独活寄生汤配合膝四针治疗风寒湿痹型膝骨关节炎的临床观察

目的:观察独活寄生汤配合膝四针治疗风寒湿痹型膝骨关节炎(KOA)的临床疗效及部分作用机制,为临床应用提供参考。方法:将91例KOA患者随机分为观察组(49例)和对照组(42例),对照组给予硫酸氨基葡萄糖胶囊0.5 g/次,3次/d,口服,观察组给予独活寄生汤150 mL/次,口服,2次/d,配合膝四针进行针刺治疗,疗程均为4周;观察两组患者治疗前后膝关节视觉模拟评分(VAS),西安大略麦马斯特大学骨关节炎指数评分(WOMAC),中医证候积分,自制膝关节肿胀评分,总有效率及综合疗效治疗反应评分变化;采用实时荧光定量聚合酶链式反应(Real-time PCR)检测两组患者治疗前后关节液中Toll样受体-4(TLR-4),髓系分化因子(MyD 88)mRNA的表达;并比较两组患者治疗后3,6个月复发率。结果:两组患者治疗后VAS,WOMAC,中医证候积分,自制膝关节肿胀评分及综合疗效治疗反应评分均较本组治疗前降低,且观察组较对照组治疗后上述评分更低(P0.05);两组患者较本组治疗前关节液中TLR-4,MyD 88 mRNA表达降低,且观察组治疗后较对照组更低(P0.05);观察组患者总体有效率,3,6个月复发率均低于对照组(P0.05)。结论:观察独活寄生汤配合膝四针治疗风寒湿痹型KOA有较好疗效,且复发率低,其作用机制可能阻断TLR-4/MyD 88信号通路,抑制下游软骨细胞分解代谢因子与炎性因子表达有关。

Effect of Duhuo Jisheng Tang Combined with Acupuncture in Treatment of Wind Cold Dampness Type Knee Osteoarthritis

Objective: To observe the clinical efficacy and part of mechanism of Duhuo Jisheng Tang combined with acupuncture in the treatment of wind cold dampness type knee osteoarthritis (KOA), in order to provide reference for clinical application. Method: Totally 91 patients with KOA were randomly divided into observation group (49 cases) and control group (42 cases). The control group was given gluconosulfate capsules, 0.5 g/time, 3 times/days. While the observation group was treated with Duhuo Jisheng Tang, 150 mL/time, 2 times/days, and the patients were treated with acupuncture at the knee. The course of treatment was 4 weeks. Before and after treatment, the changes in knee joint visual analogue scale (VAS), Xi''an Ontario McMaster University Osteoarthritis Index (WOMAC) score, traditional Chinese medicine (TCM) symptom score, self-made knee swelling score and comprehensive efficacy and treatment response score were observed, Real-time PCR was used to detect the mRNA expressions of Toll-like receptor-4 (TLR-4) and myeloid factor (MyD88) in synovial fluid of both groups before and after treatment, and the recurrence rates at 3^rd and 6^th months between both groups were compared. Result: After treatment, VAS, WOMAC, TCM symptom score, self-made knee swelling score and comprehensive efficacy, treatment response score of the two groups of patients were lower than before treatment. Compared with control group, the score was lower in observation group, with statistically significant differences (P<0.05). The expressions of TLR-4 and MyD88 mRNA in the synovial fluid of two groups were lower than those in control group (P<0.05). The total effective rate of observation group, the recurrence rate at 3^rd and 6^th months were lower than those of control group, with statistically significant differences (P<0.05). Conclusion: Duhuo Jisheng Tang combined with acupuncture has a good efficacy in the treatment of wind cold dampness type KOA, with a low recurrence rate. The mechanism of action may be correlated with the blocking of the TLR-4/MyD88 signaling pathway and the inhibition of the expression of metabolic factors in the downstream chondrocytes and the expression of inflammatory factors.