王功腾 李文文 张谦 于德家 耿秀斌 浦尔瓦·才仁 李树锋

【摘要】目的比較塞来昔布、氨基葡萄糖、塞来昔布联合氨基葡萄糖对中重度膝骨关节炎的疗效。方法将210例中重度膝骨关节患者分为塞来昔布组、氨基葡萄糖组、塞来昔布联合氨基葡萄糖组（联合组），分别单用塞来昔布、单用氨基葡萄糖或联合2种药物治疗12周。比较3组治疗及停药随访期间的西安大略和麦克马斯特大学（WOMAC）骨关节炎指数及疼痛视觉模拟评分法（VAS）评分。结果在治疗后4周，塞来昔布组的WOMAC骨关节炎指数低于氨基葡萄糖组（P<005） ，但在治疗后8周及停药后4、8、12周，2组的WOMAC骨关节炎指数比较差异均无统计学意义（P均>005）；在治疗后4、8、12周及停药后4、8、12周，联合组的WOMAC评分均低于塞来昔布组及氨基葡萄糖组（P均<005）。治疗后4周，塞来昔布组的VAS评分低于氨基葡萄糖组（P<005） ，但在治疗后8周及停药后4、8、12周，2组的VAS评分比较差异均无统计学意义（P均>005）；治疗后4、8、12周及停药后4、8、12周，联合组的VAS评分均低于塞来昔布组及氨基葡萄糖组（P均<005）。结论塞来昔布联合氨基葡萄糖较单用塞来昔布或氨基葡萄糖治疗中重度膝骨关节炎的效果更佳，单用塞来昔布比单用氨基葡萄糖起效快，但两者停药后的疗效无明显差异。

【关键词】塞来昔布；氨基葡萄糖；膝骨关节炎

Comparison of clinical efficacy of celecoxib， glucosamine and celecoxib combined with glucosamine in treatment of moderate to severe knee osteoarthritisWang Gongteng， Li Wenwen， Zhang Qian，Yu Dejia， Geng Xiubin，Puerwao·Cairen， Li Shufeng Taishan Medical University， Taian 271000， China

Corresponding author， Li shufeng

【Abstract】ObjectiveTo compare the clinical efficacy of celecoxib， glucosamine and celecoxib combined with glucosamine in treating moderate to severe knee osteoarthritis MethodsA total of 210 patients diagnosed with moderate and severe knee osteoarthritis were divided into the celecoxib， glucosamine and celecoxib combined with glucosamine groups （combined group） In three groups， celecoxib， glucosamine or the combination of two drugs was administered for 12 weeks， respectively The Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC） and visual analogue scale （VAS） score were statistically compared among three groups during treatment and followup ResultsAt 4 weeks after corresponding treatment， the WOMAC in the celecoxib group was significantly lower than that in the glucosamine group （P<005）， whereas no statistical significance was observed at 8 weeks following corresponding treatment and 4， 8 and 12week after drug withdrawal （all P>005） The WOMAC in the combined group was significantly lower compared with those in the celecoxib and glucosamine groups at 4， 8 and 12week after corresponding treatment and 4， 8 and 12week following drug withdrawal （all P<005） At 4 weeks after respective treatment， the VAS score in the celecoxib group was considerably lower than that in the glucosamine group （P<005）， whereas no statistical significance was noted at 8 weeks after treatment and 4， 8 and 12week after drug withdrawal （all P>005） At 4， 8 and 12week after corresponding treatment and 4， 8 and 12week following drug withdrawal， the VAS score in the combined group was significantly lower compared with those in the celecoxib and glucosamine groups （all P<005） ConclusionsCelecoxib combined with glucosamine yields higher clinical efficacy in the treatment of moderate and severe knee osteoarthritis compared with taking celecoxib or glucosamine alone Celecoxib takes effect earlier than glucosamine， whereas the clinical efficacy does not significantly differ after drug withdrawal

【Key words】Celecoxib； Glucosamine； Knee osteoarthritis

骨关节炎是与免疫相关的代谢性疾病，主要是以软骨进行性损伤为特征的关节慢性退行性病变[1]。骨关节炎的发病因素主要是遗传、高龄、肥胖等[2]。人口老龄化日益严重使骨关节炎发病率逐渐增加，其高发病率、高致残率给社会带来巨大的经济损失。早中期骨关节炎患者的治疗主要包括药物、控制体质量、物理疗法及功能锻炼等，但只能缓解病情的进展[3]。NSAID作为抗炎止痛药物被广泛应用于骨关节炎的治疗，其中选擇性环氧化酶2抑制剂塞来昔布因不良反应小而被广泛认可[45]。氨基葡萄糖具有一定的抗炎、止痛作用，在临床被广泛应用，但其对膝骨关节炎的效果尚存争议。……