目的 评价非甾体抗炎药塞来昔布对膝骨关节炎(KOA)患者的疗效及对半胱氨酸蛋白酶(caspase)的影响。方法 选取2019-01至2022-12在武警北京总队医院外二科就诊的80例KOA患者,随机分为对照组(低强度脉冲超声)和研究组(口服塞来昔布胶囊+低强度脉冲超声),分别于治疗前和治疗8周后,对患者膝关节进行疼痛视觉模拟量表(VAS)、日本骨科协会治疗评分(JOA)、加拿大西安大略—麦克马斯特大学骨关节炎指数(WOMAC)等评分,判定体征症状积分并计算疗效改善率,取患者血清和关节滑液检测caspase-3和caspase-9水平,并监测治疗期间药物的不良反应。结果 研究组患者总有效率为90.0%,与对照组的77.5%比较差异有统计学意义(P<0.05);两组治疗后VAS、JOA及WOMAC均较治疗前有显著改变(P<0.01),研究组治疗后VAS量表及WOMAC指数比对照组均有显著降低,JOA评分则有明显提升,组间差异均有统计学意义(P<0.05或P<0.01);治疗后,对照组血清caspase-3和caspase-9水平变化不明显,关节滑液caspase-3和caspase-9水平比治疗前有显著下调(P<0.05或P<0.01);治疗后,研究组血清、关节滑液中caspase-3和caspase-9水平比治疗前均有显著降低,与治疗后对照组比较亦有明显降低,组间差异均有统计学意义(P<0.05或P<0.01)。两组的不良反应发生率比较,差异无统计学意义。结论 塞来昔布用于KOA疗效确切,通过下调血清和关节滑液中caspase-3和caspase-9表达抑制KOA病理进程,可能与其干预软骨细胞凋亡相关。
Abstract
Objective To evaluate the clinical efficacy of celecoxib, one of the nonsteroidal anti-inflammatory drugs(NSAIDs), in the treatment of knee osteoarthritis (KOA) and its effect on the caspase. Methods A total of 80 KOA patients admitted to the Second Department ofBeijing Municipal Corps Hospital of Chinese People’s Armed Police Force from January 2019 to December 2022 wererandomlydivided into control group (treated with low-intensity pulsed ultrasound) and research group (orally treated with celecoxib capsules plus low-intensity pulsed ultrasound) before and 8 weeks after treatment respectively. Visual analogue scale (VAS), Japanese Orthopaedic Association score (JOA) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC) were scored on thepatientsto determine the score of signs and symptomsand calculatethe improvement rate of curative effect, caspase-3 and caspase-9 levels were measured in serum and synovial fluid, and adverse drug reactions were monitored during the treatment. Results The total clinical efficacy rate in research group (90.0%) were notably elevated as compared to the control group (77.5%) (P<0.05). The VAS, JOA and WOMAC in post-treatment of both groups were evidently improved as compared to those in pre-treatment (P<0.01). In comparison with the control group, the VAS, JOA and WOMAC were significantly improved and the caspase-3 and caspase-9 levels in serum and synovial fluid were significantly decreased in research group after the treatment (P<0.05 or P<0.01). The difference in the incidence of adverse reactions between the two groups was not statistically significant during the treatment (P>0.05). Conclusions The efficacy of celecoxib in treating KOA isconfirmed by the inhibition of KOA pathology through downregulation of caspase-3 and caspase-9 expression in serum and synovial fluid, which may be related withits intervention in chondrocyte apoptosis.
关键词
塞来昔布 /
膝骨关节炎 /
非甾体类抗炎药 /
半胱氨酸蛋白酶
Key words
celecoxib /
knee osteoarthritis /
nonsteroidal anti-inflammatory drugs /
caspase
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