独活寄生汤治疗肝肾亏虚型膝关节骨性关节炎疗效研究  

Curative effect of Duhuo Jisheng decoction in treating knee joint osteoarthritis with deficiency of liver and kidney

作　　者：张茜玥 彭鹏 ZHANG Xiyue;PENG Peng(Macao University of Science and Technology,Macao 999078,China;Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine,Zhuhai 519000,China)

机构地区：[1]澳门科技大学,中国澳门999078 [2]珠海市中西医结合医院,广东珠海519000

出　　处：《陕西中医》2025年第3期354-358,363,共6页Shaanxi Journal of Traditional Chinese Medicine

基　　金：广东省医学科学技术研究项目(A2021004)。

摘　　要：目的:考察独活寄生汤治疗肝肾亏虚型膝关节骨性关节炎(KOA)疗效及相关机制。方法:收集膝关节骨性关节炎150例,均为肝肾亏虚型,随机分为对照组、观察组。对照组给予双氯芬酸钠胶囊治疗,观察组在对照组基础上给予独活寄生汤治疗,两组均持续治疗4个月。记录两组KOA患者治疗前后肝肾亏虚证候积分、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)、美国膝关节协会评分(AKS)、视觉模拟评分(VAS)、外周血核因子κB(NF-κB)信号通路相关蛋白[Toll样受体(TLR)、NF-κB、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)],两组临床疗效及不良反应。随访截止至2024年12月,采用生活质量综合评定问卷(GQOL-74)评估患者治疗前、治疗后、末次随访生活质量、复发情况。结果:治疗前,两组肝肾亏虚证候积分、WOMAC、AKS、VAS、TLR、NF-κB、IL-6、TNF-α比较,差异无统计学意义(P>0.05)。治疗后,两组中医证候积分、WOMAC、VAS、TLR、NF-κB、IL-6、TNF-α均有不同程度降低,AKS不同程度增高,组间比较差异有统计学意义(均P<0.05)。与对照组比,观察组的临床疗效总有效率较高,总不良反应发生率较低(均P<0.05)。随访32个月,中位数25个月。治疗前,两组GQOL-74比较,差异无统计学意义(P>0.05);治疗后和末次随访,两组GQOL-74均增高(均P<0.05);与对照组比,观察组GQOL-74若干项增高,差异有统计学意义(P<0.05)。对照组随访期间复发1例,观察组无复发,组间比较差异无统计学意义(P>0.05)。结论:独活寄生汤能改善KOA肝肾亏虚证患者膝关节功能,降低疼痛,改善生活质量,降低复发风险,其机制可能与调节NF-κB信号通路有关。Objective:To investigate efficacy and potential mechanisms of Duhuo Jisheng prescription in treating knee osteoarthritis(KOA)of liver-kidney deficiency type.Methods:150 cases of KOA with deficiency of liver and kidney were included.They were randomly divided into control group and observation group.The control group were treated with diclofenac sodium capsules,while the observation group treated with Duhuo Jisheng prescription in addition to the control group’s treatment,treatment duration of 4 months for both groups.The changes in syndrome score of liver and kidney deficiency syndrome,western ontario and McMaster universities osteoarthritis index(WOMAC),American knee society score(AKS),visual analogue scale(VAS),peripheral blood nuclear factor kappa-light-chain-enhancer of activated B cells(NF-κB)signaling pathway-related proteins[Toll-like receptor(TLR),NF-κB,interleukin-6(IL-6)and tumor necrosis factor alpha(TNF-α)]were recorded.The clinical efficacy and adverse reactions after treatment were recorded for two groups.Follow-up were completed by December 2024,and the generic quality of life inventory 74(GQOL-74)were used to record the quality of life and KOA recurrence of all patients before treatment,after treatment,and at the last follow-up.Results:Before treatment,there were no statistically significant differences in syndrome score of liver and kidney deficiency syndrome,WOMAC,AKS,VAS,TLR,NF-κB,IL-6 and TNF-αbetween 2 groups(all P>0.05).After treatment,these parameters showed varying degrees of decrease,and AKS showed varying degrees of increase in both groups.Compared with the control group,the observation group had significantly lower TCM symptom scores,WOMAC,VAS,TLR,NF-κB,IL-6 and TNF-α,and significantly higher AKS,difference between groups statistically significant(all P<0.05).The total effective rate of clinical efficacy in the observation group was significantly higher than that in the control group,and the total adverse reactions were lower(P<0.05).Both groups were followed up,with follow-up

关 键 词：膝关节骨性关节炎 独活寄生汤 肝肾亏虚证 核因子κB 美国膝关节协会评分 西安大略和麦克马斯特大学骨关节炎指数 视觉模拟评分 

分 类 号：R274[医药卫生—中医骨伤科学]