非甾體抗炎藥物在骨性關節炎中的應用

摘 要 骨性關節炎是老年人中常見、多發的慢性進行性骨關節疾病，主要臨床表現為緩慢發展的可使活動受限的關節疼痛、僵硬和腫脹，嚴重的能導致關節功能障礙。非甾體抗炎藥物是目前治療骨性關節炎等關節炎性疾病的最常用藥物，作用機制為抑制環氧化酶活性、阻斷該酶催化花生四烯酸轉化為炎性物質前列腺素，從而發揮止痛、消炎作用。非甾體抗炎藥物分為非選擇性環氧化酶抑制劑和選擇性環氧化酶-2抑制劑兩類，應用廣泛，但也存在多種不良反應，故選擇用藥時要嚴格掌握適應證，合理用藥。

關鍵詞 非甾體抗炎藥物 骨性關節炎 環氧化酶

中圖分類號：R971.1 文獻標識碼：A 文章編號：1006-1533(2012)15-0005-04

The use of non-steroidal anti-inflammatory drugs in osteoarthritis

DONG Yu， LI Yun-xia， CHEN Shi-yi

（Sports Medicine Center， Department of Sports Medicine and Arthroscopy Surgery

of Huashan Hospital， Fudan University， Shanghai 200040， China）

Abstract Osteoarthritis (OA) is a kind of common and chronic progressing arthritis disease for the elderly. Its main clinical manifestation is progressing chronic arthralgia， rigidity， tumid accompanied with movement restriction， which lead to dysfunction of the knee joint if the condition is serious. Non-steroidal anti-inflammatory drugs (NSAID) is one of the most applied drugs for osteoarthritis and other arthritis diseases， whose mechanism is to inhibit cyclooxygenase activity and block this enzyme to catalyze arachidonic acid to prostaglandin so as to inhibit the inflammatory substance prostaglandin and play the analgesic and anti-inflammatory functions. NSAID is classified into two categories: non-selective cyclooxygenase inhibitor and selective cyclooxygenase-2 inhibitor， which are widely applied， but have a variety of adverse reactions. When choosing a drug for OA， we must strictly control its indications and rationally use it.

Key Words non-steroidal anti-inflammatory drugs; osteoarthritis; cyclooxygenase

骨性關節炎（osteoarthritis， OA）又稱退行性關節炎、退行性骨關節病等，是一種以關節軟骨生化代謝異常、進行性變性和消失以及關節邊緣和軟骨下骨質產生反應性變化、使得軟骨組織產生變化和關節囊纖維增生、最終導致關節疼痛和功能喪失為病理特點的臨床綜合征。OA可發生于各個關節，以在老年人中最為常見，男、女均可發病。隨著我國社會人口老齡化進程的加快，OA的發病率正逐年增高。因此，如何有效地延緩OA進展、改善患者的臨床癥狀并提高他們的生活質量也越來越受到人們的重視。在臨床實踐中，非甾體抗炎藥物（non-steroidal anti-inflammatory drugs， NSAID）常用于OA的治療。

1 OA的病因及病理表現

OA的病因目前尚未完全明了，多認為與年齡、損傷、過度負重、肥胖、遺傳、環境和生物力學的改變等有關。……