盐酸氨基葡萄糖联合塞来昔布治疗膝骨性关节炎的随机对照

摘要

背景：盐酸氨基葡萄糖被认为具有治疗膝关节骨性关节炎的作用，但其是否对不同程度的骨性关节炎都有效，联合应用非类固醇类抗炎药与单用盐酸氨基葡萄糖是否存在疗效差别，尚需进一步临床研究。目的：采用前瞻性研究的方法对比单用盐酸氨基葡萄糖以及联合应用塞来昔布治疗不同程度膝关节骨性关节炎的临床疗效。方法：采用Lequesne评分将152例膝关节骨关节炎患者分为轻、中、重度，然后随机配比法均分为单用盐酸氨基葡萄糖组和盐酸氨基葡萄糖联合塞来昔布用药组，于用药后2，4，6周以及停药8，12周统计患者Lequesne评分，用药前后及组间进行对比并统计盐酸氨基葡萄糖的不良反应。结果与结论：在轻度骨性关节炎治疗组中，盐酸氨基葡萄糖组治疗4周、停药12周后Lequesne评分与治疗前比较，差异有显著性意义；而联合用药组治疗2周后评分即有改善，两组比较，评分在治疗2，4周差异有显著性意义，说明联合用药组效果改善更显著；中度骨性关节炎患者在治疗2，4，6周和停药8周时，联合用药患者Lequesne评分均低于单纯使用盐酸氨基葡萄糖患者，差异均有显著性意义(P<0.05)，说明在中度骨性关节炎，盐酸氨基葡萄糖联合塞来昔布治疗效果好于单独用药；重度骨性关节炎中，两组治疗后Lequesne评分与治疗前比较，均无明显改善。结果说明对于轻度膝骨性关节炎，单用盐酸氨基葡萄糖口服即可明显改善患者临床症状，对于中度膝骨关节炎，建议联合非类固醇类抗炎药类用药，可以较好改善临床症状，而对于重度膝骨关节炎，两种方法均无效。%BACKGROUND:Glucosamine hydrochloride is considered to have the role in the treatment of knee osteoarthritis. Whether it is effective for varying degrees of osteoarthritis and whether there are efficacy differences between the combinations nonsteroidal anti-inflammatory drugs and simple glucosamine hydrochloride need further clinical research. OBJECTIVE:To compare the clinical effects between glucosamine hydrochloride capsules and combined with celecoxib for the treatment of knee osteoarthritis through prospective study. METHODS:According to Lequesne score, 152 patients with knee osteoarthritis were divided into mild, moderate and severe groups, then each group was divided into groups treated just by glucosamine hydrochloride and groups treated by glucosamine hydrochloride combined with celecoxib randomly. The Lequesne score was recorded at 2, 4 and 6 weeks after drug administration and 8 and 12 weeks after drug withdrawal, and then the adverse reactions of glucosamine hydrochloride were compared between groups and before and after treatment. RESULTS AND CONCLUSION:In the mild group, there was significant difference in Lequesne score of glucosamine hydrochloride group at 4 weeks after treatment and 12 weeks after drug withdrawal when compared with that before treatment;the Lequesne score was improved in the combined group at 2 weeks after treatment, and there was significant difference between two groups at 2 and 4 weeks after treatment, it showed that the combined group improved the score, which was more significant than the glucosamine hydrochloride group. In the moderate group, the Lequesne score in the glucosamine hydrochloride group was lower than that in the combined group at 2, 4 and 6 weeks after treatment and 8 weeks after drug withdrawal (P<0.05). It showed that the effect of glucosamine hydrochloride combined with celecoxib for the treatment of medium knee osteoarthritis was better than that of glucosamine hydrochloride. In the serious group, there was no significant difference in Lequesne score between two groups before and after treatment. The results indicate that the clinical symptoms of mild knee osteoarthritis patients can be significantly improved by a single use of glucosamine hydrochloride. To moderate osteoarthritis, combination therapy with nonsteroidal anti-inflammatory drugs is recommended to improve clinical symptoms, and both of the two methods are invalid on severe knee osteoarthritis patients.