CAJ | 학술논문

目的：探讨透明质酸关节腔内注射对膝关节骨性关节炎(OA)患者血清炎症因子水平影响及疗效。方法选取2010年1月~2013年12月在丽水市中医院骨科门诊治疗的膝关节OA患者72例，将其分为观察组和对照组。对照组予以芬必得胶囊0.3 g，口服，2次/d，连用4周。观察组予以透明质酸关节腔内注射2 mL/次，每周1次，连用4周。观察两组治疗前后血清超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)和白介素-18(IL-18)水平变化，并比较其临床效果及不良反应。结果治疗4周后，两组血清hs-CRP、IL-6和IL-18水平[观察组：(5.69±0.85)mg/L、(1.97±0.32)ng/L、(146.18±30.61)ng/L，对照组：(7.86±0.47)mg/L、(2.75±0.56)ng/L、(184.21±35.24)ng/L]均较治疗前明显下降[观察组：(8.94±2.13)mg/L、(3.51±0.56)ng/L、(211.24±40.31)ng/L，对照组：(9.07±2.05)mg/L、(3.45±0.67)ng/L、(208.07±39.82)ng/L]，差异均有统计学意义(t=3.15、3.52、2.90，t=2.29、2.42、2.21，P<0.05或P<0.01)，且观察组下降值明显大于对照组，差异均有统计学意义(t=2.37、2.40、2.21，P<0.05)；观察组患者的临床总有效率(94.44%)明显高于对照组(77.78%)，差异有统计学意义(χ2=4.18，P<0.05)；观察组和对照组治疗中分别发生不良反应3例和11例，症状均较轻微，观察组不良反应发生率明显低于对照组(8.33%比30.56%)，差异有统计学意义(χ2=6.29，P<0.05)。结论透明质酸关节腔内注射治疗膝关节OA效果及安全性均较佳，作用与降低血清hs-CRP、IL-6和IL-18等炎症因子水平密切相关。
목적：탐토투명질산관절강내주사대슬관절골성관절염(OA)환자혈청염증인자수평영향급료효。방법선취2010년1월~2013년12월재려수시중의원골과문진치료적슬관절OA환자72례，장기분위관찰조화대조조。대조조여이분필득효낭0.3 g，구복，2차/d，련용4주。관찰조여이투명질산관절강내주사2 mL/차，매주1차，련용4주。관찰량조치료전후혈청초민C반응단백(hs-CRP)、백개소-6(IL-6)화백개소-18(IL-18)수평변화，병비교기림상효과급불량반응。결과치료4주후，량조혈청hs-CRP、IL-6화IL-18수평[관찰조：(5.69±0.85)mg/L、(1.97±0.32)ng/L、(146.18±30.61)ng/L，대조조：(7.86±0.47)mg/L、(2.75±0.56)ng/L、(184.21±35.24)ng/L]균교치료전명현하강[관찰조：(8.94±2.13)mg/L、(3.51±0.56)ng/L、(211.24±40.31)ng/L，대조조：(9.07±2.05)mg/L、(3.45±0.67)ng/L、(208.07±39.82)ng/L]，차이균유통계학의의(t=3.15、3.52、2.90，t=2.29、2.42、2.21，P<0.05혹P<0.01)，차관찰조하강치명현대우대조조，차이균유통계학의의(t=2.37、2.40、2.21，P<0.05)；관찰조환자적림상총유효솔(94.44%)명현고우대조조(77.78%)，차이유통계학의의(χ2=4.18，P<0.05)；관찰조화대조조치료중분별발생불량반응3례화11례，증상균교경미，관찰조불량반응발생솔명현저우대조조(8.33%비30.56%)，차이유통계학의의(χ2=6.29，P<0.05)。결론투명질산관절강내주사치료슬관절OA효과급안전성균교가，작용여강저혈청hs-CRP、IL-6화IL-18등염증인자수평밀절상관。
Objective To discuss influence and curative effect of intra articular injection of hyaluronic acid on serum inflammatory factor levels of patients with knee osteoarthritis (OA). Methods 72 cases of patients with knee OA, who were given the medical treatment in Department of Orthopedics of Lishui Traditional Chinese Medicine Hospital during the period from January 2010 to December 2013, were divided into observation group and control group. The patients in control group were given 0.3 g Fenbid Capsules through the mouth, twice a day for 4 weeks. The patients in observation group were given 2 mL intra articular injection of hyaluronic acid per time, once a week for 4 weeks. The changes of serum hs-CRP, IL-6 and IL-18 levels of patients in two groups before and after treatment were observed, and the clinical curative effect and drug adverse reaction (DAR) were compared as well. Results After 4 weeks’treatment, serum hs-CRP, IL-6 and IL-18 levels of patients in observation group and control group [observation group:(5.69±0.85) mg/L, (1.97±0.32) ng/L, (146.18±30.61) ng/L, control group: (7.86±0.47) mg/L, (2.75±0.56) ng/L, (184.21±35.24) ng/L] were obviously declined than before [observation group:(8.94±2.13) mg/L, (3.51±0.56) ng/L, (211.24±40.31) ng/L, control group:(9.07±2.05) mg/L, (3.45±0.67) ng/L, (208.07±39.82) ng/L], there were statistically significant differences (t=3.15, 3.52, 2.90; t=2.29, 2.42, 2.21, P<0.05 or P<0.01), and the declining rate of patients in observation group was much higher than that in control group (t=2.37, 2.40, 2.21, P<0.05). The total clinical efficiency of patients in observation group (94.44%) was much higher than that in control group (77.78%) with statistically significant difference (χ2=4.18, P<0.05). 3 and 11 cases of DAR during the treatment were appeared in observation group and control group respectively with light symptom. The DAR occurrence rate of patients in observation group (8.33%) was much lower than that in control group with statistically significant difference (30.56%) (χ2=6.29, P< 0.05). Conclusion Intra articular injection of hyaluronic acid has favorable effect and security on knee OA, whose mechanism of action has close effect on reducing serum hs-CRP, IL-6 and IL-18 inflammatory factor levels.