補腎活血方對腎虛血瘀證膝關節骨性關節炎患者的療效及其對血清細胞因子的影響

馬浩哲　黃奎

摘要?目的：研究補腎活血方對腎虛血瘀證膝關節骨性關節炎（KOA）患者的療效及其對血清細胞因子的影響。方法：選取2016年2月至2017年11月荊州市第一人民醫院收治的腎虛血瘀證KOA患者262例作為研究對象，按照隨機數字表法將患者分為對照組和觀察組，每組131例。對照組給予硫酸氨基葡萄糖膠囊以及塞來昔布膠囊治療，觀察組給予補腎活血方治療，2組均治療8周，觀察2組臨床療效及不良反應，比較2組治療前后中醫癥狀總積分、視覺模擬評分（VAS）、WOMAC總評分、Michel Lequesen指數評分、血清細胞因子水平。結果：觀察組總有效率為97.71%，高于對照組的89.31%（P<0.05）。2組治療后中醫癥狀總積分、VAS、WOMAC總評分、Michel Lequesen指數評分、丙二醛（MDA）、白細胞介素-1（IL-1）、白細胞介素-6（IL-6）水平均明顯低于治療前（P<0.05），且觀察組較對照組更低（P<0.05）。2組治療后超氧化物歧化酶（SOD）、轉化生長因子-β（TGF-β）、成纖維細胞生長因子-2（FGF-2）水平明顯高于治療前，且觀察組較對照組更高（P<0.05）。觀察組不良反應發生率為0.76%，低于對照組的6.87%（P<0.05）。結論：補腎活血方治療腎虛血瘀證KOA患者療效顯著，可改善患者臨床癥狀及體征，降低炎性反應因子水平，且不良反應小。

關鍵詞?補腎活血方;腎虛血瘀證;膝關節骨性關節炎;中醫癥狀總積分;視覺模擬評分;WOMAC總評分;Michel Lequesen指數評分;細胞因子

Effects of Bushen Huoxue Recipe on Knee Osteoarthritis Patients with Kidney Deficiency and Blood Stasis Syndrome and Its Influence on Serum Cytokines

Ma Haozhe1，Huang Kui2

（1 College of Acupuncture and Orthopedics，Hubei University of Chinese Medicine，Wuhan 430000，China; 2 Department of Orthopedics，The First People′s Hospital of Jingzhou，Jingzhou 434000，China）

Abstract?Objective：To study the effects of Bushen Huoxue recipe on knee osteoarthritis（KOA）patients with kidney deficiency and blood stasis and its influence on serum cytokines. Methods：A total of 262 KOA patients with kidney deficiency and blood stasis who were treated in the first people′s Hospital of Jingzhou from February 2016 to November 2017 were selected. These patients were divided into the control group（n=131）and the observation group（n=131）according to random number table method. The control group was treated with glucosamine sulfate capsule and celecoxib capsule，while the observation group was treated with Bushen Huoxue recipe and the 2 groups were treated for 8 weeks. The clinical effects and adverse reactions of the 2 groups were observed. The total score of TCM symptoms，visual analogue score（VAS），WOMAC total score，Michel Lequesen index score and serum cytokine levels of the 2 groups before and after the treatment were compared. Results：The total effective rate of the observation group was 97.71%，which was higher than 89.31% of the control group（P<0.05）. After treatment the total score of TCM symptoms，VAS score，WOMAC total score，Michel Lequesen index score and the levels of malondialdehyde（MDA），interleukin-1（IL-1）and interleukin-6（IL-6）in the 2 groups were significantly lower than before. Those of the observation group was lower than that of the control group（P<0.05）. After treatment，the levels of superoxide dismutase（SOD），transforming growth factor-β（TGF-β）and fibroblast growth factor-2（FGF-2）in the 2 groups were significantly higher than before. Those of the observation group was higher than that of the control group（P<0.05）. The incidence of adverse reactions in the observation group was 0.76%，which was lower than 6.87% of control group（P<0.05）. Conclusion：Bushen Huoxue recipe has significant effects on KOA patients with kidney deficiency and blood stasis syndrome，which can improve the clinical symptoms and signs，reduce the level of inflammatory factors. Furthermore，it has little toxic side effects.

Key Words?Bushen Huoxue recipe; Kidney deficiency and blood stasis syndrome; Knee osteoarthritis; Total score of TCM symptoms; Visual analogue score; WOMAC total score; Michel Lequesen index score; Cytokines

中圖分類號：R274.3文獻標識碼：Adoi：10.3969/j.issn.1673-7202.2019.03.035

膝關節骨性關節炎（Knee Osteoarthritis，KOA）屬于臨床常見疾病，發病率較高，且以中老年患者居多[1]。此病歸屬于中醫學“痹癥”范疇，且通常認為可能與瘀阻等因素有關，而腎虛是本病的病理基礎[2]。KOA常由機體肝腎氣血不足、外傷瘀血內阻、風寒濕邪使血液運行失調所導致，其主要辨證屬于血瘀氣滯證和肝腎虧虛證[3]。……