applications of Juanbi Tang(蠲痹汤)and glucosamine hydrochloride capsules for treatment of knee osteoarthritis
作者:
康武林; 袁普卫; 李小群; 董博; 杨锋; 王晓玲; 孙菊; 余红超; 刘德玉; 昝强
陕西中医药大学附属医院,陕西 咸阳 712000
Author(s):
KANG Wulin; YUAN Puwei; LI Xiaoqun; DONG Bo; YANG Feng; WANG Xiaoling; SUN Ju; YU Hongchao; LIU Deyu; ZAN Qiang
The Affiliated Hospital to Shanxi University of Chinese Medicine,Xianyang 712000,Shanxi,China
关键词:
骨关节炎; 膝;  中药疗法;  蠲痹汤;  盐酸氨基葡萄糖;  Toll样受体4;  肿瘤坏死因子-α;  临床试验
Keywords:
osteoarthritis; knee;  drug therapy(TCD);  Juanbi Tang;  glucosamine hydrochloride;  toll-like receptor 4;  tumor necrosis factor-alpha;  clinical trial
摘要:
目的:观察口服蠲痹汤和盐酸氨基葡萄糖胶囊治疗膝骨关节炎的临床疗效并探讨其作用机制。方法:将80例膝骨关节炎患者随机分为2组,每组40例,分别采用口服蠲痹汤和盐酸氨基葡萄糖胶囊、单纯口服盐酸氨基葡萄糖胶囊治疗。蠲痹汤口服每日1剂,水煎400 mL,早晚各200 mL,连续服用8周; 盐酸氨基葡萄糖胶囊口服每次2粒,每日3次,连续服用8周。分别于治疗前、治疗开始后8周测量并比较2组患者膝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、日本骨科协会(Japanese orthopaedic association,JOA)膝关节功能评分以及Toll样受体4(toll-like receptor 4,TLR4)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)的血清含量。结果:①膝关节疼痛VAS评分和JOA膝关节功能评分。治疗前2组患者膝关节疼痛VAS评分及JOA膝关节功能评分比较,组间差异均无统计学意义[(8.01±1.16)分,(8.05±1.12)分,t=0.157,P=0.876;(70.02±9.86)分,(68.32±10.28)分,t=0.755,P=0.453]。治疗开始后8周,口服蠲痹汤和盐酸氨基葡萄糖胶囊组膝关节疼痛VAS评分低于单纯口服盐酸氨基葡萄糖胶囊组[(2.33±0.68)分,(5.86±0.97)分,t=18.850,P=0.000],JOA膝关节功能评分高于单纯口服盐酸氨基葡萄糖胶囊组[(86.24±5.32)分,(79.46±7.54)分,t=4.647,P=0.000]; 2组患者膝关节疼痛VAS评分均低于治疗前(t=26.720,P=0.000; t=9.348,P=0.000),JOA膝关节功能评分均高于治疗前(t=9.156,P=0.000; t=5.526,P=0.000)。②TLR4、TNF-α血清含量。治疗前2组患者TLR4、TNF-α血清含量比较,组间差异均无统计学意义[(17.90±6.80)ng·mL-1,(18.40±6.50)ng·mL-1,t=0.336,P=0.738;(188.70±38.90)pg·mL-1,(192.40±46.50)pg·mL-1,t=0.386,P=0.701]。治疗开始后8周,口服蠲痹汤和盐酸氨基葡萄糖胶囊组TLR4、TNF-α血清含量均低于单纯口服盐酸氨基葡萄糖胶囊组[(11.40±3.60)ng·mL-1,(15.10±4.30)ng·mL-1,t=4.173,P=0.000;(122.40±39.20)pg·mL-1,(158.20±37.37)pg·mL-1,t=4.181,P=0.000],2组患者TLR4、TNF-α血清含量均低于治疗前(t=5.343,P=0.000; t=2.678,P=0.000; t=7.593,P=0.000; t=3.636,P=0.000)。结论:口服蠲痹汤和盐酸氨基葡萄糖胶囊治疗膝骨关节炎,能够缓解或消除膝关节疼痛,改善膝关节功能,其疗效优于单纯口服盐酸氨基葡萄糖胶囊; 其作用机制可能是通过抑制TLR4的表达,使TNF-α的表达受到抑制,从而减轻了炎症反应。
Abstract:
Objective:To explore the curative effect and mechanism of action of oral applications of Juanbi Tang(蠲痹汤,JBT)and glucosamine hydrochloride capsules for the treatment of knee osteoarthritis(KOA).Methods:Eighty patients with KOA were randomly divided into 2 groups,40 cases in each group.The patients were treated with oral applications of JBT and glucosamine hydrochloride capsules(group A)and monotherapy of oral applications of glucosamine hydrochloride capsules(group B)respectively.The JBT were taken at a dose of 400 ml,200 ml at a time,twice a day for 8 consecutive weeks.The glucosamine hydrochloride capsules were taken three times a day,2 capsules at a time for 8 consecutive weeks.The knee pain visual analogue scale(VAS)scores,Japanese orthopaedic association(JOA)knee functional scores and the serum contents of toll-like receptor 4(TLR4)and tumor necrosis factor-α(TNF-α)were measured and compared between the 2 groups before treatment and at 8 weeks after the beginning of the treatment respectively.Results:There was no statistical difference in knee pain VAS scores and JOA knee functional scores between the 2 groups before treatment(8.01+/-1.16 vs 8.05+/-1.12 points,t=0.157,P=0.876; 70.02+/-9.86 vs 68.32+/-10.28 points,t=0.755,P=0.453).At 8 weeks after the beginning of the treatment,the knee pain VAS scores were lower in group A compared to group B(2.33+/-0.68 vs 5.86+/-0.97 points,t=18.850,P=0.000),and the JOA knee functional scores were higher in group A compared to group B(86.24+/-5.32 vs 79.46+/-7.54 points,t=4.647,P=0.000).The knee pain VAS scores of the 2 groups were lower after the treatment compared to pre-treatment(t=26.720,P=0.000; t=9.348,P=0.000),and the JOA knee functional scores of the 2 groups were higher after the treatment compared to pre-treatment(t=9.156,P=0.000; t=5.526,P=0.000).There was no statistical difference in the serum contents of TLR4 and TNF-α between the 2 groups before treatment(17.90+/-6.80 vs 18.40+/-6.50 ng/ml,t=0.336,P=0.738; 188.70+/-38.90 vs 192.40+/-46.50 pg/ml,t=0.386,P=0.701).The serum contents of TLR4 and TNF-α were lower in group A compared to group B at 8 weeks after the beginning of the treatment(11.40+/-3.60 vs 15.10+/-4.30 ng/ml,t=4.173,P=0.000; 122.40+/-39.20 vs 158.20+/-37.37 pg/ml,t=4.181,P=0.000).The serum contents of TLR4 and TNF-α of the 2 groups were lower after the treatment compared to pre-treatment(t=5.343,P=0.000; t=2.678,P=0.000; t=7.593,P=0.000; t=3.636,P=0.000).Conclusion:Oral applications of JBT and glucosamine hydrochloride capsules can relieve or eliminate the knee pain and improve the knee function in the treatment of KOA,and it surpasses the monotherapy of oral applications of glucosamine hydrochloride capsules in the clinical curative effect.It can inhibit the expression of TNF-α through inhibiting the expression of TLR4,which may be the mechanisms of action for reducing the inflammatory reaction.

参考文献/References:

[1] Loeser RF.Aging processes and the development of osteoarthritis[J].Curr Opin Rheumatol,2013,25(1):108-113. [2] Sokolove J,Lepus CM.Role of inflammation in the pathogenesis of osteoarthritis:latest findings and interpretations[J].Ther Adv Musculoskelet Dis,2013,5(2):77-94. [3] Lange-Brokaar BJ,Ioan-Facsinay A,Osch GJ,et al.Synovial inflammation,immune cells and their cytokines in osteoarthritis:a review[J].Osteoarthritis Cartilage,2012,20(12):1484-1499. [4] Kellgren JH,Lawrence JS.Radiological assessment of osteo-arthrosis[J].Ann Rheum Dis,1957,16(4):494-502. [5] 中华医学会骨科分会.骨关节炎诊治指南(2007年版)[J].中华骨科杂志,2007,27(10):793-796. [6] 国家中医药管理局医政司.22个专业95个病种中医诊疗方案[M].北京:中国中医药出版社,2001:140. [7] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:123-124. [8] 腰野富久,他.OA膝治療成績判定基凖[J].日整會誌,1988,62:901-902. [9] 谭伟欣,李国韶,傅强.黄芪鳖甲丸治疗肾虚型膝关节骨性关节炎的临床研究[J].中国医药导报,2014,11(30):83-87. [10] 王欢,王庆甫,石鑫超,等.TLRs与NF-kB在大鼠骨关节炎滑膜中的表达及意义[J].中国中医骨伤科杂志,2016,24(6):4-8. [11] Sohn DH,Sokolove J,Sharpe O,et al.Plasma proteins present in osteoarthritic synovial fluid can stimulate cytokine production via Toll-like receptor 4[J].Arthritis Res Ther,2012,14(1):7. [12] Gómez R,Villalvilla A,Largo R,et al.TLR4 signalling in osteoarthritis-finding targets for candidate DMOADs[J].Nat Rev Rheumatol,2015,11(3):159-170. [13] Timothy RD,Radstake J,Roelofs MF,et al.Expression of toll-like receptors 2 and 4 in rheumatoid synovial tissue and regulation by proinflammatory cytokines interleukin-12 and interleukin-18 via interferon-gamma[J].Arthritis&Rheumatism,2004,50(12):3856-3865. [14] 敏思聪,俞银贤,马金忠.TLR4信号转导通路与骨关节炎[J].国际骨科学杂志,2013,34(4):266-268. [15] 石继祥,纪斌,周强,等.口服补肾活血通络方治疗膝骨关节炎[J].中医正骨,2015,27(7):51-52. [16] 李念虎.补肾活血中药治疗早中期膝骨性关节炎临床观察[J].中医正骨,2006,18(10):11-12.

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金项目(81574006); 陕西省重点科技创新团队项目(2013KCT-26)
袁普卫 Email:spine_surgeon@163.com

更新日期/Last Update: 1900-01-01