2022 年第 9 期 第 17 卷

补肾除湿方联合自体富血小板血浆技术治疗中老年早中期膝骨关节炎的效果

he curative effect of Bushen Chushi decoction combined with autologous platelet-rich plasma technology on middle-aged and elderly knee osteoarthritis

作者：艾奇荆琳张洪美邸冬雪唐新宁单鹏程何名江闫奇刘兴兴赵传伟李彦

英文作者：TAi Qi Jing Lin Zhang Hongmei Di Dongxue Tang Xinning Shan Pengcheng He Mingjiang Yan Qi Liu Xingxing Zhao Chuanwei Li Yan

单位：中国中医科学院望京医院骨关节一科，北京100102

英文单位：The First Department of Bone and Joint Wangjing Hospital China Academy of Chinese Medical Sciences Beijing 100102 China

关键词：补肾除湿方；富血小板血浆；膝骨关节炎；葡萄糖-6-磷酸异构酶；沉默信息调节因子1

英文关键词：BushenChushidecoction;Platelet-richplasma;Kneeosteoarthritis;Glucose-6-phosphateisomerase;Silentinformationregulator1

• 摘要：

• 目的 探讨补肾除湿方联合自体富血小板血浆（PRP）技术治疗中老年早中期膝骨关节炎（KOA）的效果。方法  选取2020年5月至2021年5月中国中医科学院望京医院门诊收治的中老年早中期KOA患者123例，采用随机数字表法分为PRP组(41例)、补肾除湿方组(41例)和补肾除湿方联合PRP组（41例）。PRP组患者予玻璃酸钠注射液关节腔内注射+自体PRP关节腔内注射治疗；补肾除湿方组患者予玻璃酸钠注射液关节腔内注射+补肾除湿方口服治疗；补肾除湿方联合PRP组患者予玻璃酸钠注射液关节腔内注射+补肾除湿方口服+自体PRP关节腔内注射治疗。3组患者均连续治疗5周，比较3组患者的疗效、膝关节疼痛视觉模拟量表（VAS）评分、膝关节活动度、膝关节稳定性评分（KSS评分）、膝关节肿胀评分（Lequesne评分）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分、血清葡萄糖-6-磷酸异构酶（GPI）和沉默信息调节因子1（SIRT1）水平及不良反应发生情况。结果  补肾除湿方联合PRP组总有效率高于PRP组和补肾除湿方组［92.7%(38/41)比80.5%(33/41)、75.6%(31/41)］，差异均有统计学意义（均P＜0.05）。治疗后，补肾除湿方联合PRP组膝关节疼痛VAS评分低于PRP组和补肾除湿方组［（2.9±0.8）分比（4.0±1.0）、（4.1±1.1）分］，膝关节活动度大于PRP组和补肾除湿方组，差异均有统计学意义（均P＜0.05）。治疗后3组患者KSS评分、Lequesne评分比较，差异均无统计学意义（均P＞0.05）。治疗后，补肾除湿方联合PRP组WOMAC评分低于PRP组和补肾除湿方组［（17±7）分比（29±9）、（34±10）分］，血清GPI水平低于PRP组和补肾除湿方组，SIRT1水平高于PRP组和补肾除湿方组，差异均有统计学意义（均P＜0.05）。3组不良反应发生率比较，差异无统计学意义（P=0.860）。结论 补肾除湿方联合自体PRP技术治疗中老年早中期KOA疗效确切，能减轻疼痛，改善关节僵硬，提高关节活动度，降低血清GPI水平及升高血清SIRT1水平，且安全可靠。

• Objective  To investigate the therapeutic effect of Bushen Chushi decoction combined with autologous platelet-rich plasma(PRP) technology on middle-aged and elderly knee osteoarthritis (KOA). Methods  Totally 123 middle-aged and elderly patients with early and middle-term KOA admitted to the outpatient department of Wangjing Hospital, China Academy of Chinese Medical Sciences from May 2020 to May 2021 were enrolled. They were randomly divided into PRP group (41 cases), Bushen Chushi decoction group (41 cases) and Bushen Chushi decoction combined with PRP group (41 cases). Patients in PRP group were treated with intra-articular injection of sodium hyaluronate injection+autologous PRP injection; the patients in Bushen Chushi decoction group were treated with sodium hyaluronate injection intra-articular injection + Bushen Chushi decoction orally; the patients in Bushen Chushi decoction combined with PRP group were treated with intra-articular injection of sodium hyaluronate injection+Bushen Chushi decoction orally+autologous PRP injection. The three groups were treated for 5 weeks. The efficacy, knee visual analogue scale (VAS) score, knee range of motion, knee stability score (KSS score), knee swelling score (Lequesne score), osteoarthritis index score of Western Ontario and McMaster Universities (WOMAC), serum glucose-6-phosphate isomerase (GPI) and silent information regulator 1 (SIRT1) levels and adverse reactions were compared among the groups. Results  The total effective rate of Bushen Chushi decoction combined with PRP group was higher than that of PRP group and Bushen Chushi decoction group ［92.7%(38/41) vs 80.5%(33/41), 75.6%(31/41)］(both P＜0.05). After treatment, the VAS score of Bushen Chushi decoction combined with PRP group was lower than that of PRP group and Bushen Chushi decoction group ［(2.9±0.8) vs (4.0±1.0), (4.1±1.1)］(both P＜0.05). The knee joint activity of Bushen Chushi decoction combined with PRP group was better than that of PRP group and Bushen Chushi decoction group(both P＜0.05). There were no significant differences in KSS score and Lequesne score among the three groups (both P＞0.05). The WOMAC score of Bushen Chushi decoction combined with PRP group was lower than that of PRP group and Bushen Chushi decoction group ［(17±7) vs (29±9), (34±10)］(both P＜0.05). After treatment, the serum GPI level of Bushen Chushi decoction combined with PRP group was lower than that of PRP group and Bushen Chushi decoction group, and the SIRT1 level was higher than that of PRP group and Bushen Chushi decoction group (all P＜0.05). There was no significant difference in the incidence of adverse reactions among the three groups (P=0.860). Conclusions  Bushen Chushi decoction combined with PRP technology is effective on treating middle-aged and elderly KOA. It can relieve pain, improve joint stiffness and joint mobility, reduce serum GPI and increase serum SIRT1, and is safe and reliable.