体外冲击波治疗老年膝骨性关节炎的疗效及对患者炎性因子的影响

摘要

目的 观察体外冲击波疗法(ESWT)对老年膝骨性关节炎的治疗效果,并探讨其对患者白细胞介素-1(IL-1)、一氧化氮(NO)及肿瘤坏死因子-α(TNF-α)水平的影响.方法 选取2014年1月至2016年12月青海省人民医院收治的158例老年膝骨性关节炎患者,采用随机数表法分为ESWT组(n=79)和对照组(n=79).ESWT组采用体外冲击波治疗(1次/周),对照组口服塞来昔布胶囊(200 mg/次,1次/d),疗程均为4周.两组分别于治疗前、治疗后1个月及3个月采用肢体活动疼痛视觉模拟评分(VAS)、Lequesne指数评分和WOMAC骨关节炎指数评价患者膝关节疼痛和功能情况,并采用ELISA法检测患者关节液IL-1、NO及TNF-α水平变化.结果 治疗后1个月及3个月,两组患者的VAS评分、Lequesne指数评分及WOMAC评分均明显低于治疗前,差异均有统计学意义(P<0.05),且ESWT组患者治疗后1个月及3个月的VAS评分、Lequesne指数评分及WOMAC评分明显低于对照组,差异均有统计学意义(P<0.05);治疗后1个月及3个月,两组患者的IL-1、NO及TNF-α水平均明显低于治疗前,差异有统计学意义(P<0.05),且ESWT组患者治疗后1个月及3个月的IL-1、NO及TNF-α水平明显低于对照组,差异均有统计学意义(P<0.05).结论 体外冲击波治疗老年膝骨性关节炎患者的疗效较好,且能有效调控关节液中IL-1、NO及TNF-α水平表达.%Objective To observe the effect of extracorporeal shock wave on the elderly patients with knee os-teoarthritis (KOA) and the effects on the levels of interleukin-1 (IL-1), nitric oxide (NO) and tumor necrosis factor-α(TNF-α). Methods A total of 158 cases of elderly patients with knee osteoarthritis, who admitted to Qinghai Provin-cial People's Hospital from January 2014 to December 2016, were selected and divided into the ESWT group (n=79) and the control group (n=79) according to random number table. The ESWT group was treated with extracorporeal shock wave (1 time/week), and the control group was treated with Celecoxib Capsules (200 mg/times, 1 time/d). The course of treatment was 4 weeks. The knee pain and function of the two groups were evaluated by the limb movement pain Visual Analogue Scale (VAS), the Lequesne index score and the Western Ontario and McMaster Universities (WOMAC) osteo-arthritis index before the treatment, 1 months and 3 months after the treatment, respectively. The levels of IL-1, NO and TNF-α in synovial fluid of patients were detected by enzyme-linked immunosorbent assay (ELISA). Results The scores of VAS, Lequesne and WOMAC in the two groups at 1 month and 3 months after the treatment were significantly lower than those before treatment (P<0.05). The scores of VAS, Lequesne and WOMAC in the ESWT group at 1 month and 3 months after the treatment were significantly lower than those in the control group (P<0.05). The levels of IL-1, NO and TNF-αin the two groups at 1 month and 3 months after treatment were significantly lower than those before treatment (P<0.05). The levels of IL-1, NO and TNF-α in the ESWT group at 1 month and 3 months after treatment were significantly lower than those in the control group (P<0.05). Conclusion The efficacy of extracorporeal shock wave therapy in elderly patients with knee osteoarthritis is good, and it can effectively control the expression of IL-1, NO and TNF-αin synovial fluid.