目的 探讨中药骨炎平1号方联合妥布霉素骨水泥珠链对慢性骨髓炎老年患者的临床疗效。方法 选取2015-05至2018-05医院骨科治疗的72例慢性骨髓炎老年患者,随机分为对照组(妥布霉素骨水泥珠链 + 抗菌药物)和研究组(妥布霉素骨水泥珠链+骨炎平1号方),治疗8周后,对两组患者白细胞计数(blood cell count, WBC)、红细胞沉降率(erythrocyte sedimentation rate, ESR)、C反应蛋白(C-reactive protein, CRP)、白介素-1β(interleukin-1β, IL-1β)、IL-4、IL-6和IL-10含量进行对比分析,并随访治疗后1年内的复发情况。结果 研究组总有效率为86.11%,明显高于对照组的58.33%,两组比较差异有统计学意义(P<0.05);治疗后两组感染性指标WBC、ESR、CRP及血清促炎细胞因子IL-1β和IL-6水平均较治疗前明显降低,差异有统计学意义(P<0.01),研究组抗炎细胞因子IL-4和IL-10水平治疗后较治疗前有明显升高(P<0.01);治疗后,研究组WBC、ESR、CRP及IL-1β、IL-6水平较对照组均有明显降低(P<0.05);IL-4和IL-10水平较对照组明显升高,差异均有统计学意义(P<0.05);治疗后1年,研究组复发率为9.52%,显著低于对照组的35.71%,差异有统计学意义(P<0.05)。结论 骨炎平1号方联合妥布霉素骨水泥珠链用于老年慢性骨髓炎疗效确切,治疗机制与控制感染、抑制炎性反应、恢复促炎与抗炎细胞因子平衡等有关。
Abstract
Objective To evaluate the clinical efficacy of Guyanping No.1 Prescription (GNP) combined with tobramycin bone cement chain beads (TBC) against chronic osteomyelitis (CO) among elderly patients.Methods Seventy-two elderly patients with CO treated in the Department of Orthopaedics between May 2015 and May 2018 were randomly divided into the control group (treated with TBC and antibiotics) and GNP group (treated with TBC and GNP). After 8 weeks of treatment, the blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and levels of interleukin (IL)-1β, IL-4, IL-6 and IL-10 were detected in both groups. Within a year of treatment, the recurrence in all the cured cases was monitored by follow-up visits.Results The clinical efficacy rate in the GNP group (86.11%) was significantly higher than in the control group (58.33%) (P<0.05). The infection indexes (WBC, ESR and CRP) and serum levels of proinflammatory cytokines (IL-1β and IL-6) were significantly decreased after treatment (P<0.01) while the serum levels of anti-inflammatory cytokines (IL-4 and IL-10) were significantly elevated (P<0.01). Compared with the control group, WBC, ESR, CRP and IL-1β and IL-6 levels in the GNP group were significantly reduced (P<0.05) while IL-4 and IL-10 levels were significantly enhanced (P<0.05)after treatment. The recurrence rate in the GNP group (9.52%) was significantly lower than that of the control group (35.71%, P<0.05) within a year of treatment.Conclusions The severity of CO in elderly patients can be mitigated by GNP combined with TBC, and the main mechanism may involve the inhibition of infections, improvement of inflammatory responses and modulation of proinflammatory/anti-inflammatory cytokine balance.
关键词
骨炎平1号方 /
慢性骨髓炎 /
抗生素骨水泥珠链 /
炎性反应 /
促炎/抗炎细胞因子
Key words
Guyanping No.1 Prescription /
chronic osteomyelitis /
antibiotic bone cement chain beads /
inflammatory response /
proinflammatory and anti-inflammatory cytokines
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