独活寄生汤加减配合中药熏洗治疗膝骨关节炎临床研究

目的探讨独活寄生汤加减配合中药熏洗对膝骨关节炎患者关节功能及滑膜液中炎性介质的影响。方法将符合入选标准的2020年3月-2021年3月本院膝骨关节炎患者203例,按随机数字表法分为观察组102例,对照组101例。对照组口服塞来昔布胶囊+中药熏洗,观察组在对照组基础上给予独活寄生汤加减治疗。2组均治疗3个月。分别于治疗前后进行中医症状评分,采用日本骨科协会评估治疗分数(Japanese Orthopaedic Association scores,JOA)评估膝关节功能,采用免疫比浊法检测血清超敏C反应蛋白(hs-CRP),ELISA法检测关节液中TNF-α、IL-6水平,评价临床疗效。结果观察组总有效率为90.2%(92/102)、对照组为79.2%(80/101),2组比较差异有统计学意义(χ²=4.74,P=0.030)。观察组治疗后1、3个月JOA评分高于对照组(t值分别为3.17、7.74,P值<0.01);观察组治疗后,膝关节冷痛、腰膝酸软、关节肿胀、屈伸不利评分低于对照组(t值分别为7.61、10.81、6.62、8.77,P值均<0.001),关节液TNF-α、IL-6水平及血清hs-CRP水平低于对照组(t值分别为7.97、9.52、9.56,P值均<0.001)。治疗期间,对照组不良反应发生率为32.7%(33/101)、观察组为19.6%(20/102),2组比较差异有统计学意义(χ²=4.49,P=0.034)。结论独活寄生汤加减配合中药熏洗可有效改善膝骨关节炎患者临床症状及膝关节功能,减轻炎症反应,提高临床疗效。

Clinical study on modified Duhuo Jisheng Decoction combined with Traditional Chinese Medicine fumigation in the treatment of knee osteoarthritis

Objective:To explore the effects of modified Duhuo Jisheng Decoction combined with Traditional Chinese Medicine (TCM) fumigation on joint function and inflammatory mediators in synovial fluid of patients with knee osteoarthritis.Methods:A total of 203 patients with knee osteoarthritis who met the inclusion criteria between March 2020 and March 2021 in the hospital were divided into observation group (102 cases) and control group (101 cases) according to the random number table method. The control group was given oral administration of celecoxib capsules + TCM fumigation, and the observation group was given modified Duhuo Jisheng Decoction on the basis of the control group. Both groups were treated for 3 months. TCM symptoms were scored before and after treatment, and Japanese Orthopaedic Association scores (JOA) was used to evaluate the knee function. Immunoturbidimetry was adopted to detect serum high-sensitivity C-reactive protein (hs-CRP), and ELISA was used for the detection of levels of TNF-α and IL-6 in synovial fluid, and the clinical efficacy was evaluated.Results:The total effective rate was 90.2% (92/102) in observation group and was 79.2% (80/101) in control group ( χ2=4.74, P=0.030). The JOA scores at 1 month and 3 months after treatment in observation group were significantly higher than those in the control group ( t=3.17, 7.74, all Ps<0.01). The scores of cold and painful knee joint, soreness and weakness of waist and knees, joint swelling and inhibited bending and stretching were significantly in the observation group after treatment lower than those in the control group ( t=7.61, 10.81, 6.62, 8.77, all Ps<0.001). The levels of TNF-α and IL-6 in synovial fluid and level of serum hs-CRP were significantly in the observation group after treatment lower than those in the control group ( t=7.97, 9.52, 9.56, all Ps<0.001). During treatment, the incidence rate of adverse reactions was 32.7% (33/101) in control group and that of observation group was 19.6% (20/102) ( χ2=4.49, P=0.034). Conclusion:Modified Duhuo Jisheng Decoction combined with TCM fumigation can improve the clinical symptoms and knee function, relieve the inflammatory response and enhance the clinical efficacy of patients with knee osteoarthritis.