赵依娜　周江涛

[摘要] 目的 探討依托考昔联合运动训练治疗膝骨性关节炎（KOA）的临床疗效及作用机制。 方法 选取2015年2月～2016年9月我院治疗的144例膝骨关节炎患者，采用统计软件 SAS9.1 程序产生随机分配序列，将其以1∶1∶1∶1的比例被随机分配四组，再实施盲法用A、B、C、D分别表示组别，依托考昔组（A组）、运动训练组（B组）、依托考昔联合运动训练组（C组）和健康教育组（D组）四组，各36例，所有患者均予以KOA常规治疗，A组加以依托考昔治疗，B组加以运动功能训练，C组加以运动训练联合依托考昔治疗，D组进行健康教育，四组患者均治疗12周，比较治疗前后四组患者的骨性关节炎指数评分（WOMAC）、6 min步行距离、SF-36评分及血清炎性因子表达，并记录比较四组患者临床疗效及不良反应的发生情况。 结果 （1）A、B、C组治疗后WOMAC评分均低于治疗前，且C组降低更明显（P<0.05）；（2）A、B、C组治疗后6 min步行距离和SF-36评分均高于治疗前，且C组升高更明显（P<0.05）；（3）A、B、C组治疗后NF-κB、IL-1β和MMP-1水平均低于治疗前，且C组降低更明显（P<0.05）；（4）治疗后四组临床总有效率比较存在显著差异，且C组升高更明显（P<0.05）；（5）四组不良反应发生率比较差异无显著性（P>0.05）。 结论 依托考昔联合功能训练治疗KOA临床疗效显著，可改善患者疼痛及关节运动功能，减少炎性因子表达水平，安全可靠，其机制可能通过调控NF-κB信号通路相关蛋白的表达发挥作用。

[关键词] 依托考昔；运动训练；膝骨性关节炎；作用机制

[中图分类号] R684.3 [文献标识码] B [文章编号] 1673-9701（2018）10-0091-04

Therapeutic effect and mechanism of combined treatment of knee knee osteoarthritis by etoricoxib and exercise

ZHAO Yina1 ZHOU Jiangtao2

1.Pharmacy Department， Wenzhou Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medicine University， Wenzhou 325000， China； 2.Department of Orthopedics， Wenzhou Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medicine University， Wenzhou 325000， China

[Abstract] Objective To investigate the clinical effect and mechanism of knee osteoarthritis（KOA） treated by the combination of Etoricoxib and exercise. Methods A total of 144 patients with KOA were randomly divided into 4 groups： Etoricoxib group（group A）， exercise training group （group B）， Etoricoxib combined with exercise group （group C）， health education group（group D）， with 36 cases in each group. All patients were given KOA conventional treatment， A group was treated with Etoricoxib， group B was given functional training， group C was given exercise training combined with Etoricoxib treatment， and group D was given health education. The Osteoarthritis Index score （WOMAC）， 6 minute walk distance， SF-36 score and serum inflammatory factor expression were compared between the 4 groups before and after treatment. Then the clinical efficacy and adverse reactions of the 4 groups were recorded and compared. Results （1）The scores of WOMAC in group A， B and C after treatment were lower than those before treatment， and the decrease level in group C was more obvious （P<0.05）； （2）The 6 min walking distance and SF-36 score after treatment in group A， B and C were higher than those before treatment， and the increase level in group C was more obvious（P<0.05）； （3）The levels of NF-κB， IL-1β and MMP-1 in group A， B and C after treatment were significantly lower than those before treatment， and the decrease level in group C was more obvious（P<0.05）； （4）The total effective rate of the four groups after treatment showed a significant difference， and the increase level in group C was more obvious（P<0.05）； （5）The incidence of adverse reactions between the four groups showed no significant difference（P>0.05）. Conclusion The combination of Etoricoxib and exercise is an effective， safe， and reliable way in the treatment of KOA， which can reduce the pain and improve the joint motor function， and reduce the expression level of inflammatory factors. Its mechanism may play an important role in regulating the expression of NF-κB signaling pathway related proteins.

[Key words] Etoricoxib； Exercise training； Knee osteoarthritis； Mechanism of action

膝骨性关节炎（knee oteoarthritis，KOA）又称退行性骨关节炎，临床上较为常见，反复发作的关节疼痛、晨僵、关节肿胀及活动障碍为其主要症状，严重者可导致膝关节畸形，影响患者的正常工作和生活[1-2]。有学者指出，依托考昔可有效降低KOA患者的疼痛，且副作用小[3]。但是KOA患者仅依靠单纯的药物治疗疗效欠佳，其膝关节功能障碍难以得到完全恢复。……