透明质酸联合加味阳和汤对膝骨性关节炎患者脂质过氧化损伤的保护作用

于乐惠　　郑锦辉

[摘要] 目的 探讨透明质酸联合加味阳和汤对膝骨性关节炎（KOA）患者脂质过氧化损伤的保护作用。 方法 选择86例KOA患者，随机分为中西医组和西医组。西医组予以透明质酸钠20 mg关节腔内注射，1次/周。中西医组在西医组基础上加用加味阳和汤口服，1剂/d，两组疗程均为4周。观察并比较两组治疗前后关节液超氧化物歧化酶（SOD）和丙二醛（MDA）含量的变化，评估其近期疗效及不良反应，并随访6个月评估其远期疗效。 结果 治疗4周后，两组关节液SOD含量明显上升，MDA含量明显下降（P<0.05或P<0.01），且中西医组较西医组变化更明显（P<0.05）；同时中西医组近期总有效率较西医组更佳（χ2=4.44，P<0.05）；中西医组治疗中出现不良反应5例，西医组3例，症状较轻，两组比较差异无统计学意义（χ2=0.14，P>0.05）。隨访6个月，中西医组远期临床总有效率较西医组更佳（χ2=4.17，P<0.05）。 结论 透明质酸联合加味阳和汤治疗KOA患者的近期及远期疗效均较确切，且安全性较好，其机制可能与其分别升高和降低关节液SOD含量和MDA含量、减轻氧自由基对关节损伤、对膝关节的脂质过氧化损伤具有保护作用有关。

[关键词] 膝骨性关节炎；透明质酸；加味阳和汤；脂质过氧化损伤

[中图分类号] R274 [文献标识码] B [文章编号] 1673-9701（2017）21-0118-03

Protection effect of hyaluronic acid combined with modifed Yanghe Decoction on lipid peroxidation damage of patients with knee osteoarthritis（OA）

YU Lehui1 ZHENG Jinhui2

1.Department of Neck Pain and Lumbago， Rongjun Hospital in Zhejiang Province， Jiaxing 314000， China； 2.Department of Science and Education， Taizhou Enze Medical Center （Group） Luqiao Hospital， Taizhou 318050， China

[Abstract] Objective To investigate the protective effect of hyaluronic acid combined with modifed Yanghe decoction on lipid peroxidation injury in patients with knee osteoarthritis（KOA）. Methods A total of 86 patients with KOA were randomly divided into the Chinese combined with western medicine group and western medicine group. The western medicine group was given intra-articular injection of sodium hyaluronate 20 mg， 1 time/week. The Chinese and western medicine group was also treated with modifed Yanghe decoction on the basis of the treatment of the western medicine group， 1 dose/d. And the treatment course of the two groups was 4 weeks. The changes of superoxide dismutase（SOD） and malondialdehyde（MDA） in synovial fluid between the two groups before and after treatment were observed and compared. The short-term efficacy， adverse reactions were evaluated， and the long-term efficacy were observed in following-up for 6 months. Results After 4 weeks of treatment， the content of SOD in the synovial fluid increased significantly and the content of MDA decreased significantly in both groups（P<0.05 or P<0.01）. And the changes of the Chinese combined with western medicine group were more significant than those of the western medicine group（P<0.05）. At the same time， the short-term total effective rate of Chinese combined with western medicine group was better than that of the western medicine group（χ2=4.44， P<0.05）. There were 5 cases of adverse reactions in the Chinese combined with western medicine group and 3 cases of the western medicine group. The symptoms were mild， and there was no significant difference between the two groups（χ2=0.14， P>0.05）. Within follow-up for 6 months， the long-term clinical effective rate of Chinese combined with western medicine group was better than that of the western medicine group（χ2=4.17， P<0.05）. Conclusion The short-term and long-term efficacy of hyaluronic acid combined with modifed Yanghe decoction is exact with good safety， and its mechanism may be that the treatment increases the content of SOD and decreases the content of MDA in synovial fluid， and reduces the damage of oxygen free radical to the joint injury， which has a protective effect on the knee lipid peroxidation damage.

[Key words] Knee osteoarthritis； Hyaluronic acid； Modifed Yanghe decoction； Lipid peroxidation injury

膝骨性关节炎（knee osteoarthritis，KOA）是好发于中老年的常见慢性骨关节疾病，主要表现为关节肿痛和功能受限[1]。KOA的发病机制较复杂，研究已证实氧自由基的代谢紊乱引起的脂质过氧化损伤在其发病中的作用逐渐引起重视[2]。透明质酸关节腔内注射治疗KOA是西医常用方法，但部分患者疗效欠理想，近年来研究发现联合中药治疗具有独特的优势[3，4]。本研究观察了透明质酸联合加味阳和汤对KOA患者脂质过氧化损伤的保护作用，现报道如下。

1 资料与方法

1.1 一般资料

选取86例KOA患者，均为2015年1月～2016年1月本院骨科门诊就诊患者。纳入标准：西医诊断符合《骨关节炎诊治指南（2007年版）》中的诊断及病情程度标准[5]；中医诊断符合《中药新药临床研究指导原则（2002年版》的诊断标准[6]。……