李爽　李振彬　杨静

[摘要] 目的 探讨解毒止痛法与双醋瑞因联合应用治疗膝骨关节炎的临床效果与安全性。 方法 选取2013年5月～2014年5月解放军白求恩国际和平医院收治的120例膝骨关节炎患者为研究对象，随机分为三组；观察组：双醋瑞因口服+解毒止痛法（中药熏洗）；对照组A：双醋瑞因口服+辣椒碱软膏（外用）；对照组B：双醋瑞因口服+复方南星止痛膏（外用）；每组40例患者。共治疗2周，分别于基线期和用药2周后比较三组西安大略和麦克马斯特大学关节炎指数量表（WOMAC）评分、视觉模拟评分（VAS）、美国膝关节协会（AKS）膝关节评分和功能评分以及不良反应发生情况。 结果 观察组治疗后WOMAC总分和VAS评分均显著低于对照组A（t = 2.995、2.823，均P < 0.05）；观察组治疗后AKS膝关节评分和功能评分均显著高于对照组A（t = 2.346、2.478，均P < 0.05）。而观察组各项评分与对照组B比较差异无统计学意义（P > 0.05）。观察组不良反应发生率显著小于对照组A（χ2=8.556，P < 0.05），亦明显小于对照组B（χ2=9.667，P < 0.05）。 结论 解毒止痛法联合双醋瑞因治疗膝骨关节炎能明显提高临床疗效，且安全性较好，具有临床推广价值。

[关键词] 解毒止痛；双醋瑞因；联合；膝骨关节炎

[中图分类号] R684.3 [文献标识码] A [文章编号] 1673-7210（2015）05（c）-0081-04

[Abstract] Objective To explore the clinical efficacy and safety of detoxification and analgesia method combined with Diacerein in treating knee osteoarthritis. Methods 120 knee osteoarthritis patients from May 2013 to May 2014 in Bethune International Peace Hospital of PLA were divided into observation group （40 cases）， control group A （40 cases） and control group B （40 cases） randomly. The observation group was treated with oral Diacerein combined with detoxification and analgesia mothod （Chinese drugs fume-cleansing）. The control group A was treated with oral Diacerein combined with Capsaicin Ointment （topical）. The control group B was treated with oral Diacerein combined with Compound Nanxing Analgesic Cream （topical）. The treatment course was 2 weeks. The WOMAC scores， VAS scores， AKS knee and function scores and adverse reactions among the three groups at baseline and 2 weeks after treatment were compared. Results WOMAC scores and VAS scores after treatment of observation group were significantly lower than those of control group A （t = 2.995， 2.823， all P < 0.05）. AKS knee and function scores after treatment of observation group were significantly higher than those of control group A （t = 2.346， 2.478， all P < 0.05）. While the scores of all indexes between observation group and control group B showed no significant differences （P > 0.05）. The incidence of adverse events in observation group was significantly lower than that of control group A （χ2=8.556， P < 0.05） and control group B （χ2=9.667， P < 0.05）. Conclusion Diacerein combined with detoxification and analgesia method for treating knee osteoarthritis can improve clinical effect obviously， and has good safety， which has clinical promotion value.

[Key words] Detoxification and analgesia； Diacerein； Combination； Knee osteoarthritis

骨性关节炎（osteoarthritis，OA）是一种慢性退行性关节病变，以关节软骨部位的变性损坏及边缘骨质增生为主要特征[1]。国内的初步调查数据显示OA的总患病率达15%，40岁以上人群患病率约为14%，60岁以上人群达50%，而75岁以上人群中80%为OA患者[2-3]。绝大部分OA患者活动受限，25% OA患者无法进行正常日常活动[4]，出现关节疼痛、肿胀、功能障碍甚至畸形等症状，严重影响了患者的生活质量，给家庭及社会带来沉重负担[5]。非甾体类抗炎药（NSAIDs）和对乙酰氨基酚在OA的治疗中应用较为广泛[6]，但长期使用NSAIDs会引发胃十二指肠与肾脏损害，增加心血管事件发生率等，且停药后易复发[7-8]。因此寻求安全有效的治疗方式十分必要，本次研究即探讨解毒止痛法与双醋瑞因联合应用治疗膝骨关节炎的临床效果与安全性，以期为临床治疗提供更多参考依据。……