双醋瑞因治疗老年膝骨关节炎的临床疗效及机制探讨

目的]观察双醋瑞因对老年膝骨关节炎（KOA）的临床疗效,并探讨其机制.方法]KOA患者62例,予双醋瑞因胶囊50mg、2次/天口服治疗,疗程12周.在治疗前和随访3个月、6个月、12个月时分别进行关节功能测定,同时检测膝关节液MMP-3的含量.结果]治疗3个月后,患者WOMAC评分较治疗前下降;治疗6个月时,WOMAC评分进一步下降;治疗12个月时,WOMAC评分保持稳定（F=15.264,P=0.000）.OA严重程度指数变化也显示出相同的趋势（F=11.145,P=0.000）.MRI的Recht分级显示随着治疗时间的延长,膝关节软骨的正常到轻度异常的比例增高 （χ^2=28.269,P=0.003）.关节液MMP-3的含量治疗3个月时下降;至6个月时,MMP-3含量继续下降;到12个月,MMP-3含量保持稳定（F=12.375,P=0.000）.MMP-3含量和WOMAC评分及OA严重程度指数均呈正相关,相关系数分别为0.775（t=6.876,P=0.003）和0.710（t=5.461,P=0.014）.结论：]双醋瑞因治疗老年KOA有较好的临床疗效,其机制可能与MMP-3的表达下降有关.

Effect of Diacerein Treatment on MMP-3 in Elderly Knee Osteoarthritis and Its Relationship with the Efficacy

Objective]To observe the clinical efficacy of diacerein for the treatment of elderly knee osteoarthritis（KOA） and explore the change of matrix metalloproteinase-3 （MMP-3） expression. Methods]Totally 62 patients with KOA were enrolled in this study. Orally 50mg diacerein capsule twice a day was given for 12 weeks. The joint function was measured before treatment and 3-, 6- and 12-month follow-up after treatment. The level of MMP-3 in knee joint fluid was also detected at the same time. Results]After 3-month treatment, WOMAC score of patients decreased compared with that before treatment. After 6-month treatment, WOMAC score declined further. After 12-month treatment, WOMAC score remained stable （F = 15. 264, P = 0. 000）. Changes in OA severity index also showed a similar trend（F= 11. 145, P =0. 000）. MRI of the Recht classification showed that with the extension of treatment time, the ratio of knee cartilage from normal to mildly abnormal increased（X^2 = 28. 269, P = 0. 003）. The MMP-3 content in synovial fluid declined after 3 months of treatment. MMP-3 content continued to fall until 6 months after treatment. And MMP-3 content remained stable until 12 months（F= 12. 375, P =0. 000）. MMP-3 content was positively correlated with WOMAC score and OA severity index, and the correlation coefficient was 0. 775（ t =6. 876, P =0. 003） and 0. 710 （ t = 5. 461, P = 0.014）, respectively. Conclusion]Diacerein for the treatment of elderly KOA has good clinical efficacy, which may be related to that it can decrease the MMP-3 expression.