目的：观察骨刺消合剂对膝骨关节炎患者临床疗效及血清超氧化物歧化酶(SOD)、一氧化氮(NO)和肿瘤坏死因子-α(TNF-α)的影响。方法选择2013年1月~2015年3月在南京中医药大学扬州附属医院骨科门诊就诊的膝骨关节炎患者60例,采用随机数字表法分为两组。治疗组30例,服用骨刺消合剂,40 mL/次,晚餐后口服,1次/d,配合蜈蚣粉0.5 g冲服,每周服药6 d后停用1 d,共计5周；对照组30例,服用金乌骨通胶囊,三餐后口服,3片/次,3次/d,每周服药6 d后停用1 d,共计5周。观察两组临床疗效、治疗前后骨关节炎指数(WOMAC)评分及血清SOD、NO和TNF-α。结果治疗组总有效率(90.00%)明显高于对照组(76.67%),差异有统计学意义(P<0.05)。治疗后,治疗组和对照组WOMAC评分[疼痛评分(2.26±1.24)、(7.32±1.51)分；关节僵硬评分(0.51±0.28)、(2.63±0.51)分；日常活动评分(16.87±2.27)、(30.76±4.16)分；综合评分(22.13±3.13)、(40.81±5.32)分]均较治疗前[疼痛评分(15.46±3.23)、(15.58±3.43)分；关节僵硬评分(6.51±1.24)、(6.81±1.36)分；日常活动评分(56.89±8.36)、(57.41±6.55)分；综合评分(86.77±9.36)、(84.81±9.81)分]显著降低(P<0.05)；治疗组治疗后WOMAC各项评分显著低于对照组(P<0.05)。治疗后,治疗组和对照组血清SOD水平[(146.47±22.48)、(126.28±19.57)U/mL]均较治疗前[(104.37±16.21)、(105.53±14.78)U/mL]显著升高,NO水平[(40.24±14.92)、(49.29±16.38)μmol/L]和TNF-α水平[(54.33±17.69)、(66.43±21.07)ng/L]均较治疗前[(57.42±21.78)、(58.03±20.36)μmol/L；(97.25±32.06)、(95.79±30.27)ng/L]显著降低,差异有统计学意义(P<0.05或P<0.01)；两组治疗后血清SOD、NO和TNF-α水平比较,差异有统计学意义(P<0.05)。结论骨刺消合剂治疗膝骨关节炎具有较好的临床效果,可以保护患者膝关节软骨及其基质免受继发性损害,延迟膝关节软骨的退变速度,改善膝关节软骨的营养及代谢,促进膝关节软骨的修复,在一定程度上可以预防和治疗膝骨关节炎。%Objective To observe influence of Gucixiao Mixtures on clinical curative effect and serum superoxide dis-mutase (SOD), nitric oxide (NO) and tumor necrosis factor-α (TNF-α) in patients with knee osteoarthritis. Methods 60 patients with knee osteoarthritis in Orthopaedics Outpatient of Yangzhou Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from January 2013 to March 2015 were selected and divided into two groups by random number table method. Patients in treatment group (n=30) received 40 mL oral Gucixiao Mixtures combined with 0.5 g cen-tipede powder once daily after supper and discontinuation for one day per week for 5 weeks; patients in control group (n=30) received 3 tablets Jinwugutong Capsules thrice daily and discontinuation for one day per week for 5 weeks. Clinical efficacy, WOMAC score and serum SOD, NO and TNF-α before and after treatment between two groups were observed. Results Total effective rate of treatment group (90.00%) was significantly higher than that of control group (76.67%), the difference was statistically significant (P<0.05). After treatment, WOMAC scores of treatment group and control group [pain score (2.26±1.24), (7.32±1.51) point;ankylosis score (0.51±0.28), (2.63±0.51) point; daily ac-tivity score (16.87 ±2.27), (30.76 ±4.16) point; compre-hensive score (22.13±22.13), (40.81±5.32) point] were lower than those before treatment [pain score (15.46±3.23), (15.58±3.43) point; ankylosis score (6.51±1.24), (6.81±1.36) point; daily activity score (56.89±8.36), (57.41±6.55) point;comprehensive score (86.77±86.77), (84.81±9.81) point] (P<0.05). WOMAC scores of treatment group after treatment were significantly lower than those of control group (P<0.05). After treatment, serum SOD levels of treatment group and control group [(146.47±22.48), (126.28±19.57) U/mL] were significantly higher than those before treatment[(104.37±16.21), (105.53±14.78) U/mL], NO levels of treatment group and control group [(40.24±14.92), (49.29±16.38) μmol/L] and TNF-α levels of treatment group and control group [(54.33± 17.69), (66.43±21.07) ng/L] were significantly lower than those before treatment [(57.42±21.78), (58.03±20.36) μmol/L;(97.25±32.06), (95.79±30.27) ng/L], the differences were statistically significant (P<0.05 or P<0.01). Serum SOD, NO and TNF-αlevels after treatment between two groups were compared, the differences were statistically significant (P<0.05). Conclusion Gucixiao Mixtures in the treatment of knee osteoarthritis have good clinical effect. It can protect the patient's knee joint cartilage and its matrix from secondary damage, delay degeneration of knee articular cartilage, im-prove the nutrition and metabolism of knee joint cartilage, promote the repair of knee joint cartilage. To a certain ex-tent, it can be prevention and treatment of knee osteoarthritis.
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