【摘要】 目的 观察臭氧联合富血小板血浆(PRP)灌注疗法治疗老年膝关节骨性关节炎的疗效及其对血清白细胞介素-17(IL-17)、沉默信息调节因子1(SIRT1)、碱性成纤维细胞生长因子(b FGF)水平的影响。方法 前瞻性选取2022年6月至2024年6月北京市昌平区中医医院收治的老年膝关节骨性关节炎患者96例作为研究对象，采用信封法将其分为臭氧组和综合组，每组各48例。两组均给予关节镜治疗，臭氧组给予臭氧治疗，综合组给予臭氧联合PRP灌注疗法治疗。评估两组的关节功能改善效果，比较两组治疗前、治疗4周后的西安大略和麦克马斯特大学骨关节炎指数(WOMAC)量表评分、膝关节活动度、疼痛[视觉模拟评分法(VAS)评分]，并比较血清IL-17、SIRT1、b FGF、Ang-Ⅰ水平与Wnt/β-catenin通路基因表达差异。结果 综合组关节功能优良率为91.67%，高于臭氧组(75.00%)，差异有统计学意义(P<0.05)。治疗4周后，两组膝关节疼痛、僵硬、日常生活受限程度评分及WOMAC总分均较治疗前降低，且综合组膝关节疼痛、僵硬、日常生活受限程度评分及WOMAC总分均低于臭氧组，差异均有统计学意义(P<0.05)。治疗4周后，两组膝关节活动度均较治疗前升高，VAS评分均较治疗前降低，且综合组膝关节活动度高于臭氧组，VAS评分低于臭氧组，差异均有统计学意义(P<0.05)。治疗4周后，两组血清IL-17、b FGF、Ang-Ⅰ水平均较治疗前降低，血清SIRT1水平均较治疗前升高，且综合组血清IL-17、b FGF、Ang-Ⅰ水平均低于臭氧组，血清SIRT1水平低于臭氧组，差异均有统计学意义(P<0.05)。治疗4周后，两组血清Wnt-5a、β-catenin、BMP-2 mRNA均较治疗前降低，且综合组血清Wnt-5a、β-catenin、BMP-2 mRNA均低于臭氧组，差异均有统计学意义(P<0.05)。结论 臭氧联合PRP灌注疗法治疗老年膝关节骨性关节炎可减轻疼痛，改善关节功能，提高疗效，可能与调节Wnt/β-catenin信号通路有关。更多还原

【Abstract】 Objective To observe the efficacy of ozone combined with platelet-rich plasma(PRP) infusion therapy in the treatment of osteoarthritis of the knee joint in the elderly and the effects on serum interleukin-17(IL-17),silent information regulator 1(SIRT1) and basic fibroblast growth factor(b FGF) levels. Methods A total of 96 elderly patients with knee osteoarthritis admitted to Beijing Changping District Hospital of Traditional Chinese Medicine from June 2022 to June 2024 were prospectively selected as the research objects. They were divided into the ozone group and the comprehensive group by envelope method,with 48 cases in each group. Both groups were given arthroscopic treatment,the ozone group was given ozone treatment,and the comprehensive group was given ozone combined with PRP perfusion therapy. The improvement effect of joint function in the two groups was evaluated. The scores of Western Ontario and Mc Master Universities osteoarthritis index(WOMAC)scale,knee joint mobility and pain [visual analogue scale(VAS) score],and the levels of serum IL-17,SIRT1,bFGF and Ang-I and the gene expression of Wnt/β-catenin pathway were compared between the two groups before and after 4 weeks of treatment. Results The excellent and good rate of joint function in the comprehensive group was 91. 67 %,which was higher than that in the ozone group(75. 00 %),and the difference was statistically significant(P < 0. 05). After 4 weeks of treatment,the scores of knee joint pain,stiffness,limitation of daily life and the total score of WOMAC in the two groups were lower than those before treatment,and the scores of knee joint pain,stiffness,limitation of daily life and the total score of WOMAC in the comprehensive group were lower than those in the ozone group,the differences were statistically significant(P < 0. 05). After 4 weeks of treatment,the knee joint activity of the two groups was higher than that before treatment,and the VAS score was lower than that before treatment. The knee joint activity of the comprehensive group was higher than that of the ozone group,and the VAS score was lower than that of the ozone group,the differences were statistically significant(P < 0. 05). After 4 weeks of treatment,the levels of serum IL-17,b FGF and Ang-I in the two groups were lower than those before treatment,and the levels of serum SIRT1 were higher than those before treatment. The levels of serum IL-17,bFGF and Ang-I in the comprehensive group were lower than those in the ozone group,and the levels of serum SIRT1 were lower than those in the ozone group,the differences were statistically significant(P < 0. 05). After 4 weeks of treatment,the serum Wnt-5a,β-catenin and BMP-2 mRNA in the two groups were lower than those before treatment,and the serum Wnt-5a,β-catenin and BMP-2 mRNA in the comprehensive group were lower than those in the ozone group,the differences were statistically significant(P < 0. 05).Conclusion Ozone combined with PRP infusion therapy for the treatment of osteoarthritis of the knee in the elderly can alleviate pain,improve joint function,and enhance therapeutic efficacy,which may be related to the regulation of the Wnt/β-catenin signaling pathway.更多还原