双醋瑞因联合玻璃酸钠治疗膝骨关节炎的疗效分析

The effects of diacerein combined with sodium hyaluronate in the treatment of knee osteoarthritis

摘要:

：目的 探讨双醋瑞因联合玻璃酸钠治疗膝骨关节炎的疗效及其对细胞因子和 Toll 样受体 4 （TLR4）/核因子κB（NF-κB）信号通路的影响。方法 选取2016年6月—2019年5月在西安市红会医院和西京 医院就诊的膝骨关节炎患者100例，随机分为观察组和对照组，每组50例。对照组患者给予玻璃酸钠关节腔注射 液，1次/周；观察组患者在对照组基础上口服双醋瑞因胶囊，50 mg/次，2次/d。两组疗程均为5周。比较两组疗 效和治疗前后Lysholm膝关节功能评分和视觉模拟评分（VAS）、血清细胞因子［白细胞介素-1β（IL-1β）、IL-6 和肿瘤坏死因子-α（TNF-α）］，以及关节滑膜中TLR4和NF-κB蛋白相对表达量。结果 两组患者总有效率 比较，差异无统计学意义（P >0.05）。观察组治疗前后Lysholm膝关节功能评分和VAS评分的差值高于对照组 （P <0.05）。观察组治疗前后血清IL-1β、IL-6、TNF-α的差值高于对照组（P <0.05）。观察组治疗前后关节滑膜 中TLR4和NF-κB蛋白相对表达量的差值高于对照组（P <0.05）。结论 双醋瑞因联合玻璃酸钠治疗膝骨关节炎 患者效果良好，其作用机制可能与降低细胞因子IL-1β、IL-6、TNF-α水平及下调TLR4/NF-κB表达有关。

Abstract:

Objective To investigate the effects of diacerein combined with sodium hyaluronate in the treatment of knee osteoarthritis and its effects on cytokines and toll-like receptor 4 (TLR4)/nuclear factor kappa B (NF- κB) signal pathway. Methods A total of 100 patients with knee osteoarthritis receiving treatment in Xi'an Honghui Hospital and Xijing Hospital from June 2016 to May 2019 were randomly divided into observation group (n = 50) and control group (n = 50). The control group was given sodium hyaluronate injection once a week, while the observation group was given 50 mg diacerein capsules twice daily on the basis of the control group. The course of treatment was 5 weeks in both groups. The Lysholm knee score, visual analogue scale (VAS) score, serum cytokines including interleukin (IL)-1β, IL-6 and tumor necrosis factor-α (TNF-α), and TLR4 and NF-κB protein expression in synovium before and 5 weeks after treatment were compared between the two groups. Results There was no significant difference in the overall effective rate between the two groups (P > 0.05). The differences of Lysholm knee score and VAS score before and 5 weeks after treatment in the observation group were higher than those in the control group (P < 0.05). The differences of serum IL-1β, IL-6 and TNF-α before and 5 weeks after treatment in the observation group were higher than those in the control group (P < 0.05). The differences of TLR4 and NF-κB protein expression in synovium before and 5 weeks after treatment in the observation group were higher than those in the control group (P < 0.05). Conclusion The diacerein combined with sodium hyaluronate has a good effect in the treatment of knee osteoarthritis. The underlying mechanism may be related to the decrease of IL1β, IL-6 and TNF-α levels and the down-regulation of TLR4/NF-κB expression.