目的 研究鹽酸氨基葡萄糖聯合雙醋瑞因在伴有骨髓水腫（BME）的膝骨關節炎（KOA）中的療效評估。 方法 依據MRI檢查結果，選取2011年1月－2012年6月入院60例伴BME的KOA患者隨機分入A組（口服鹽酸氨基葡萄糖）、B組（口服雙醋瑞因）、C組（口服鹽酸氨基葡萄糖和雙醋瑞因），每組各20例；另納入同期30例不伴BME的KOA患者30例為D組（口服鹽酸氨基葡萄糖和雙醋瑞因）。完成標準方案后24周，隨訪臨床療效和影像學評分及炎癥因子變化。 結果 治療24周后4組在20 m 步行后視覺模擬評分（VAS）、關節壓痛VAS評分較治療前有改善（P＜0.05）；在BME改善方面，C組容積積分和程度積分均優于A、B兩組（P＜0.05）；在炎癥因子方面，治療24周后4組白細胞介素（IL）-1β、IL-6和腫瘤壞死因子α表達水平明顯降低（P＜0.05）。 結論 鹽酸氨基葡萄糖聯合雙醋瑞因能有效改善伴有BME的KOA患者臨床癥狀、降低炎癥因子表達水平以及促進BME在影像學方面的改善。
Objective To investigate the correlation of elderly knee osteoarthritis with bone marrow edema and osteoprotegerin, DKK-1 (dickkopf-1), sclerostin. Methods A total of 100 elderly patients with knee osteoarthritis in Sichuan Province Orthopedic Hospital from September 2017 to December 2018 were selected and divided into bone marrow edema group (50 cases) and non-bone marrow edema group (50 cases). The patients’ basic data, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores and Visual Analogue Scale scores were collected. The patients’ serum osteoprotegerin, DKK-1, sclerostin, C-reactive protein, and erythrocyte sedimentation rate were tested, and the differences between the two groups were compared. The correlation of the detection indicators and bone marrow edema and its clinical indicators was explored. Results There was no significant difference in age, gender, course of disease, C-reactive protein and erythrocyte sedimentation rate between the two groups (P>0.05). WOMAC scores (76.1±5.4 vs. 67.5±6.6), Visual Analogue Scale scores (8.4±1.1 vs. 5.5±0.9), proportion of synovitis (84.0% vs. 52.0%), osteoprotegerin [(1.3±1.1) vs. (0.6±0.5) μg/L], DKK-1 [(18.4±16.9) vs. (6.9±6.0) μg/L] and sclerostin [(147.3±119.4) vs. (99.7±70.7) pg/mL] in the bone marrow edema group were higher than those in the non-bone marrow edema group (P<0.05). There was no statistically significant correlation of the bone marrow edema volume score and degree score and serum osteoprotegerin of patients in the bone marrow edema group (P>0.05). The bone marrow edema volume score and degree score of patients in the bone marrow edema group were positively correlated with serum DKK-1 (volume score rs=0.464, P=0.001; degree score rs=0.379, P=0.007) and sclerostin (volume score rs=0.316, P=0.025; degree score rs=0.461, P=0.003). Conclusion In elderly patients with knee osteoarthritis and bone marrow edema, the local bone metabolism indicators of osteoprotegerin, DKK-1 and sclerostin are up-regulated, especially DKK-1 and sclerostin are related to the severity of bone marrow edema.
目的 研究鹽酸氨基葡萄糖聯合抗骨增生片治療膝骨關節炎（KOA）的可行性及安全性。 方法 2011年1月－2012年8月選取90例KOA患者，按關節面改變部位歸入A組（髕股關節面改變）、B組（脛股關節面改變）、C組（全關節軟骨改變），每組30例。均予以鹽酸氨基葡萄糖、抗骨增生片治療，12周后觀察治療前后臨床療效、綜合療效及安全性等指標及評分。 結果 ① 3組比較，A組療效高于B、C組（P＜0.05）；② A組與B、C兩組在平地行走20 m疼痛評分、關節壓痛度評分和骨關節炎指數（WOMAC）評分方面差異有統計學意義（P＜0.05）；③ A組和B、C兩組在患者自我療效評價、醫生療效評價方面差異有統計學意義（P＜0.05）；④ A組在治療12周后血液血沉、C反應蛋白（CRP）、白細胞介素（IL）-1、IL-6、腫瘤壞死因子-α（TNF-α）較治療前差異有統計表學意義（P＜0.05）；B組則在CRP、IL-6、TNF-α較治療前有差異（P＜0.05）；C組僅在CRP、TNF-α較前有差異（P＜0.05）；⑤3組不良反應發生率則無明顯差異（P＞0.05）。 結論 鹽酸氨基葡萄糖聯合抗骨增生片治療髕股關節面改變的KOA療效優于脛股關節改變，且治療方案可行、安全、優效。