世界中医药

作者	单位
李元森1，孙成磊1，古今2，罗琳3	1 中药制药共性技术国家重点实验室，临沂，276000； 2 北京大学首钢医院药剂科，北京，100144； 3 西南医科大学附属中医医院骨伤科，泸州，646000

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中文摘要:

目的：探讨脉络舒通丸治疗膝关节骨性关节炎的疗效及对炎性反应因子水平的影响。方法：选取2016年6月至2018年8月西南医科大学附属中医医院收治的膝关节骨性关节炎患者126例作为研究对象，随机分为塞来昔布组、脉络舒通丸组和联合组，每组42例；单药观察组分别服用塞来昔布和脉络舒通丸，联合组同时服用2种药物，3组患者连续治疗4周；观察3组患者治疗前后关节液中白细胞介素-1β（IL-1β）、肿瘤坏死因子-α（TNF-α）及基质金属蛋白酶（MMPs）水平变化，采用国际DOA（临床体征）评分标准对膝关节休息痛、运动痛、压痛、关节活动度、晨僵及行走能力进行评分并记录治疗后临床疗效。结果：3组患者治疗后IL-1β、TNF-α、MMP-3水平较治疗前均有下降，其中联合组IL-1β、TNF-α、MMP-3的水平均低于塞来昔布组和脉络舒通组，治疗后联合组各因子水平值与塞来昔布组和脉络舒通组比较，差异有统计学意义（P<0.05），治疗后塞来昔布组和脉络舒通丸组各因子水平值比较，差异有统计学意义（P<0.05）；塞来昔布组痊愈11例（26.2%），与脉络舒通组结果相近（28.6%）低于联合组（35.7%）；同时塞来昔布组总有效率为83.3%，脉络舒通组总有效率为88.1%，而联合组总有效率达到92.9%，高于单一用药组；联合组无效率仅为7.1%，而单一用药组均高于10%，无效率高于联合组；治疗后各组临床体征评分较治疗前明显下降，其中联合组治疗后各体征评分均显著低于脉络舒通组和塞来昔布组，治疗后3组评分比较，差异有统计学意义（t＝3.577，P<0.05）。结论：脉络舒通丸联合塞来昔布可以提高患者的治愈率，降低炎性反应因子水平，缓解患者疼痛感，提高患者生命质量，适合临床应用。

English Summary:

To investigate the effects of Mailuo Shutong Pills on osteoarthritis and its effects on inflammatory factors.Methods:A total of 126 cases of patients with knee osteoarthritis admitted to The Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University from June 2016 to August 2018 were randomly divided into a celecoxib group，a Mailuo Shutong Pills group and a combined group according to different treatment methods，with 42 cases in each group.Celecoxib and Mailuo Shutong Pills were taken in the monotherapy group，and two drugs were taken in the combination group.Patients in the 3 groups received continuous treatment for 4 weeks.The joint fluid interleukin 1 beta(IL-1β)，tumor necrosis factor alpha(TNF-α)and matrix metalloproteinases(MMPs)level change of the 3 groups before and after treatment were observed.The international DOA grading standard was used to score the knee pain，rest pain，tenderness，motion，morning stiffness and the ability to walk，and record the clinical effect after treatment.Results:The levels of IL-1β，TNF-α and MMP-3 in the 3 groups decreased after treatment compared with those before treatment.The levels of IL-1β，TNF-α and MMP-3 in the combined group were lower than those in the celecoxib group and Mailuo Shutong Pills group after treatment，and the levels of all factors in the combined group were statistically different from those in the celecoxib group and the Mailuo Shutong Pills group after treatment(P<0.05).The levels of all factors in the celecoxib group were statistically different from those in Mailuo Shutong Pills group after treatment(P<0.05).In the celecoxib group，11 cases(26.2%)were cured，which was similar to the results of Mailuo Shutong Pills group(28.6%)and lower than that of the combined group(35.7%).Meanwhile，the total effective rate of celecoxib group was 83.3%，that of Mailuo Shutong Pills group was 88.1%，and that of combination group was 92.9%，higher than that of monotherapy group.In addition，the inefficiencies in the combination group were only 7.1%，while those in the monotherapy group were all higher than 10%，and the inefficiencies were higher than those in the combination group.After treatment，the scores of all clinical signs decreased significantly compared with those before treatment，among which，the scores of all signs in the combined group were significantly lower than those in the Mailuo Shutong Pills group and the celecoxib group after treatment，and the scores of the 3 groups showed statistically significant differences after treatment(t=3.577，P<0.05).Conclusion:Mailuo Shutong Pills combined with celexib can improve the curative rate，reduce the level of inflammatory factors，relieve pain and improve the quality of life of patients，which is suitable for clinical application.

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