独活续断汤离子导入对膝骨关节炎患者膝关节肿胀和疼痛程度的影响

doi:10.3760/cma.j.cn441417-20241120-07010

摘要/Abstract

摘要：

目的　探讨独活续断汤离子导入对膝骨关节炎患者膝关节肿胀、疼痛程度的影响。方法　纳入2022年6月至2023年12月榆林市中医医院收治的200例膝骨关节炎患者，采用摸球法分组，奇数为对照组（100例），偶数为观察组（100例）。对照组男58例，女42例，年龄（59.57±4.69）岁，病程（3.24±0.67）年，发病位置：左膝46例，右膝54例；观察组男60例，女40例，年龄（59.68±4.75）岁，病程（3.36±0.69）年，发病位置：左膝48例，右膝52例。对照组接受硫酸氨基葡萄糖胶囊治疗（每次0.5 g，每天两次），观察组在对照组基础上予以独活续断汤离子导入治疗（每天30 min），连续治疗1个月。比较两组临床疗效，治疗前后的膝关节肿胀程度、疼痛程度［视觉模拟评分法（Visual Analogue Scale，VAS）］、骨关节炎指数［西安大略麦马斯特大学骨关节炎指数评分（Western Ontario and McMaster Universities，WOMAC）］、关节炎生物标志物［基质细胞衍生因子1（stromal cell-derived factor 1，SDF-1）、基质金属蛋白酶-3（matrix metalloproteinase 3，MMP-3）、CXC趋化因子受体4（CXC chemokine receptor 4，CXCR4）］、炎症因子水平［前列腺素E₂（prostaglandin E₂，PGE₂）、环氧合酶-2（cyclooxygenase-2，COX-2）］。统计学分析采用χ²检验、独立样本t检验。结果　治疗后，观察组总有效率较对照组高［95.00%（95/100）比81.00%（81/100）］，差异有统计学意义（χ²=9.280，P=0.002）；观察组膝关节肿胀评分、VAS评分较对照组低［（0.60±0.05）分比（0.81±0.08）分，（3.49±0.52）分比（4.81±0.76）分］，差异均有统计学意义（t=22.260、14.334，均P<0.05）；观察组WOMAC中疼痛、僵硬、日常生活难度得分较对照组低［（4.58±0.96）分比（6.21±1.27）分，（0.70±0.21）分比（1.30±0.49）分，（10.03±1.68）分比（15.54±2.57）分］，差异均有统计学意义（t=10.239、11.255、17.946，均P<0.05）；观察组SDF-1、MMP-3、CXCR4水平较对照组低［（103.25±8.93）pg/L比（119.16±10.37）pg/L，（1.79±0.31）μg/L比（2.41±0.68）μg/L，（37.52±3.54）pg/L比（49.87±4.76）pg/L］，差异均有统计学意义（t=11.626、8.296、20.819，均P<0.05）；观察组PGE₂、COX-2水平较对照组低［（116.54±9.43）ng/L比（152.34±13.27）ng/L，（6.20±1.47）ng/L比（9.21±2.34）ng/L］，差异均有统计学意义（t=21.991、10.892，均P<0.05）。结论　独活续断汤离子导入治疗能提高膝骨关节炎患者的临床疗效，改善膝关节肿胀和疼痛程度，降低炎症因子水平。

关键词:

膝骨关节炎, 独活续断汤, 离子导入, 膝关节肿胀, 疼痛程度, 骨关节炎指数

Abstract:

Objective　To investigate the effects of iontophoresis of Duhuo Xuduan decoction on knee swelling and pain in patients with knee osteoarthritis. Methods　A total of 200 patients with knee osteoarthritis admitted to Yulin Traditional Chinese Medicine Hospital from June 2022 to December 2023 were divided into two groups by touching ball method, with odd numbers as a control group (100 cases) and even numbers as an observation group (100 cases). In the control group, there were 58 males and 42 females, aged (59.57±4.69) years, with a course of disease of (3.24±0.67) years, and the location of disease was left knee in 46 cases and right knee in 54 cases. In the observation group, there were 60 males and 40 females, aged (59.68±4.75) years, with a course of disease of (3.36±0.69) years, and the location of disease was left knee in 48 cases and right knee in 52 cases. The control group was treated with glucosamine sulfate capsules (0.5 g each time, twice a day), and the observation group was additionally treated with iontophoresis of Duhuo Xuduan decoction (30 min a day) for 1 month. The clinical effects of the two groups were compared, as well as the degree of knee swelling, pain level [Visual Analogue Scale (VAS)], osteoarthritis index [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)], arthritis biomarkers [stromal cell-derived factor 1 (SDF-1), matrix metalloproteinase 3 (MMP-3), and CXC chemokine receptor 4 (CXCR4)], levels of inflammatory factors [prostaglandin E₂ (PGE₂) and cyclooxygenase-2 (COX-2)] before and after treatment. χ² test and independent sample t test were used for statistical analysis. Results　After treatment, the total effective rate of the observation group was higher than that of the control group [95.00% (95/100) vs. 81.00% (81/100)], with a statistically significant difference (χ²=9.280, P=0.002); the knee swelling score and VAS score in the observation group were lower than those in the control group [(0.60±0.05) points vs. (0.81±0.08) points, (3.49±0.52) points vs. (4.81±0.76) points], with statistically significant differences (t=22.260 and 14.334, both P<0.05); the scores of pain, stiffness, and difficulty of daily living of the WOMAC in the observation group were lower than those in the control group [(4.58±0.96) points vs. (6.21±1.27) points, (0.70±0.21) points vs. (1.30±0.49) points, (10.03±1.68) points vs. (15.54±2.57) points], with statistically significant differences (t=10.239, 11.255, and 17.946, all P<0.05); the levels of SDF-1, MMP-3, and CXCR4 in the observation group were lower than those in the control group [(103.25±8.93) pg/L vs. (119.16±10.37) pg/L, (1.79±0.31) μg/L vs. (2.41±0.68) μg/L, (37.52±3.54) pg/L vs. (49.87±4.76) pg/L], with statistically significant differences (t=11.626, 8.296, and 20.819, all P<0.05); the levels of PGE₂ and COX-2 in the observation group were lower than those in the control group [(116.54±9.43) ng/L vs. (152.34±13.27) ng/L, (6.20±1.47) ng/L vs. (9.21±2.34) ng/L], with statistically significant differences (t=21.991 and 10.892, both P<0.05). Conclusion　Iontophoresis of Duhuo Xuduan decoction can enhance clinical efficacy in patients with knee osteoarthritis, reduce knee swelling and pain, and decrease inflammation level.

Key words:

Knee osteoarthritis, Duhuo Xuduan , decoction, Iontophoresis, Knee swelling, Pain level, Osteoarthritis index

刘杰王瑜牛永强.

独活续断汤离子导入对膝骨关节炎患者膝关节肿胀和疼痛程度的影响 [J]. 国际医药卫生导报, 2025, 31(7): 1098-1102.

Liu Jie, Wang Yu, Niu Yongqiang.

Effects of iontophoresis of Duhuo Xuduan decoction on knee swelling and pain in patients with knee osteoarthritis [J]. International Medicine and Health Guidance News, 2025, 31(7): 1098-1102.

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