补肾活血解毒法治疗骨关节炎的临床研究

发布时间：2019-06-25 00:18

【摘要】：目的:针对肾虚血瘀型骨关节炎的病因病机特点,以补肾活血解毒为治法,观察自拟骨痹汤治疗骨关节炎的临床疗效和安全性,并对本方治疗骨关节炎的作用机制进行初步探讨。方法:收集2012年12月至2014年12月于日照市人民医院风湿免疫科和五莲县中医医院内科接受诊治的符合入组条件的骨关节炎患者病例100例,并随机分成治疗组和对照组,每组50例,两组患者性别、年龄、病程均无显著性差异。对照组给予硫酸氨基葡萄糖+双氯芬酸钠缓释片治疗,治疗组在对照组的基础上再给予自拟骨痹汤治疗,4周为一疗程。治疗前对两组患者进行病情程度评分和临床指标量化评分,治疗结束后,比较两组患者病情程度、临床指标及相关实验室指标(C反应蛋白、血沉),评价骨痹汤治疗骨关节炎的临床疗效。对治疗组及对照组患者进行安全性评价。治疗前后取血液标本,离心后取血清检测MMP-3、TIMP-1的含量;取关节液,离心后取上清液检测IL-1β、TNF-α的表达,对治疗作用机制进行初步探讨。结果:1、改善病情程度方面:治疗组治疗骨关节炎临床总有效率为86.0%,明显高于对照组(74.0%)。2、中医症状:两组治疗主要中医症状消失例(%)比较具有统计学意义上的差异(P0.05);且治疗后两组患者舌象与脉象的例数低于治疗前,治疗后舌象与脉象的例数与同期对照组比较也有显著性差异(P0.05)。3、改善临床指标方面:骨痹汤能显著减轻骨关节炎患者主症积分,改善患病关节疼痛、压痛数、肿胀、活动度、晨僵时间、功能评分及行走评分。4、改善实验室指标方面:骨痹汤能显著降低患者血沉及C反应蛋白。5、治疗作用机制研究结果:治疗4周后,患者血清MMP-3、TIMP-1的含量明显降低,关节液中的IL-1β、TNF-α含量也明显降低,降低程度均高于对照组。骨痹汤能有效改善OA患者的关节胀痛,屈伸不利,膝腰酸软,畏寒喜温,关节压痛,伴有耳鸣,头晕目眩,关节胀痛、膝腰酸软、关节压痛等中医症状。6、安全性评价结果:两组患者主要不良反应为胃肠道反应反应以及肝功能异常,两组的不良反应比较有显著性差异(P0.05)。结论:1、骨痹汤可明显改善骨关节炎患者的临床症状及中医证候,且无明显不良反应,是一种安全有效的治疗骨关节炎的方法,值得临床推广。2、骨痹汤能降低骨关节炎患者的血清MMP-3、TIMP-1的含量,降低关节液中的IL-1β、TNF-α含量,其作用机制可能与调控基质金属蛋白酶和抑制炎症反应有关,其他机制有待进一步探讨。
[Abstract]:Objective: to observe the clinical efficacy and safety of self-made Gubi decoction in the treatment of osteoarthritis caused by kidney deficiency and blood stasis, and to explore the mechanism of the prescription in the treatment of osteoarthritis. Methods: from December 2012 to December 2014, 100 patients with osteoarthritis were randomly divided into treatment group and control group. There were no significant differences in sex, age and course of disease between the two groups. The control group was treated with glucosamine sulfate diclofenac sodium sustained-release tablets, and the treatment group was treated with self-made Gubi decoction on the basis of the control group, 4 weeks as a course of treatment. Before treatment, the severity score and clinical index quantitative score of the two groups were carried out. after the treatment, the severity, clinical index and related laboratory indexes (C-reactive protein, erythrocyte sedimentation rate) of the two groups were compared, and the clinical efficacy of Gubi decoction in the treatment of osteoarthritis was evaluated. The safety of the patients in the treatment group and the control group was evaluated. Before and after treatment, blood samples were taken, serum was taken to detect the content of MMP-3,TIMP-1, joint fluid was taken, and the expression of IL-1 尾 and TNF- 伪 was detected in the culture medium after centrifugation, and the therapeutic mechanism was discussed. Results: 1, to improve the degree of disease: the total effective rate of treatment group was 86.0%, which was significantly higher than that of the control group (74.0%). 2, TCM symptoms: there was significant difference between the two groups in the disappearance of the main TCM symptoms (%) (P 0.05), and the total effective rate of osteoarthritis in the treatment group was 86.0%, which was significantly higher than that in the control group (74.0%). After treatment, the number of cases of tongue and pulse in the two groups was lower than that before treatment, and the number of cases of tongue and pulse after treatment was also significantly different from that in the control group (P 0.05). 3, the improvement of clinical indexes: Gubi decoction could significantly reduce the main symptom score of patients with osteoarthritis, improve the number of pain, tenderness, swelling, range of motion, morning stiffness time, function score and walking score. 4, Improvement of laboratory indexes: Gubi decoction could significantly reduce erythrocyte sedimentation rate and C-reactive protein. Results: after 4 weeks of treatment, the content of serum MMP-3,TIMP-1 and the contents of IL-1 尾 and TNF- 伪 in synovial fluid were significantly decreased, and the degree of decrease was higher than that of the control group. Gubi decoction can effectively improve the symptoms of joint distension and pain, flexion and extension, weakness of knee and waist, fear of cold and warm, joint tenderness, tinnitus, dizziness, joint distension pain, knee waist weakness, joint tenderness and so on. 6, the results of safety evaluation: the main adverse reactions of the two groups were gastrointestinal reaction and abnormal liver function, and there was significant difference between the two groups (P 0.05). Conclusion: 1. Gubi decoction can obviously improve the clinical symptoms and TCM syndromes of patients with osteoarthritis, and has no obvious adverse reactions. It is a safe and effective method for the treatment of osteoarthritis, which is worthy of clinical promotion. 2, Gubi decoction can reduce the content of serum MMP-3,TIMP-1 and the content of IL-1 尾 and TNF- 伪 in synovial fluid of patients with osteoarthritis. Its mechanism may be related to the regulation of matrix metalloproteinases and the inhibition of inflammatory reaction, and other mechanisms need to be further discussed.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.9

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