独活寄生汤治疗肝肾亏虚型膝骨关节炎患者临床疗效及关节液代谢组学变化

发布时间：2019-04-24 06:11

【摘要】：目的:观察独活寄生汤治疗肝肾亏虚型膝骨关节炎(knee osteoarthritis,KOA)的临床疗效,并分析经独活寄生汤治疗前后关节液中小分子化合物的变化。方法:将73例天津中医药大学第一附属医院确诊的KOA患者随机分为观察组(42例)及对照组(31例),观察组给予独活寄生汤150 m L/次,2次/d,口服,对照组给予硫酸氨基葡萄糖胶囊0.5 g/次,3次/d,口服,两组患者均治疗1个月,以膝关节视觉模拟评分法(visual analogue scale score,VAS),西安大略麦马斯特大学骨关节炎指数评分(The Western Ontario and Mc Maste Universities,WOMAC),自制膝关节肿胀评分及综合疗效治疗反应评价作为临床疗效判定指标;所有KOA患者均在治疗前及治疗后抽取关节液,采用超高效液相色谱仪与主成分分析法(principal components analysis,PCA)分析两组患者治疗前后关节液代谢差异物,并用EZinfo 2.0软件进行PCA潜在差异生物标记物。结果:治疗1个月后,两组患者VAS,WOMAC,自制膝关节肿胀评分均较治疗前有明显改善(P0.05);治疗1个月后与对照组比较,观察组患者VAS,WOMAC,自制膝关节肿胀评分、综合疗效治疗反应评价均明显升高(P0.05);与治疗前比较,两组治疗后膝关节关节液中泛酸、犬尿氨酸、酪氨酸表达降低,苯甲酸、柠檬酸及脯氨酸表达升高(P0.05);与对照组治疗后比较,观察组关节液中泛酸、犬尿氨酸、酪氨酸表达更低,苯甲酸、柠檬酸及脯氨酸表达更高(P0.05),此外观察组关节液中牛磺酸,β-隐黄素及赖氨酸表达明显升高(P0.05)。结论:独活寄生汤可减少肝肾亏虚型KOA患者关节疼痛、肿胀程度,增加活动范围,改善KOA患者生活质量;同时随着肝肾亏虚型KOA患者症状的改善,关节液中泛酸、犬尿氨酸、酪氨酸、苯甲酸,柠檬酸,脯氨酸,牛磺酸,β-隐黄素及赖氨酸表达出现变化。
[Abstract]:Aim: to observe the clinical efficacy of Duhuozhi decoction in treating knee osteoarthritis (knee osteoarthritis,KOA) with deficiency of liver and kidney, and to analyze the changes of small molecule compounds in synovial fluid before and after treatment. Methods: 73 patients with KOA diagnosed in the first affiliated Hospital of Tianjin University of traditional Chinese Medicine were randomly divided into observation group (n = 42) and control group (n = 31). The control group was given Glucosamine Sulfate capsule 0.5g / time, 3 times / d orally. The patients in both groups were treated for 1 month, and the visual analogue score of knee joint (visual analogue scale score,VAS) was used. The osteoarthritis index (The Western Ontario and Mc Maste Universities,WOMAC), knee swelling score and comprehensive response evaluation of knee joint were used as the index of clinical curative effect, and the osteoarthritis index of Xi'an University of Masters was used as the index of clinical curative effect. The joint fluid was extracted from all patients with KOA before and after treatment, and the foreign bodies in joint fluid metabolism were analyzed by ultra-high performance liquid chromatography (HPLC) and principal component analysis (principal components analysis,PCA) before and after treatment. EZinfo 2.0 software was used to carry out PCA potential differential biomarkers. Results: 1 month after treatment, the VAS,WOMAC, self-made knee swelling scores of the two groups were significantly improved (P0.05). 1 month after treatment, compared with the control group, the VAS,WOMAC, self-made knee swelling score in the observation group was significantly higher than that in the control group (P0.05), and the comprehensive therapeutic response was significantly increased (P0.05). Compared with pre-treatment, the expression of pan-acid, urine, tyrosine in knee joint fluid of the two groups decreased, and the expression of benzoic acid, citric acid and proline increased after treatment (P0.05). Compared with the control group, the expression of pan-acid, urine, tyrosine, benzoic acid, citric acid and proline in the synovial fluid of the observation group was lower than that of the control group (P0.05), and taurine in the synovial fluid of the observation group was higher than that of the control group. The expression of 尾-cryptoflavin and lysine was significantly increased (P0.05). Conclusion: Duhuozhizhi decoction can reduce the degree of joint pain and swelling, increase the range of activities and improve the quality of life of KOA patients with deficiency of liver and kidney. At the same time, with the improvement of symptoms in KOA patients with liver and kidney deficiency, the expression of panacid, urine, tyrosine, benzoic acid, citric acid, proline, taurine, 尾-cryptoflavin and lysine in synovial fluid changed.
【作者单位】：天津中医药大学第一附属医院;内蒙古民族大学附属医院;
【基金】：内蒙古自治区自然科学基金项目(2016MS08125)
【分类号】：R274.9

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