膝骨关节炎关节液中丙二醛、超氧化物歧化酶在玻璃酸钠注射前后的变化

背景：玻璃酸钠关节腔注射是治疗膝骨关节炎的一种有效方法，疗效显著，不良反应少，但其作用机制尚不明确。目的：通过检测玻璃酸钠注射前后膝骨关节炎关节液中丙二醛、超氧化物歧化酶水平，评价玻璃酸钠治疗膝骨关节炎的具体机制。方法：纳入膝骨关节炎患者37例（40膝），根据日本膝骨关节炎指征等级分轻度组10例10膝、中度组17例18膝、重度组10例12膝，患膝关节注入玻璃酸钠25 mg，每周注射1次，连续5次为1个疗程。注射前及注射4周后检测关节液丙二醛、超氧化物歧化酶水平，以及按照日本膝骨关节炎指征等级对所有患者治疗前后行临床评分。结果与结论：轻度组、中度组注射4周后临床评分较注射前显著降低（P〈0.05），重度组注射前后临床评分比较差异无显著性意义。3组注射4周后关节液丙二醛水平均较注射前显著下降（P 〈0.05），关节液超氧化物歧化酶水平均较注射前显著升高（P 〈0.05）。结果表明玻璃酸钠可通过降低关节液中丙二醛水平、升高超氧化物歧化酶水平治疗膝骨关节炎，并且更适用于轻、中度患者。

Effect of sodium hyaluronate on malondialdehyde and superoxide dismutase levels in the synovial fluid of patients with knee osteoarthritis

BACKGROUND：Intra-articular injection of sodium hyaluronate is an effective method for the treatment of knee osteoarthritis, with significant effect and less adverse reactions, but the mechanism is unclear. OBJECTIVE：Through testing the malondialdehyde and superoxide dismutase levels in the synovial fluid of knee osteoarthritis before and after injection of sodium hyaluronate, to evaluate the clinical efficacy of sodium hyaluronate in the treatment of knee osteoarthritis. METHODS：Thirty-seven patients with knee osteoarthritis （40 knees） were enroled and divided into mild （n=10, 10 knees）, moderate （n=17, 18 knees）, and severe （n=10, 12 knees） groups according to the Japan＇s knee osteoarthritis indications. Patients were subjected to intra-articular injection of 25 mg sodium hyaluronate, once a week for 5 weeks. The levels of malondialdehyde and superoxide dismutase in the synovial fluid before and 4 weeks after treatment were detected, and then clinical effects were evaluated based on the clinical scores according to the Japan’s knee osteoarthritis indications. RESULTS AND CONCLUSION： The indication rating results of the mild and moderate groups were decreased significantly 4 weeks after injection （P 〈 0.05）, but there were no significant difference in the severe group before and after treatment. The malondialdehyde level in the synovial fluid was decreased obviously in the three groups at 4 weeks after injection （P 〈 0.05）, while the level of superoxide dismutase was increased remarkably （P 〈 0.05）. These findings indicate that sodium hyaluronate can treat knee osteoarthritis by reducing the malondialdehyde level and increasing superoxide dismutase level in the synovial fluid, but this method is more suitable for treatment of mild to moderate knee osteoarthritis.