目的:通过比较塞来昔布、塞来昔布联合玻璃酸钠治疗膝骨关节病的疗效,为临床治疗提供参考。方法:选取2019年1月至6月于我院接受保守治疗的膝骨关节病患者100例,按照随机数法分为单纯口服塞来昔布组和塞来昔布联合玻璃酸钠组各50例,塞来昔布200 mg,2次/日,连续口服8周;玻璃酸钠注射液2.5 ml,1次/周,5周为1疗程。随访患者接受治疗前、治疗后1个月、3个月、6个月的VAS疼痛评分、Lysholm评分及WOMAC评分。结果:两组患者治疗前VAS疼痛评分、Lysholm评分及WOMAC评分无明显差异(P > 0.05);治疗后1个月、3个月、6个月的VAS疼痛评分、Lysholm评分联合组均明显优于塞来昔布组,1个月、3个月的WOMAC评分联合组优于塞来昔布组(P < 0.05),6个月时两组差异无统计学意义(P > 0.05)。结论:单纯口服塞来昔布、联合治疗均可取得良好的效果,但塞来昔布联合玻璃酸钠效果更佳,建议临床使用。 Objective: To provide reference for clinical treatment by comparing the efficacy of celecoxib and celecoxib combined with sodium hyaluronate in the treatment of knee osteoarthritis. Method: A total of 100 patients with knee osteoarthritis who received conservative treatment in our hospital from January to June 2019 were randomly divided into oral celecoxib group (50) and celecoxib combined with sodium hyaluronate group (50); for example, celecoxib 200 mg, twice a day, orally for 8 consecutive weeks; sodium hyaluronate injection 2.5 ml, once a week, 5 weeks as a course of treatment. The VAS pain score, Lysholm score and WOMAC score were followed up before treatment, 1 month, 3 months, and 6 months after treatment. Results: There was no significant difference in VAS pain score, Lysholm score and WOMAC score between the two groups before treatment (P > 0.05); the VAS pain score and Lysholm score in combined group were significantly better at 1 month, 3 months, and 6 months after treatment. In the celecoxib group, the combined WOMAC score of 1 month and 3 months was better than that of the celecoxib group (P < 0.05), and there was no significant difference between the two groups at 6 months (P > 0.05). Conclusion: Simple oral celecoxib and combination therapy can achieve good results, but the effect of celecoxib combined with sodium hyaluronate is better, and clinical use is recommended.
目的:通过比较塞来昔布、塞来昔布联合玻璃酸钠治疗膝骨关节病的疗效,为临床治疗提供参考。方法:选取2019年1月至6月于我院接受保守治疗的膝骨关节病患者100例,按照随机数法分为单纯口服塞来昔布组和塞来昔布联合玻璃酸钠组各50例,塞来昔布200 mg,2次/日,连续口服8周;玻璃酸钠注射液2.5 ml,1次/周,5周为1疗程。随访患者接受治疗前、治疗后1个月、3个月、6个月的VAS疼痛评分、Lysholm评分及WOMAC评分。结果:两组患者治疗前VAS疼痛评分、Lysholm评分及WOMAC评分无明显差异(P > 0.05);治疗后1个月、3个月、6个月的VAS疼痛评分、Lysholm评分联合组均明显优于塞来昔布组,1个月、3个月的WOMAC评分联合组优于塞来昔布组(P < 0.05),6个月时两组差异无统计学意义(P > 0.05)。结论:单纯口服塞来昔布、联合治疗均可取得良好的效果,但塞来昔布联合玻璃酸钠效果更佳,建议临床使用。
塞来昔布,玻璃酸钠,膝骨关节病,疗效
Xuan Zhao, Weipeng Shi, Bin Yang, Kuishuai Xu, Rui Shen
Affiliated Hospital of Qingdao University, Qingdao Shandong
Received: Aug. 30th, 2020; accepted: Sep. 14th, 2020; published: Sep. 21st, 2020
Objective: To provide reference for clinical treatment by comparing the efficacy of celecoxib and celecoxib combined with sodium hyaluronate in the treatment of knee osteoarthritis. Method: A total of 100 patients with knee osteoarthritis who received conservative treatment in our hospital from January to June 2019 were randomly divided into oral celecoxib group (50) and celecoxib combined with sodium hyaluronate group (50); for example, celecoxib 200 mg, twice a day, orally for 8 consecutive weeks; sodium hyaluronate injection 2.5 ml, once a week, 5 weeks as a course of treatment. The VAS pain score, Lysholm score and WOMAC score were followed up before treatment, 1 month, 3 months, and 6 months after treatment. Results: There was no significant difference in VAS pain score, Lysholm score and WOMAC score between the two groups before treatment (P > 0.05); the VAS pain score and Lysholm score in combined group were significantly better at 1 month, 3 months, and 6 months after treatment. In the celecoxib group, the combined WOMAC score of 1 month and 3 months was better than that of the celecoxib group (P < 0.05), and there was no significant difference between the two groups at 6 months (P > 0.05). Conclusion: Simple oral celecoxib and combination therapy can achieve good results, but the effect of celecoxib combined with sodium hyaluronate is better, and clinical use is recommended.
Keywords:Celecoxib, Sodium Hyaluronate, Knee Osteoarthropathy, Curative Effect
Copyright © 2020 by author(s) and Hans Publishers Inc.
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膝骨关节病(Knee osteoarthrosis, KOA)是全球性的老年性致残性疾病,发病率高,早期表现为关节疼痛、活动受限,随着病程的进展,逐渐出现关节畸形、功能障碍等情况,严重影响患者生活质量,同时给家庭和社会带来了沉重的经济负担 [
纳入标准:1) 符合OA诊断标准 [
排除标准:1) 合并心脑血管及神经、精神系统疾病;2) 既往有磺胺类药物过敏或合并消化道相关疾病;3) 诊断为类风湿性关节炎、银屑病性关节炎等。
选取2019年1月至6月于我院接受保守治疗且符合标准的膝骨关节病患者100例,按照随机数法分为单纯口服塞来昔布组和塞来昔布联合玻璃酸钠组各50例,所有患者均签署知情同意书,本研究通过医院伦理委员会批准。
塞来昔布组:200 mg/次,2次/日,连续口服8周为1疗程;联合组:在口服塞来昔布的基础上注射玻璃酸钠注射液(商品名:阿尔治) 2.5 ml/次,1次/周,连续注射5周为1疗程。注射方法:患者取坐位,双膝下垂,关节自然弯曲约至90˚,取髌腱外侧1 cm关节间隙处为进针点,碘酊消毒3次,酒精脱碘3次后铺单,用5 ml空针行关节腔穿刺,有突破感后停止进针,回抽无血说明进入关节腔,若有积液,尽可能抽取干净后注射玻璃酸钠2.5 ml,拔针后碘伏棉球消毒,敷贴粘贴进针点,协助患者活动膝关节数次,使玻璃酸钠均匀涂抹关节,嘱其在随访期间禁止接受其他治疗方案。
记录患者基础治疗前年龄、性别、BMI等基本资料,随访并分析患者接受治疗后1个月、3个月及6个月的VAS疼痛评分、WOMAC评分 [
采用SPSS 26.0软件行数据分析。对数据进行正态性检验,符合正态分布的计量资料用( x ¯ ± s )表示,组间比较:非正态分布的计量资料用非参数U检验;正态分布的计量资料组间比较用独立样本t检验,计数资料用卡方检验;检验水准(P)为0.05。
两组共100名患者均获得随访,其中塞来昔布组女性28例(56%),男性22例,平均年龄(60.64 ± 6.11)岁,左膝关节26例(52%),右膝关节24例,平均BMI为(27.39 ± 3.13) kg/m2,治疗前VAS评分平均为(5.38 ± 1.86)分,Lysholm评分为(45.24 ± 5.56)分,WOMAC评分为(54.00 ± 4.08)分;联合组女性29例(58%),男性21例,平均年龄(58.24 ± 6.93)岁,左膝关节26例(52%),右膝关节24例,平均BMI为(27.51 ± 2.73) kg/m2,治疗前VAS评分平均为(5.84 ± 1.63)分,Lysholm评分为(45.20 ± 6.05)分,WOMAC评分为(54.10 ± 2.82)分。两组患者治疗前所有指标差异均无统计学意义(P > 0.05),研究具有可行性。详见表1。
塞来昔布组 | 联合组 | U值 | P值 | |
---|---|---|---|---|
性别(女,%) | 28 (56) | 29 (58) | 0.041 | 0.840 |
年龄(岁) | 60.64 ± 6.11 | 58.24 ± 6.93 | 969.000 | 0.052 |
BMI (kg/m2) | 27.39 ± 3.13 | 27.51 ± 2.73 | 1157.500 | 0.524 |
VAS评分 | 5.38 ± 1.86 | 5.84 ± 1.63 | 1074.000 | 0.218 |
Lysholm评分 | 45.24 ± 5.56 | 45.20 ± 6.05 | 1245.000 | 0.972 |
WOMAC评分 | 54.00 ± 4.08 | 54.10 ± 2.82 | 1196.500 | 0.711 |
表1. 两组患者治疗前基本资料(n = 50)
两组患者治疗后1个月、3个月及6个月VAS评分较治疗前均有明显降低(P < 0.05);治疗后1个月、3个月、6个月时联合组VAS评分均明显低于塞来昔布组(P < 0.05)。详见表2。
塞来昔布组 | 联合组 | U值 | P值 | |
---|---|---|---|---|
1个月 | 5.16 ± 0.79 | 4.08 ± 0.83 | 495.000 | 0.000* |
3个月 | 4.14 ± 0.81 | 3.52 ± 1.11 | 849.000 | 0.004* |
6个月 | 3.74 ± 1.21 | 2.46 ± 1.15 | 561.500 | 0.000* |
表2. 两组患者VAS评分(n = 50)
*表示两组差异有统计学意义(P < 0.05)。
两组患者治疗后1个月、3个月及6个月VAS评分较治疗前均有明显降低(P < 0.05);治疗后1个月、3个月、6个月时联合组Lysholm评分均明显低于塞来昔布组(P < 0.05)。详见表3。
塞来昔布组 | 联合组 | U值 | P值 | |
---|---|---|---|---|
1个月 | 60.04 ± 6.54 | 70.22 ± 5.79 | 321.500 | 0.000* |
3个月 | 68.72 ± 5.61 | 78.98 ± 5.31 | 241.000 | 0.000* |
6个月 | 75.30 ± 2.83 | 88.28 ± 4.88 | 275.000 | 0.000* |
表3. 两组患者Lysholm评分(n = 50)
两组患者治疗后1个月、3个月及6个月VAS评分较治疗前均有明显降低(P < 0.05);治疗后1个月、3个月时联合组WOMAC评分均明显低于塞来昔布组(P < 0.05),6个月时两组患者的WOMAC评分无明显差异(P > 0.05)。详见表4。
塞来昔布组 | 联合组 | U值 | P值 | |
---|---|---|---|---|
1个月 | 44.64 ± 3.15 | 38.34 ± 3.92 | 411.000 | 0.000* |
3个月 | 35.10 ± 2.99 | 29.46 ± 2.57 | 223.000 | 0.000* |
6个月 | 16.04 ± 2.10 | 15.70 ± 3.46 | 1007.500 | 0.093 |
表4. 两组患者WOMAC评分(n = 50)
塞来昔布组患者随访期间未出现并发症,联合组1例患者注射玻璃酸钠后出现膝关节酸胀,疼痛加重,活动不便,休息辅助冰袋冷敷3天后症状消失。两组患者均未出现感染等严重并发症。
膝骨关节病(KOA)是最常见的骨性关节病(osteoarthrosis),其特征是关节软骨和软骨下骨的进行性损伤,在成年人中的患病率约为24%,且女性较男性更为常见 [
2013年美国骨科医师学会(AAOS)强烈推荐NSAIDs类药物用于治疗有症状的KOA,在骨关节炎的诊疗指南中,也推荐NSAIDs药物作为一线用药,其治疗效果也得到证实 [
透明质酸(HA)作为粘多糖的一种是关节滑液和软骨基质的重要部分,在KOA患者关节液中透明质酸浓度和分子量均下降,文献报道,中分子量的透明质酸每周注射3次治疗KOA6个月以上的效果优于低分子量的透明质酸,且安全性相似 [
在该研究中有几点需要注意,一是,关节腔穿刺属于有创操作并且直通关节腔,必须严格按照无菌原则操作,避免引起关节腔感染;二是,塞来昔布类药物虽是选择性COX-2抑制剂,对胃肠道刺激较小,且在本实验中未出现消化道相关并发症,但在研究中仍要严格把握纳入排除标准,避免不良事件的发生。本研究仍存在不足之处,首先是样本量较小,得出的结论需要在进一步更大样本量的研究中得到验证;二是随访时间短,停止治疗以后的后续效果是下一步研究的重点。
总之,单纯口服塞来昔布、塞来昔布联合玻璃酸钠均可有效缓解KOA患者膝关节疼痛,但联合组效果更加明显,两者之间互相促进,相辅相成,从不同的角度共同治疗KOA,在缓解症状,提高生活质量方面更具有优势,因此值得临床推广。
赵 旋,史为鹏,杨 斌,徐奎帅,沈 瑞. 塞来昔布联合玻璃酸钠治疗膝骨关节病疗效探究The Effect of Celecoxib Combined with Sodium Hyaluronate in the Treatment of Knee Osteoarthropathy[J]. 临床医学进展, 2020, 10(09): 2042-2047. https://doi.org/10.12677/ACM.2020.109306