【摘要】：目的：通過實驗研究與臨床觀察相結(jié)合的方式,探討?yīng)毣罴纳蟿┞?lián)合尼莫地平治療早期膝關(guān)節(jié)骨性關(guān)節(jié)炎(KOA)的療效及安全性。方法：將造模成功后的21只早期KOA大鼠隨機分為三組：A組(n=6),生理鹽水2m1灌胃、B組(n=7),獨活寄生合劑2m1/kg灌胃、C組(n=8),獨活寄生合劑2ml/kg+尼莫地平4mg/kg灌胃,2次/日,治療3周。灌胃治療前后進行尾靜脈采血檢測定IL-1β、TNF-α、PGE2的變化,治療結(jié)束后處死大鼠用肉眼及顯微鏡觀察膝關(guān)節(jié)軟骨情況。臨床觀察：自2013年6月-2014年5月,將符合納入標(biāo)準(zhǔn)的86例早期膝關(guān)節(jié)骨性關(guān)節(jié)炎患者隨機分為兩組：A組(n=42)口服獨活寄生合劑,B組(n=44)口服獨活寄生合劑及尼莫地平片。治療6周后比較各組的WOMAC骨關(guān)節(jié)炎指數(shù)評分、不良反應(yīng)率及臨床療效。結(jié)果：動物實驗：B、C兩組治療后血清中IL-1β、TNF-α及PGE2的含量與A組比均降低,且與A組比較有顯著性差異(P0.05),B、C組間IL-1β、TNF-α及PGE2的含量比較有顯著性差異(P0.05)。Mankin評分比較：A組9.86±1.56分,B組6.08±1.73分,C組4.07±1.27分,三組間評分兩兩比較均有顯著性差異(P0.05)。臨床觀察：A、B兩組治療后的疼痛、僵硬及活動度評分均有降低,其中兩組間的疼痛評分比較有顯著性差異(P0.05)；兩組間的僵硬評分比較無顯著性差異(P0.05)；兩組間的活動難度評分比較有顯著性差異(P0.05)；兩組間的WOMAC總積分比較有顯著性差異(P0.05)；兩組的顯效率分別為50.00%、72.73%,組間比較有顯著性差異(P0.05)；兩組的不良反應(yīng)率分別為2.38%、2.27%,組間比較無顯著性差異(P0.05)。結(jié)論：1、大鼠實驗證實：運用獨活寄生合劑聯(lián)合尼莫地平能降低血清中炎性因子IL-1β、TNF-α、PGE2的表達(dá),延緩早期KOA大鼠膝關(guān)節(jié)軟骨退變。2、臨床觀察證實：在調(diào)節(jié)軟骨代謝、減輕膝關(guān)節(jié)疼痛癥狀及改善膝關(guān)節(jié)功能等方面的療效,獨活寄生合劑聯(lián)合尼莫地平治療早期KOA的療效優(yōu)于單獨服用獨活寄生合劑。
[Abstract]:Objective: to investigate the efficacy and safety of Duhuzhongji combined with nimodipine in the treatment of early knee osteoarthritis (KOA) by means of experimental study and clinical observation. Methods: Twenty-one early KOA rats were randomly divided into three groups: group A (n = 6), group B (n = 7) treated with normal saline 2m1, group C (n = 8) treated with 2m1/kg, and group C (n = 8) treated with 2ml/kg nimodipine 4mg/kg for 3 weeks. The changes of IL-1 尾 TNF- 偽 PGE2 were detected before and after gastric administration. The articular cartilage of knee joint was observed with naked eye and microscope. Clinical observation: from June 2013 to May 2014, 86 patients with early knee osteoarthritis who met the inclusion criteria were randomly divided into two groups: group A (n = 42) and group B (n = 44). After 6 weeks of treatment, WOMAC osteoarthritis index score, adverse reaction rate and clinical efficacy were compared. Results: the contents of IL-1 尾 -TNF- 偽 and PGE2 in the serum of group C were lower than those of group A after treatment. There was significant difference in the content of IL-1 尾 TNF- 偽 and PGE2 between group A and group A (P0.05). Mankin score was 9.86 鹵1.56 in group A and 4.07 鹵1.27 in group C (P 0.05). The clinical observation showed that the scores of pain, stiffness and activity of the two groups were decreased after treatment, and there was significant difference between the two groups (P0.05), and there was no significant difference between the two groups in the scores of stiffness (P0.05). There were significant differences in the score of activity difficulty between the two groups (P0.05), the total score of WOMAC in the two groups (P0.05), the apparent effect rate of the two groups were 50.005% and 72.73% (P0.05), and there was significant difference between the two groups (P0.05). The adverse reaction rates of the two groups were 2.38 and 2.27, respectively. There was no significant difference between the two groups (P0.05). Conclusion: the rat experiment shows that Duhuo parasitic mixture combined with nimodipine can reduce the expression of IL-1 尾 TNF- 偽 PGE2 in serum and delay the degeneration of articular cartilage in early KOA rats. The clinical observation shows that it is regulating cartilage metabolism. The curative effect of Duhuzhongji combined with nimodipine in the treatment of early KOA was better than that of Duhuozhongji alone in relieving the symptoms of knee joint pain and improving the function of knee joint.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R684.3

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