目的：探讨透明质酸关节腔内注射对膝关节骨性关节炎(OA)患者血清炎症因子水平影响及疗效。方法选取2010年1月~2013年12月在丽水市中医院骨科门诊治疗的膝关节OA患者72例，将其分为观察组和对照组。对照组予以芬必得胶囊0.3 g，口服，2次/d，连用4周。观察组予以透明质酸关节腔内注射2 mL/次，每周1次，连用4周。观察两组治疗前后血清超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)和白介素-18(IL-18)水平变化，并比较其临床效果及不良反应。结果治疗4周后，两组血清hs-CRP、IL-6和IL-18水平[观察组：(5.69±0.85)mg/L、(1.97±0.32)ng/L、(146.18±30.61)ng/L，对照组：(7.86±0.47)mg/L、(2.75±0.56)ng/L、(184.21±35.24)ng/L]均较治疗前明显下降[观察组：(8.94±2.13)mg/L、(3.51±0.56)ng/L、(211.24±40.31)ng/L，对照组：(9.07±2.05)mg/L、(3.45±0.67)ng/L、(208.07±39.82)ng/L]，差异均有统计学意义(t=3.15、3.52、2.90，t=2.29、2.42、2.21，P<0.05或P<0.01)，且观察组下降值明显大于对照组，差异均有统计学意义(t=2.37、2.40、2.21，P<0.05)；观察组患者的临床总有效率(94.44%)明显高于对照组(77.78%)，差异有统计学意义(χ²=4.18，P<0.05)；观察组和对照组治疗中分别发生不良反应3例和11例，症状均较轻微，观察组不良反应发生率明显低于对照组(8.33%比30.56%)，差异有统计学意义(χ²=6.29，P<0.05)。结论透明质酸关节腔内注射治疗膝关节OA效果及安全性均较佳，作用与降低血清hs-CRP、IL-6和IL-18等炎症因子水平密切相关。%Objective To discuss influence and curative effect of intra articular injection of hyaluronic acid on serum inflammatory factor levels of patients with knee osteoarthritis (OA). Methods 72 cases of patients with knee OA, who were given the medical treatment in Department of Orthopedics of Lishui Traditional Chinese Medicine Hospital during the period from January 2010 to December 2013, were divided into observation group and control group. The patients in control group were given 0.3 g Fenbid Capsules through the mouth, twice a day for 4 weeks. The patients in observation group were given 2 mL intra articular injection of hyaluronic acid per time, once a week for 4 weeks. The changes of serum hs-CRP, IL-6 and IL-18 levels of patients in two groups before and after treatment were observed, and the clinical curative effect and drug adverse reaction (DAR) were compared as well. Results After 4 weeks’treatment, serum hs-CRP, IL-6 and IL-18 levels of patients in observation group and control group [observation group:(5.69±0.85) mg/L, (1.97±0.32) ng/L, (146.18±30.61) ng/L, control group: (7.86±0.47) mg/L, (2.75±0.56) ng/L, (184.21±35.24) ng/L] were obviously declined than before [observation group:(8.94±2.13) mg/L, (3.51±0.56) ng/L, (211.24±40.31) ng/L, control group:(9.07±2.05) mg/L, (3.45±0.67) ng/L, (208.07±39.82) ng/L], there were statistically significant differences (t=3.15, 3.52, 2.90; t=2.29, 2.42, 2.21, P<0.05 or P<0.01), and the declining rate of patients in observation group was much higher than that in control group (t=2.37, 2.40, 2.21, P<0.05). The total clinical efficiency of patients in observation group (94.44%) was much higher than that in control group (77.78%) with statistically significant difference (χ²=4.18, P<0.05). 3 and 11 cases of DAR during the treatment were appeared in observation group and control group respectively with light symptom. The DAR occurrence rate of patients in observation group (8.33%) was much lower than that in control group with statistically significant difference (30.56%) (χ²=6.29, P< 0.05). Conclusion Intra articular injection of hyaluronic acid has favorable effect and security on knee OA, whose mechanism of action has close effect on reducing serum hs-CRP, IL-6 and IL-18 inflammatory factor levels.
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