目的 观察黑地雷方联合艾瑞昔布治疗风湿热痹型骨关节炎的临床疗效,评价其对基质金属蛋白酶9(MMP-9)及组织金属蛋白酶抑制因子1(TIMP-1)的影响。方法 选取2021-04至2023-04在武警北京总队医院外二科就诊的风湿热痹型骨关节炎患者63例,随机分为对照组(艾瑞昔布片,n=31)和联合治疗组(黑地雷方 + 艾瑞昔布片,n=32),疗程4周,进行疼痛视觉模拟量表(VAS)、加拿大西安大略—麦克马斯特大学骨关节炎评分(WOMAC)、奎森膝关节功能演算指数(Lequesne)等判定,计算临床疗效及总有效率,取患者血清测定MMP-9、TIMP-1含量及MMP-9/TIMP-1比值,并监测两组患者治疗期间的不良反应及随访6个月内的疾病复发率。结果 联合治疗组患者总有效率为90.6%,与对照组的80.6%比较差异有统计学意义(P<0.05);两组治疗后膝关节VAS评分、WOMAC评分、Lequesne指数及血清MMP-9含量、TIMP-1含量、MMP-9/TIMP-1比值均较治疗前显著降低(P<0.05或P<0.01);治疗后,联合治疗组膝关节VAS评分、WOMAC评分、Lequesne指数及血清MMP-9含量、TIMP-1含量、MMP-9/TIMP-1比值均低于治疗后对照组,组间差异均有统计学意义(P<0.01);联合治疗组不良反应发生率12.4%,与对照组的9.6%比较,差异无统计学意义(P>0.05);随访6个月内,联合治疗组复发率为10.3%,显著低于对照组的32.0%(P<0.05)。结论 黑地雷方联合艾瑞昔布可有效缓解风湿热痹型骨关节炎症状,降低疾病复发率,可能与其调控MMPs及其抑制物TIMPs的动态平衡有关。
Abstract
Objective To evaluate the clinical efficacy of of Heidilei Decoction combined with imrecoxib (CHDI) on osteoarthritis with wind dampness heat Bi syndrome (OA-WDHB) and its effect on matrix metalloproteinases (MMPs) and tissue inhibitor of matrix metalloproteinases (TIMPs) expression.Methods A total of 63 OA-WDHB patients who attended the Beijing Municipal Corps Hospital of Chinese People's Armed Police Force from April 2021 to April 2023 were selected, and randomly divided into control group (treated with imrecoxib, n=31) and combined drugs group (treated with CHDI, n=32). After 4 weeks of treatment, the pain visual analogue scale (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and Lequesne algofunctional index (LAI) in knee joints of patients were evaluated, the improvement rate of clinical efficacy was calculated, and the MMP-9 and TIMP-1 expression and MMP-9/TIMP-1 in serum were detected. The adverse reactions of the two groups during the treatment and disease recurrence within 6 months of follow-up were monitored.Results The clinical efficacy rate in CHDI group (90.6%) were notably elevated as compared to the control group (80.6%) (P<0.05). The VAS, WOMAC, LAI, serum MMP-9 and TIMP-1 expression and MMP-9/TIMP-1 in post-treatment of both groups were evidently improved as compared to those in pre-treatment (P<0.05 or P<0.01). In comparison with the control group, the VAS, WOMAC, LAI, serum MMP-9 and TIMP-1 expression and MMP-9/TIMP-1 were significantly improved in CHDI group after the treatment (P<0.01). The incidence of adverse reactions in CHDI group was 12.4%, which was not statistically significant when compared with 9.6% in the control group (P>0.05). The recurrence rate in CHDI group was 10.3% during the follow-up, which was significantly lower than that in the control group, which was 32.0% (P<0.05).Conclusions The efficacy of CHDI in improving the OA-WDHB symptoms and reducing the disease recurrence rate may be related to its ability to modulate the dynamic balance of MMPs and their inhibitors, TIMPs.
关键词
骨关节炎 /
风湿热痹 /
黑地雷方 /
基质金属蛋白酶9 /
组织金属蛋白酶抑制因子1
Key words
osteoarthritis /
wind dampness heat Bi syndrome /
Heidilei Decoction /
matrix metalloproteinase-9 /
tissue inhibitor of matrix metalloproteinases-1
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参考文献
[1] 薛庆云,王坤正,裴福兴,等.中国40岁以上人群原发性骨关节炎患病状况调查[J].中华骨科杂志, 2015, 35(12):1206-1212.
[2] 中华医学会骨科学分会关节外科学组,中国医师协会骨科医师分会骨关节炎学组,国家老年疾病临床医学研究中心,等. 中国骨关节炎诊疗指南(2021年版)[J]. 中华骨科杂志,2021,41(18):1291-1314.
[3] 陈卫衡.膝骨关节炎中医诊疗指南(2020年版)[J].中医正骨,2020,32(10):1-14.
[4] Hochberg M C, Altman R D, April K T, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee [J]. Arthritis Care Res (Hoboken), 2012, 64(4): 465-474.
[5] 国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994: 197.
[6] Castrejón I, Chua J R, Pincus T. A RheuMetric physician checklist to quantitate levels of inflammation, damage and distress on 0-10 visual analogue scales [J]. Clin Exp Rheumatol, 2017, 107(5): 21-25.
[7] Kim M J, Kang B H, Park S H, et al. Association of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) with muscle strength in community-dwelling elderly with knee osteoarthritis [J]. Int J Environ Res Public Health, 2020, 17(7): 2260.
[8] Franchignoni F, Salaffi F, Giordano A, et al. Psychometric properties of self-administered Lequesne Algofunctional Indexes in patients with hip and knee osteoarthritis: an evaluation using classical test theory and Rasch analysis [J]. Clin Rheumatol, 2012, 31(1): 113-121.
[9] 郑筱萸. 中药新药临床研究指导原则[M]. 北京: 中国医药科技出版社, 2002: 353.
[10] 戴国玮,王 芳,郭 信,等.宣痹汤加减联合常规治疗对风湿热痹型膝骨关节炎发作期患者的临床疗效[J].中成药,2021,43(7):1974-1976.
[11] 张元媛,赵艳荣,陈 圆,等.黑地雷方治疗痛风性关节炎的临床研究[J].中医药导报, 2017,23(13):96-97,107.
[12] 姚诗琪,莫国艳,韩林涛.基于代谢组学研究鹅掌草三萜皂苷抑制肝癌初步作用机制[J].湖北中医药大学学报,2020,22(4):5-9.
[13] 魏鹏飞,王玲秀,梁 宇,等.加味四妙散治疗风湿热痹型膝骨关节炎31例临床观察[J].中国民族民间医药, 2017,26(14):108-109.
[14] 王 轩,郑允彬,王秀明,等.四神煎合四妙散加减治疗湿注关节型膝骨关节炎性滑膜炎的临床研究[J].中华中医药杂志,2021,36(5):3045-3048.
[15] 郭奉波,臧建国,毕宾娜,等.加味四妙散联合黄帝内针疗法治疗膝骨关节炎的临床研究[J].山东医学高等专科学校学报,2022,44(4):276-278.
[16] 张 辽,邓颖萍,金 甬,等.基于数据挖掘法的叶海教授治疗膝骨关节炎用药规律研究[J].中医正骨,2020,32(2):36-41.
[17] 孙 宇. 膝痛膏方联合骨科洗药治疗中老年膝骨关节炎(气滞血瘀)疗效观察[D].北京:北京中医药大学,2018.
[18] Ko J H, Kang Y M, Yang J H, et al. Regulation of MMP and TIMP expression in synovial fibroblasts from knee osteoarthritis with flexion contracture using adenovirus-mediated relaxin gene therapy [J]. Knee, 2019, 26(2):317-329.
[19] 罗 媚,杜信眉,周学东.基质金属蛋白酶与骨关节炎发生发展关系的研究进展[J].四川大学学报(医学版),2023,54(1):77-82.
[20] 康伯寅,吴媛君.基质金属蛋白酶-9、基质金属蛋白酶抑制物-1及其在评估膝骨关节炎患者病情严重程度中的价值[J].中国骨与关节杂志,2020,9(10):758-761.
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