目的 研究雷公藤多苷(Tripterygium wilfordii Hook F,TwHF)对活动性膝骨关节炎(osteoarthritis,OA)患者的临床疗效及其对血清基质金属蛋白酶(matrix metalloproteinase,MMP)-3、-9、-13的影响.方法 采用临床随机对照试验研究TwHF的临床疗效,60例活动性膝OA患者分为治疗组和对照组,分别应用TwHF和非甾体类抗炎药(non-steroidal anti-inflammatory drugs,NSAIDs)双氯芬酸钠缓释片(扶他林)或塞来昔布(西乐葆)共12周.采用西安大略大学和麦克马斯特大学骨关节炎(Western Ontario and McMaster University Osteoarthritis,WOMAC)指数、 疼痛评分(visual analog scale,VAS)作为观察疾病活动性及疗效判定的标准;采用酶联免疫吸附(enzyme-linked immunosorbent as-say,ELISA)双抗体夹心法测定治疗前后外周血MMP-3、-9、-13的变化.探讨其作用机制,采用t检验、 χ2检验、 秩和检验对数据进行统计学分析.结果 经TwHF和NSAIDs治疗12周后,2组患者临床症状明显改善,治疗组和对照组总有效率分别为73.3％和63.3％,治疗组总有效率高于对照组,但差异无统计学意义(χ2=0.693,P=0.405);两组患者MMP-3、-9、-13浓度[治疗组MMP-3(259.7±144.1)ng/L、MMP-9(38.8±31.0)ng/L、MMP-13(230.6±148.9)ng/L,对照组MMP-3(274.1±149.9)ng/L、MMP-9(39.6±26.2)ng/L、MMP-13(231.3±128.6)ng/L]均高于正常人[MMP-3(137.9±70.1)ng/L、MMP-9(21.5±12.1)ng/L、MMP-13(122.5±74.6)ng/L],治疗12周MMP-3、-9、-13浓度[治疗组MMP-3(184.1±67.4)ng/L、MMP-9(25.5±14.8)ng/L、MMP-13(157.1±79.2)ng/L,对照组MMP-3(183.5±82.6)ng/L、MMP-9(26.9±15.9)ng/L、MMP-13(159.4±76.4)ng/L]较治疗前均明显下降,差异有统计学意义(P<0.01).结论 雷公藤多苷能够显著改善活动性膝骨关节炎患者的临床症状,可有效抑制OA患者外周血MMP-3、-9、-13的表达,具有良好的安全性.%Objective To study the clinical efficacy of Tripterygium wilfordii Hook F ( TwHF ) on patients with active knee osteoarthritis ( OA) and its effect on serum matrix metalloproteinase ( MMP )-3, -9, -13.Methods To evaluate the clinical effects of TwHF on patients with active knee OA in a randomized controlled clinical trial .Sixty patients with active knee OA were divided into treatment group and control group.TwHF and non-steroidal anti-inflammatory drugs (NSAIDs) were used respectively in these two groups for 12 weeks.The University of Western Ontario and the University of McMaster ?s Osteo-arthritis ( WOMAC) index and pain score ( VAS) were used as the criteria for disease activity and therapy efficacy.Serum matrix metalloproteinases ( MMP ) -3、 -9、 -13 were determined by sandwich enzyme-linked immunosorbent ( ELISA ) before and after treatment .Results The symptoms of all patients in both of the groups improved significantly after therapy .The total effective rate of treatment group was high-er than that of the control group ( 73.3％v s.63.3％) , although there was no significant difference ( χ2=0.693 , P=0.405) .Serum levels of MMP-3,-9 and-13in both of these two groups were higher than those of healthy controls ( P<0.05 ) , and they decreased significantly after the treatments ( P<0.05 ) . Conclusion TwHF can effectively improve the clinical symptoms of patients with active knee OA , and in-hibit the expression of MMP-3,-9,-13.
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