玻璃酸钠联合不同剂量阿魏酸钠关节腔注射治疗膝骨关节炎的临床效果

摘要

Objective To observe the clinical efficacy of intra-articular injection with different dosages of sodium hyaluronate combined with sodium ferulate for knee osteoarthritis(KOA). Methods Eighty patients with KOA were randomly divided into four groups,with 20 cases in each group.Group A,B and C were given sodium hyaluronate combined with sodium ferulate(sodium hyaluronate dosage 20 mg in each group,sodium ferulate dosage 0.25 g,0.50 g and 0.75 g respectively),group D was given sodium hyaluronate alone.All patients in the four groups were given intra-articular injection therapy once a week,and the course of treatment was 5 weeks.The levels of synovial fluid superoxide dismutase(SOD),malondialdehyde(MDA),tumor necrosis factor(TNF)-α and the Lequesne knee joint function score were compared among the four groups before and after treatment.Results Before treatment,there was no significant difference in the level of synovial fluid SOD,MDA or TNF-α,or the Lequesne score among the four groups(all P>0.05).After treatment,the level of synovial fluid SOD was higher,while the levels of synovial fluid MDA and TNF-α as well as the Lequesne scores were lower in the four groups compared to those before treatment(all P<0.05);the levels of synovial fluid SOD and MDA and the Lequesne scores of group B and C were superior to those of group A and D(all P<0.05),but there was no significant difference in the synovial fluid SOD,MDA level or the Lequesne score between group B and group C,or between group A and group D(all P>0.05);in group A,B or C,the level of synovial fluid TNF-α after treatment was lower than that in group D(all P<0.05),but there was no significant difference in the level of synovial fluid TNF-α among group A,group B and group C(all P>0.05).Conclusion Intra-articular injection with sodium hyaluronate combined with sodium ferulate,especially with higher dosage of sodium ferulate,achieves better efficacy for KOA compared to the injection with sodium hyaluronate alone,which might correlate with the role of sodium ferulate in inhibiting the intra-articular inflammatory cytokines, antioxidant effects and free radicals.%目的 观察玻璃酸钠联合不同剂量阿魏酸钠关节腔注射治疗膝骨关节炎(KOA)的临床疗效.方法 将80例KOA患者随机分为4组,每组20例,其中A、B、C组为玻璃酸钠联合阿魏酸钠组(玻璃酸钠用量为20 mg,阿魏酸钠用量分别为25 mg、50 mg、75 mg),D组为单纯玻璃酸钠组.4组患者均给予每周1次关节腔注射治疗,疗程均为5周.比较4组患者治疗前后关节液超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子(TNF)-α 水平及 Lequesne 膝关节功能评分.结果 治疗前4组关节液SOD、MDA、TNF-α水平及Lequesne评分比较,差异均无统计学意义(均P>0.05).治疗后4组关节液SOD水平均高于治疗前,而关节液MDA、TNF-α水平及Lequesne评分均低于治疗前(均P<0.05);B组与C组关节液SOD、MDA水平及Lequesne评分均优于A组与D组(均P<0.05),而B组与C组间及A组与D组间关节液SOD、MDA水平及Lequesne 评分比较,差异均无统计学意义(均 P >0. 05);A 组、B 组及 C 组关节液 TNF-α 水平均低于 D 组(均P<0.05),而A组、B组及C组关节液TNF-α水平比较,差异均无统计学意义(均P>0.05).结论 玻璃酸钠联合阿魏酸钠(尤其是较高剂量的阿魏酸钠)关节腔注射治疗KOA效果较单纯使用玻璃酸钠效果更佳,其机制可能与阿魏酸钠抑制关节腔内炎性细胞因子、抗氧化和抑制自由基作用有关.