[1]周江涛,赵依娜,王庆来.独活寄生汤口服联合玻璃酸钠关节腔注射治疗早中期膝骨关节炎[J].中医正骨,2019,31(02):18-21.
　ZHOU Jiangtao,ZHAO Yina,WANG Qinglai.Oral application of Duhuo Jisheng Tang(独活寄生汤)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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独活寄生汤口服联合玻璃酸钠关节腔注射治疗早中期膝骨关节炎()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期数:
2019年02期
页码:
18-21
栏目:
临床研究
出版日期:
2019-02-20

文章信息/Info

Title:
Oral application of Duhuo Jisheng Tang(独活寄生汤)combined with intra-articular injection of sodium hyaluronate for treatment of early-middle knee osteoarthritis
作者:
周江涛; 赵依娜; 王庆来
(温州市中医院,浙江 温州 325000)
Author(s):
ZHOU Jiangtao; ZHAO Yina; WANG Qinglai
Wenzhou Hospital of Traditional Chinese Medicine,Wenzhou 325000,Zhejiang,China
关键词:
骨关节炎; 膝;  独活寄生汤;  透明质酸;  氧化应激;  临床试验
Keywords:
osteoarthritis; knee;  Duhuo Jisheng Tang;  hyaluronic acid;  oxidative stress;  clinical trial
摘要:
目的:观察独活寄生汤口服联合玻璃酸钠关节腔注射治疗早中期膝骨关节炎(knee osteoarthritis,KOA)的临床疗效及对氧化应激指标的影响。方法:将106例符合要求的早中期KOA患者随机分为2组。联合组(54例)采用独活寄生汤口服联合玻璃酸钠关节腔注射治疗,玻璃酸钠组(52例)采用玻璃酸钠关节腔注射治疗。独活寄生汤水煎服,每日1剂,连续治疗5周; 玻璃酸钠关节腔注射治疗每周1次,连续治疗5周。评定患者的骨关节炎严重性指数(index of severity for osteoarthritis,ISOA)、膝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分及总体疗效,测定血清超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛、谷胱甘肽(glutathione,GSH)水平及总抗氧化能力(total antioxidant capacity,T-AOC)。结果:①临床疗效。治疗前2组患者的ISOA比较,差异无统计学意义(t=0.397,P=0.692); 治疗结束后2组患者的ISOA均较治疗前降低[(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],联合组的ISOA低于玻璃酸钠组(t=7.384,P=0.000)。治疗前2组患者的膝关节疼痛VAS评分比较,差异无统计学意义(t=0.303,P=0.763); 治疗结束后2组患者的膝关节疼痛VAS评分均较治疗前降低[(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],联合组的膝关节疼痛VAS评分低于玻璃酸钠组(t=6.226,P=0.000)。联合组的总体疗效优于玻璃酸钠组((-overR)联合组=47.37,(-overR)玻璃酸钠组=59.87,Z=-2.205,P=0.027)。②氧化应激指标。治疗前2组患者的血清SOD水平比较,差异无统计学意义(t=0.284,P=0.777); 治疗结束后2组患者的血清SOD水平均较治疗前升高[(65.37±9.33)单位·mL-1,(97.58±12.46)单位·mL-1,t=15.103,P=0.000;(64.83±10.21)单位·mL-1,(78.45±9.47)单位·mL-1,t=7.099,P=0.000],联合组的血清SOD水平高于玻璃酸钠组(t=8.874,P=0.000)。治疗前2组患者的血清丙二醛水平比较,差异无统计学意义(t=0.360,P=0.720); 治疗结束后2组患者的血清丙二醛水平均较治疗前降低[(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],联合组的血清丙二醛水平低于玻璃酸钠组(t=3.083,P=0.003)。治疗前2组患者的血清GSH水平比较,差异无统计学意义(t=0.631,P=0.529); 治疗结束后2组患者的血清GSH水平与治疗前相比,差异均无统计学意义[(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]。治疗前2组患者的血清T-AOC比较,差异无统计学意义(t=0.341,P=0.734); 治疗结束后2组患者的血清T-AOC均较治疗前降低[(34.74±9.38)单位·L-1,(17.48±5.04)单位·L-1,t=11.911,P=0.000;(35.39±10.22)单位·L-1,(21.81±6.40)单位·L-1,t=8.121,P=0.000],联合组的血清T-AOC低于玻璃酸钠组(t=3.878,P=0.000)。结论:独活寄生汤口服联合玻璃酸钠关节腔注射可有效减轻早中期KOA患者的膝关节疼痛程度、延缓病情进展,升高血清SOD水平、降低血清丙二醛水平和T-AOC,其效果优于单纯玻璃酸钠关节腔注射治疗。
Abstract:
Objective:To observe the clinical curative effects of oral application of Duhuo Jisheng Tang(独活寄生汤,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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备注/Memo

备注/Memo:
基金项目:2015年浙江省中医药科技计划项目(2015ZQ031) 通讯作者:周江涛 E-mail:franky_zhou2000@163.com(收稿日期:2018-10-25 本文编辑:李晓乐)
更新日期/Last Update: 2019-02-20