【摘要】 目的 评价瘀肾合治方加减治疗膝骨关节炎（KOA）急性期（肾虚血瘀证）患者的临床疗效及对疼痛指标、炎症因子、基质金属蛋白酶的影响。方法 将110例KOA患者随机分为对照组与观察组，每组各55例。对照组口服塞来昔布胶囊和盐酸氨基葡萄糖胶囊，观察组在对照组的基础上加用瘀肾合治方加减，疗程均为2周。比较两组临床疗效；评估治疗前后WOMAC骨关节炎指数（疼痛部分）、Lequesne指数和肾虚血瘀证评分；检测白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、炎症因子高迁移率族蛋白B1(HMGB1)、基质金属蛋白酶-3(MMP-3)、MMP-13和基质金属蛋白酶组织抑制因子1(TIMP-1)水平。结果 治疗后，观察组临床疗效总有效率为90.91%，高于对照组的74.55%(P<0.05)；治疗后，两组患者静息痛、运动痛、夜间痛、站立痛、上下楼痛评分及总分均降低（P<0.05），且观察组均低于对照组（P<0.05）；治疗后，两组患者疼痛不适、步行距离、日常活动障碍评分及总分均降低（P<0.05），且观察组均低于对照组（P<0.05）；治疗后，两组患者疼痛、肿胀、伸屈受限等主要症状及肾虚血瘀证总分降低（P<0.05），且观察组肾虚血瘀证主要症状（疼痛、肿胀、伸屈受限）评分和总分均低于对照组（P<0.05）；治疗后，两组患者血清TNF-α、IL-1β和HMGB1水平均下降（P<0.05），且观察组低于对照组（P<0.05）；治疗后，两组患者TIMP-1增加（P<0.05），且观察组TIMP-1高于对照组（P<0.05）；治疗后，两组MMP-3、MMP-13水平下降（P<0.05），观察组低于对照组（P<0.05）。结论 瘀肾合治方联合西医疗法治疗KOA急性发作期（肾虚血瘀证）患者，能明显减轻疼痛等症状，改善关节功能，临床疗效优于单用西医常规疗法，其作用机制可能与抑制炎症反应和调节MMPs有关。更多还原

【Abstract】 Objective:To evaluate the effect of Yushen Hezhi Decoction on pain index,inflammatory factors and matrix metalloproteinases in patients with kidney deficiency and blood stasis syndrome in acute stage of knee osteoarthritis(KOA). Methods:110 patients with KOA were randomly divided into a control group and a observation group,with 55 patients in each group. The control group was orally administered with celecoxib capsules and glucosamine hydrochloride capsules;the observation group was added with Yushen Hezhi Decoction on the basis of the control group. Course lasted for 2 weeks. The clinical efficacy was compared after treatment;WOMAC osteoarthritis index(pain part),Lequesne index and kidney deficiency and blood stasis syndrome score were assessed before and after treatment;interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),inflammatory factors high mobility group box 1(HMGB1),matrix metalloproteinase-3(MMP-3),MMP-13 and tissue inhibitor of metalloproteinase-1(TIMP-1)levels were measured. Results:After treatment,the total effective rate of the combined group was 90.91%,which was higher than that of the control group(74.55%)(P < 0.05). After treatment,the scores of rest pain,movement pain,night pain,standing pain,upstairs and downstairs pain and the total score of the two groups were decreased(P < 0.05),and the observation group was lower than that of the control group(P < 0.05).After treatment,pain discomfort,walking distance,daily activity disorder score and total score decreased in the two groups(P < 0.05),and the observation group was lower than those of the control group(P < 0.05);after treatment,the main symptoms such as pain,swelling,extension and flexion limitation and the total score of kidney deficiency and blood stasis syndrome decreased in the two groups(P < 0.05),and the main symptoms of kidney deficiency and blood stasis syndrome(pain,swelling,extension and flexion limitation)score and total score in the observation group were lower than those in the control group(P < 0.05);after treatment,the serum TNF-α,IL-1β and HMGB1 levels decreased in the two groups(P < 0.05),and the observation group was lower than those of the control group(P < 0.05);after treatment,TIMP-1 increased in the two groups(P < 0.05),and TIMP-1 in the observation group was higher than that in the control group(P < 0.05);after treatment,MMP-3 and MMP-13 levels decreased in the two groups(P < 0.05),and the observation group was lower than those of the control group(P <0.05). Conclusion:Yushen Hezhi Decoction combined with conventional western medicine can obviously relieve pain and improve joint function in patients with acute attack of KOA with kidney deficiency and blood stasis syndrome. The clinical efficacy is superior to conventional western medicine. The mechanism may be related to the inhibition of inflammatory response and the regulation of MMPs.更多还原