强化药物方案辅助关节镜清理术治疗膝骨性关节炎疗效及作用机制探讨

目的探讨艾瑞昔布联合七叶皂苷钠辅助关节镜清理术治疗膝骨性关节炎疗效及作用机制。方法前瞻性选取大连大学附属新华医院2016年1月至2018年8月收治膝骨性关节炎患者共180例。以随机数字表法分为A组(60例)、B组(60例)及C组(60例),均行关节镜清理术治疗,其中A组术后采用艾瑞昔布治疗,B组术后采用七叶皂苷钠治疗,C组术后采用艾瑞昔布+七叶皂苷钠治疗。比较三组临床疗效,治疗前后疼痛视觉模拟评分(VAS)、西大略湖麦克马斯特骨性关节炎(WOMAC)量表评分和Lysholm膝关节评分(LKSS)量表评分、生活质量综合评定(GQOLI-74)量表评分;关节液基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-13(MMP-13)及金属蛋白酶组织抑制因子-1(TIMP-1)水平,血清白细胞介素-1(IL-1)、白细胞介素-1β(IL-1β)及一氧化氮(NO)水平。结果 C组临床疗效均显著优于A组、B组(P<0.05);C组治疗后疼痛VAS评分、WOMAC评分及、LKSS评分及GQOLI-74评分均显著优于A组、B组和治疗前(P<0.05);C组治疗后关节液MMP-2、MMP-13及TIMP-1水平均显著低于A组、B组和治疗前(P<0.05);同时C组治疗后血清IL-1、IL-1β及NO水平均显著优于A组、B组和治疗前(P<0.05)。结论艾瑞昔布联合七叶皂苷钠辅助关节镜清理术治疗膝骨性关节炎可有效缓解疼痛症状,改善肢体活动功能,并有助于提高生存质量;而这一疗效优势形成与其对于炎性细胞因子、MMP-2、MMP-13及TIMP-1更佳调节作用有关。

Clinical effects and mechanism of imrecoxib combined with sodium aescinate assisted with arthroscopic debridement in the treatment knee osteoarthritis

Objective To investigate the clinical effects and mechanism of imrecoxib combined with sodium aescinate assisted with arthroscopic debridement in the treatment of patients with knee osteoarthritis.Methods 180 patients with knee osteoarthritis were selected from January2016 to August 2018 in our hospital and randomly divided into 3 groups including A group(60 patients)treated with imrecoxib,B group(60 patients)treated with sodium aescinate and C group(60 patients)treated with imrecoxib combined with sodium aescinate on the basis of arthroscopic debridement;and the clinical efficacy,VAS score,WOMAC score,Lysholm score,GQOLI-74 score,the levels of joint fluid MMP-2,MMP-13 and TIMP-1 and serum IL-1,IL-1β and NO before and after treatment of the three groups were compared.Results The clinical efficacy of group C was significantly better than that of group A and group B(P<0.05).The VAS score,WOMAC score,Lysholm score and GQOLI-74 score after treatment of group C were significantly better than those of group A,group B and before treatment(P<0.05).The joint fluid MMP-2,MMP-13 and TIMP-1 after treatment of group C were significantly lower than those of group A,group B and before treatment(P< 0.05).The serum IL-1,IL-1β and NO after treatment of group C were significantly lower than those of group A,group B and before treatment(P<0.05).Conclusion Imrecoxib combined with sodium aescinate assisted with arthroscopic debridement in the treatment of patients with knee osteoarthritis can efficiently relieve pain,improve limb function and be helpful to higher quality of life;and the formation of its clinical efficacy advantage is related to its better regulation of inflammatory cytokines,MMP-2,MMP-13 and TIMP-1.