独活寄生合剂联合尼莫地平治疗早期膝骨性关节炎的实验研究及临床初步观察

发布时间：2018-07-28 08:14

【摘要】：目的：通过实验研究与临床观察相结合的方式,探讨独活寄生合剂联合尼莫地平治疗早期膝关节骨性关节炎(KOA)的疗效及安全性。方法：将造模成功后的21只早期KOA大鼠随机分为三组：A组(n=6),生理盐水2m1灌胃、B组(n=7),独活寄生合剂2m1/kg灌胃、C组(n=8),独活寄生合剂2ml/kg+尼莫地平4mg/kg灌胃,2次/日,治疗3周。灌胃治疗前后进行尾静脉采血检测定IL-1β、TNF-α、PGE2的变化,治疗结束后处死大鼠用肉眼及显微镜观察膝关节软骨情况。临床观察：自2013年6月-2014年5月,将符合纳入标准的86例早期膝关节骨性关节炎患者随机分为两组：A组(n=42)口服独活寄生合剂,B组(n=44)口服独活寄生合剂及尼莫地平片。治疗6周后比较各组的WOMAC骨关节炎指数评分、不良反应率及临床疗效。结果：动物实验：B、C两组治疗后血清中IL-1β、TNF-α及PGE2的含量与A组比均降低,且与A组比较有显著性差异(P0.05),B、C组间IL-1β、TNF-α及PGE2的含量比较有显著性差异(P0.05)。Mankin评分比较：A组9.86±1.56分,B组6.08±1.73分,C组4.07±1.27分,三组间评分两两比较均有显著性差异(P0.05)。临床观察：A、B两组治疗后的疼痛、僵硬及活动度评分均有降低,其中两组间的疼痛评分比较有显著性差异(P0.05)；两组间的僵硬评分比较无显著性差异(P0.05)；两组间的活动难度评分比较有显著性差异(P0.05)；两组间的WOMAC总积分比较有显著性差异(P0.05)；两组的显效率分别为50.00%、72.73%,组间比较有显著性差异(P0.05)；两组的不良反应率分别为2.38%、2.27%,组间比较无显著性差异(P0.05)。结论：1、大鼠实验证实：运用独活寄生合剂联合尼莫地平能降低血清中炎性因子IL-1β、TNF-α、PGE2的表达,延缓早期KOA大鼠膝关节软骨退变。2、临床观察证实：在调节软骨代谢、减轻膝关节疼痛症状及改善膝关节功能等方面的疗效,独活寄生合剂联合尼莫地平治疗早期KOA的疗效优于单独服用独活寄生合剂。
[Abstract]:Objective: to investigate the efficacy and safety of Duhuzhongji combined with nimodipine in the treatment of early knee osteoarthritis (KOA) by means of experimental study and clinical observation. Methods: Twenty-one early KOA rats were randomly divided into three groups: group A (n = 6), group B (n = 7) treated with normal saline 2m1, group C (n = 8) treated with 2m1/kg, and group C (n = 8) treated with 2ml/kg nimodipine 4mg/kg for 3 weeks. The changes of IL-1 尾 TNF- 伪 PGE2 were detected before and after gastric administration. The articular cartilage of knee joint was observed with naked eye and microscope. Clinical observation: from June 2013 to May 2014, 86 patients with early knee osteoarthritis who met the inclusion criteria were randomly divided into two groups: group A (n = 42) and group B (n = 44). After 6 weeks of treatment, WOMAC osteoarthritis index score, adverse reaction rate and clinical efficacy were compared. Results: the contents of IL-1 尾 -TNF- 伪 and PGE2 in the serum of group C were lower than those of group A after treatment. There was significant difference in the content of IL-1 尾 TNF- 伪 and PGE2 between group A and group A (P0.05). Mankin score was 9.86 卤1.56 in group A and 4.07 卤1.27 in group C (P 0.05). The clinical observation showed that the scores of pain, stiffness and activity of the two groups were decreased after treatment, and there was significant difference between the two groups (P0.05), and there was no significant difference between the two groups in the scores of stiffness (P0.05). There were significant differences in the score of activity difficulty between the two groups (P0.05), the total score of WOMAC in the two groups (P0.05), the apparent effect rate of the two groups were 50.005% and 72.73% (P0.05), and there was significant difference between the two groups (P0.05). The adverse reaction rates of the two groups were 2.38 and 2.27, respectively. There was no significant difference between the two groups (P0.05). Conclusion: the rat experiment shows that Duhuo parasitic mixture combined with nimodipine can reduce the expression of IL-1 尾 TNF- 伪 PGE2 in serum and delay the degeneration of articular cartilage in early KOA rats. The clinical observation shows that it is regulating cartilage metabolism. The curative effect of Duhuzhongji combined with nimodipine in the treatment of early KOA was better than that of Duhuozhongji alone in relieving the symptoms of knee joint pain and improving the function of knee joint.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R684.3

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