清热祛痹汤治疗湿热痹型膝关节骨性关节炎疗效观察

目的:观察清热祛痹汤治疗湿热痹型膝关节骨性关节炎的疗效以及对膝关节液和血清解聚蛋白样金属蛋白酶-7(ADAMTS-7)和软骨寡聚基质蛋白(COMP)水平的影响。方法:选择湿热痹型膝关节骨性关节炎病例共120例,按照数字表法随机分为治疗组和对照组各60例;对照组口服依托考昔片,1片/次,1次/d;治疗组在对照组用药的基础上采用清热祛痹汤治疗,1剂/2 d,早晚温开水内服;两组疗程均为6周。比较两组中医临床症状评分和西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分;分析两组治疗后临床疗效;检测两组膝关节液和血清解聚蛋白样金属蛋白酶-7(ADAMTS-7)和软骨寡聚基质蛋白(COMP)水平。结果:治疗组治疗后中医临床症状评分均显著低于对照组(P0.01);治疗组临床疗效有效率为98.33%,对照组的85%,两组比较有统计学意义(P0.05);治疗组治疗后WOMAC量表各项评分均低于对照组(P0.01);治疗后治疗组关节液和血清中ADAMTS-7水平明显高于对照组,COMP水平明显低于对照组,比较差异有统计学意义(P0.01)。结论:在西医治疗的基础上,清热祛痹汤治疗湿热痹型膝关节骨性关节炎可明显改善临床症状,降低WOMAC量表各项评分,提高临床治疗效果,上调关节液和血清中ADAMTS-7水平而降低COMP水平可能与上述疗效有关。

Effect of Qingre Qubi Decoction in Treating Damp-heat Arthralgia Knee Osteoarthritis

Objective: To observe clinical efficacy of Qingre Qubi decoction in treating damp-heat arthralgia knee osteoarthritis(KOA)and its influences on knee joint fluid,serum levels of depolymerization metalloproteinases protein sample-7(ADAMTS-7) and cartilage oligomeric matrix protein(COMP). Method: One hundred and twenty damp-heat arthralgia KOA patients were randomly divided into control group(60 cases)and treatment group(60 cases) by random number table for control group, patients receivedetoncoxib tablets by oral(1 tablet/time,qd).Based on the treatment of control group,patients in the treatment group were also treated with Qingre Qubi decoction(1 dose/2 days, swallow with boiled water every morning and evening). Courseof treatment was 6 weeks for both groups.Traditional Chinese medicine clinical symptom scores, and the western ontario and McMaster universities osteoarthritis index(WOMAC index) scores were compared between two groups.Clinical efficacy after treatment was analyzed in two groups.The knee joint fluid,serum levels of ADAMTS-7 and COMP in two groups were detected. Result: The traditional Chinese medicine clinical symptom scores in treatment group after treatment were significantly lower than those of control group(P<0.01).The clinical effective rate in treatment group was 98.33%,superior to 85% of control group(P<0.05).The scores of WOMAC scale in treatment group after treatment were significantly lower than those in control group(P<0.01).After treatment,knee joint fluid,serum level of ADAMTS-7 in treatment group were significantly higher than those of control group,while serum level of COMP was significantly lower with statistical difference(P<0.01). Conclusion: Based on Western medicine therapy,additional Qingre Qubi decoction in treating damp-heat arthralgia knee osteoarthritis(KOA) could significantly improve the clinical symptoms,decrease scores of WOMAC scale and improve the clinical effect.Its mechanism may be related with up-regulating knee joint fluid,serum level of ADAMTS-7 and decreasing level of COMP.