中华地方病学杂志
中華地方病學雜誌
중화지방병학잡지
Chinese Journal of Endemiology
2014年
6期
685-688
,共4页
余方方%夏传涛%方华%郭雄
餘方方%夏傳濤%方華%郭雄
여방방%하전도%방화%곽웅
关节功能障碍指数%大骨节病%透明质酸钠%疗效%一致性评价
關節功能障礙指數%大骨節病%透明質痠鈉%療效%一緻性評價
관절공능장애지수%대골절병%투명질산납%료효%일치성평개
Joint dysfunction index%Kashin-Beck disease%Hyaluronic acid%Therapeutic effect%Consistency evaluation
目的 评价透明质酸钠治疗成人大骨节病的远期效果及用关节功能障碍指数评价的适用性.方法 依据《大骨节病治疗效果判断标准》中的关节功能障碍指数综合评分及患者对治疗的总体评价,采用整群随机分组、以淀粉片为对照的临床试验.99例大骨节病患者来自陕西省永寿县,分为治疗组(50例)和对照组(49例).治疗组膝关节腔内每周注射1支透明质酸钠(2.5 ml),连续注射4次;对照组口服淀粉片3个月,每次2粒,3次/d.治疗开始后随访48月,评价透明质酸钠治疗大骨节病的可行性.结果 治疗组膝关节功能障碍改善率在治疗后1周和1、2、3、6、48月分别为80.0％ (40/50)、83.0％ (39/47)、86.4％ (38/44)、85.7％(36/42)、80.0％(36/45)、47.1％(16/34),显著高于对照组[25.0％(12/48)、28.3％(13/46)、33.3％(16/48)、25.0％ (10/40)、30.0％ (12/40)、21.4％(6/28)],二者比较差异有统计学意义(x2值分别为29.744、28.236、17.762、30.665、21.537、4.406,P均＜0.05).在治疗前,关节功能障碍指数评分分数:治疗组为7.59±1.82,对照组为6.89±1.97(t=1.837,P＞0.05);治疗后1个月随访分数分别为3.44±1.71、5.55±2.34(t=4.972,P＜0.01);治疗后6个月随访分数分别为3.46±2.78、6.10±1.83(t=5.102,P＜0.01);治疗后48个月随访分数分别为5.13±2.88、6.81±3.07(t=2.219,P＜0.05).治疗组患者满意度(85.1％,40/47)显著高于对照组(60.9％,28/46;Z=-4.012,P＜ 0.01).治疗组总体评价透明质酸钠治疗后的Kappa值为0.526,一致性强度为中度(P＜0.01).结论 膝关节腔内注射透明质酸钠治疗大骨节病效果显著且疗效持久,用关节功能障碍指数评价治疗的远期效果具有较好的适用性.
目的 評價透明質痠鈉治療成人大骨節病的遠期效果及用關節功能障礙指數評價的適用性.方法 依據《大骨節病治療效果判斷標準》中的關節功能障礙指數綜閤評分及患者對治療的總體評價,採用整群隨機分組、以澱粉片為對照的臨床試驗.99例大骨節病患者來自陝西省永壽縣,分為治療組(50例)和對照組(49例).治療組膝關節腔內每週註射1支透明質痠鈉(2.5 ml),連續註射4次;對照組口服澱粉片3箇月,每次2粒,3次/d.治療開始後隨訪48月,評價透明質痠鈉治療大骨節病的可行性.結果 治療組膝關節功能障礙改善率在治療後1週和1、2、3、6、48月分彆為80.0％ (40/50)、83.0％ (39/47)、86.4％ (38/44)、85.7％(36/42)、80.0％(36/45)、47.1％(16/34),顯著高于對照組[25.0％(12/48)、28.3％(13/46)、33.3％(16/48)、25.0％ (10/40)、30.0％ (12/40)、21.4％(6/28)],二者比較差異有統計學意義(x2值分彆為29.744、28.236、17.762、30.665、21.537、4.406,P均＜0.05).在治療前,關節功能障礙指數評分分數:治療組為7.59±1.82,對照組為6.89±1.97(t=1.837,P＞0.05);治療後1箇月隨訪分數分彆為3.44±1.71、5.55±2.34(t=4.972,P＜0.01);治療後6箇月隨訪分數分彆為3.46±2.78、6.10±1.83(t=5.102,P＜0.01);治療後48箇月隨訪分數分彆為5.13±2.88、6.81±3.07(t=2.219,P＜0.05).治療組患者滿意度(85.1％,40/47)顯著高于對照組(60.9％,28/46;Z=-4.012,P＜ 0.01).治療組總體評價透明質痠鈉治療後的Kappa值為0.526,一緻性彊度為中度(P＜0.01).結論 膝關節腔內註射透明質痠鈉治療大骨節病效果顯著且療效持久,用關節功能障礙指數評價治療的遠期效果具有較好的適用性.
목적 평개투명질산납치료성인대골절병적원기효과급용관절공능장애지수평개적괄용성.방법 의거《대골절병치료효과판단표준》중적관절공능장애지수종합평분급환자대치료적총체평개,채용정군수궤분조、이정분편위대조적림상시험.99례대골절병환자래자합서성영수현,분위치료조(50례)화대조조(49례).치료조슬관절강내매주주사1지투명질산납(2.5 ml),련속주사4차;대조조구복정분편3개월,매차2립,3차/d.치료개시후수방48월,평개투명질산납치료대골절병적가행성.결과 치료조슬관절공능장애개선솔재치료후1주화1、2、3、6、48월분별위80.0％ (40/50)、83.0％ (39/47)、86.4％ (38/44)、85.7％(36/42)、80.0％(36/45)、47.1％(16/34),현저고우대조조[25.0％(12/48)、28.3％(13/46)、33.3％(16/48)、25.0％ (10/40)、30.0％ (12/40)、21.4％(6/28)],이자비교차이유통계학의의(x2치분별위29.744、28.236、17.762、30.665、21.537、4.406,P균＜0.05).재치료전,관절공능장애지수평분분수:치료조위7.59±1.82,대조조위6.89±1.97(t=1.837,P＞0.05);치료후1개월수방분수분별위3.44±1.71、5.55±2.34(t=4.972,P＜0.01);치료후6개월수방분수분별위3.46±2.78、6.10±1.83(t=5.102,P＜0.01);치료후48개월수방분수분별위5.13±2.88、6.81±3.07(t=2.219,P＜0.05).치료조환자만의도(85.1％,40/47)현저고우대조조(60.9％,28/46;Z=-4.012,P＜ 0.01).치료조총체평개투명질산납치료후적Kappa치위0.526,일치성강도위중도(P＜0.01).결론 슬관절강내주사투명질산납치료대골절병효과현저차료효지구,용관절공능장애지수평개치료적원기효과구유교호적괄용성.
Objective To evaluate the long-term therapeutic effect of hyaluronic acid on adults with Kashia-Beck disease and the applicability of the joint dysfunction index.Methods A cluster-randomized,starch tablets-controlled trial was carried out depending on the joint dysfunction index of assessment for therapeutic efficacy on Kashin-Beck disease and self-assessment by patients of the "Treatment Effect of Kaschin Beck Disease in Criterion".A total of 99 adults with Kashia-Beck disease were randomly divided into two groups:treatment group including 50 patients were intra-articular injected hyaluronic acid in knee weekly for 4 weeks,and the control group including 49 patients were treated with oral starch tablets for 3 months,2 tablets each time,3 times a day.We carried out 48 months follow-up and assessed the applicability of Kashia-Beck disease with treatment of hyaluronic acid.Results The improvement rates of joint dysfunction index were 80.0％ (40/50),83.0％ (39/47),86.4％ (38/44),85.7％(36/42),80.0％(36/45),and 47.1％(16/34) for 1 week and 1,2,3,6,48 months in treatment group,respectively,which were significantly higher than those of corresponding control group 25.0％ (12/48),28.3％ (13/46),33.3％ (16/48),25.0％ (10/40),30.0％ (12/40),and 21.4％ (6/28),and the differences were statistically significant between corresponding groups (x2=29.744,28.236,17.762,30.665,21.537,4.406; all P ＜ 0.05).Before treatment,the treatment group and control group in the joint dysfunction index scores were 7.59 ± 1.82 and 6.89 ± 1.97(t =1.837,P ＞ 0.05),respectively.After treatment,1 month follow up of the treatment group and control group in the joint dysfunction index scores were 3.44 ± 1.71 and 5.55 ± 2.34(t =4.972,P ＜ 0.01),respectively; 6 months follow up were 3.46 ± 2.78 and 6.10 ± 1.83(t =5.102,P ＜ 0.01),respectively; 48 months follow up were 5.13 ± 2.88 and 6.81 ± 3.07(t =2.219,P ＜ 0.05),respectively.The satisfaction of 85.1％ (40/47) in treatment group was significantly higher than that of 60.9％(28/46) in control group (Z =-4.012,P ＜ 0.01).Kappa value between joint dysfunction index and the overall evaluation of the treatment group after treatment was 0.526,which belong to moderate intensity of consistent degree (P ＜ 0.01).Conclusion The therapeutic effect of intra-articular injection of hyaluronic acid on adults with Kashia-Beck disease is significant and lasting,and the joint dysfunction index has better applicability to evaluate the long-term therapeutic effect.
