四妙散加味对膝关节滑膜炎湿热阻络证患者关节液炎性因子和神经肽物质的影响  

Effect of Modified Simiaosan on Inflammatory Factors and Neuropeptide Substances of Patients with Synovitis of Knee Joint and Damp-heat Obstruction Collateral Syndrome

作　　者：胡华[1] 李连泰[1] 刘艳伟[1] 王书君[1] 谢双喜[1] 孙建君 HU Hua;LI Lian-tai;LIU Yan-wei;WANG Shu-jun;XIE Shuang-xi;SUN Jian-jun(The Affiliated Hospital of Chengde Medical College,Chengde 067000,China)

机构地区：[1]承德医学院附属医院,河北承德067000

出　　处：《中国实验方剂学杂志》2020年第6期97-102,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河北省中医药管理局科研计划项目(2016066)。

摘　　要：目的:观察四妙散加味对膝关节滑膜炎(KS)湿热阻络证的临床疗效及对关节液炎性因子和神经肽物质的影响。方法:将135例患者分为对照组67例和观察组68例。对照组抽净关节内积液后,以曲安奈德注射液关节内注射,1周1次,共2次,并口服醋氯芬酸缓释片,0. 2 g/次,1次/d。观察组西医治疗措施同对照组,并内服四妙散加味,1剂/d,两组疗程均为连续治疗4周。进行治疗前后膝关节疼痛和肿胀程度评分,膝关节功能采用美国西安大略和麦克马斯特大学骨关节炎评分(WOMAC),进行治疗前后湿热阻络证和膝关节局部体征评价;检测治疗前后关节液白细胞介素-1β(IL-1β),IL-6,肿瘤坏死因子-α(TNF-α),超敏C反应蛋白(hs-CRP),P物质(SP),钙素基因相关肽(CGRP),神经肽Y(NPY)和血管活性肠肽(VIP)水平。结果:治疗后观察组膝关节疼痛程度和肿胀程度均低于对照组(P <0. 01);观察组WOMAC量表各因子评分和总分均低于对照组(P <0. 01);观察组湿热阻络证积分、膝关节屈伸范围评分和浮髌试验评分均低于对照组(P <0. 01);观察组关节液IL-1β,IL-6,TNF-α和hs-CRP水平均低于对照组(P <0. 01);观察组关节液SP,CGRP,NPY和VIP水平均低于对照组(P <0. 01);经秩和检验,观察组临床疗效优于对照组(Z=2. 089,P <0. 05)。结论:四妙散加味治疗KS湿热阻络证患者,能明显减轻疼痛、肿胀症状,促进膝关节活动功能恢复,并能抑制关节液中促炎因子和神经肽类物质表达,提高了临床治疗效果。Objective: To observe the clinical efficacy of modified Simiaosan on synovitis of knee joint with damp-heat obstruction collateral syndrome and the effect on inflammatory factors and neuropeptide substances in synovial fluid. Method: One hundred and thirty-five patients were randomly divided into control group( 67 cases)and observation group( 68 cases) by random number table. Patients ’ intra-articular effusion was drawn out.Triamcinolone acetonide was injected into arthrosis for 2 times,1 time/week,and aceclofenac sustained-release tablets were given for 4 weeks,0. 2 g/time,1 time/day. In addition to the therapy of control group,patients in observation group were also given modified Simiaosan for 4 weeks,1 dose/day. Before and after treatment,pain,swelling of knee joint and were scored,Western Ontario and Mc Master University( WOMAC) were adopted for scoring knee score,and damp-heat obstruction syndrome and local signs of knee joint were also assessed. And levels of interleukin-1 beta( IL-1 beta),IL-6,tumor necrosis factor-alpha( TNF-alpha),hypersensitive C-reactive protein( hs-CRP),substance P( SP),calcitonin gene-related peptide( CGRP),neuropeptide Y( NPY) and vasoactive intestinal peptide( VIP) were detected. Result: After treatment,scores of pain and swelling of knee joint in observation group were lower than those in control group( P < 0. 01). Scores of WOMAC,the total score,integral of damp-heat obstruction collateral syndrome,knee flexion-extension range score and floating patella test were all lower than those in control group( P < 0. 01). And levels of IL-1β,IL-6,TNF-α,hs-CRP,SP,CGRP,NPY and VIP were all lower than those in control group( P < 0. 01). Analyzed by rank sum test,the clinical efficacy in observation group was better than those in control group( Z = 2. 089,P < 0. 05). Conclusion: Modified Simiaosan can significantly alleviate pain and swelling symptoms,promote the recovery of knee joint function,and inhibit the expressions of proinflammatory factors and neuropeptides in synovial fluid,wi

关 键 词：膝关节滑膜炎 湿热阻络证 四妙散 炎性因子 神经肽物质 

分 类 号：R24[医药卫生—中医临床基础] R274[医药卫生—中医学]