木瓜壳寡糖复合营养素对膝骨关节炎的干预研究_刘志英.pdf

木瓜壳寡糖复合营养素对膝骨关节炎的干预研究刘志英1，翟俊霞2，白伟侠1，邸海灵1，俞丹1，黄晓丹1，薛苏娟1，雷敏1(1 河北医科大学第三医院，河北 石家庄 050051;2 河北省医学情报研究所，河北 石家庄 050021)摘要目的探讨木瓜壳寡糖复合营养素对膝骨关节炎患者的干预作用。方法选取2020 年 5 月2021 年 12 月在河北医科大学第三医院就诊的膝骨关节炎患者 95 例，按照随机数字表法分为 2 组，随访过程中试验组脱落 1 例，最终对照组 46 例、试验组 48 例完成研究。对照组患者给予双膝关节腔内注射玻璃酸钠注射液，每周 1 次，每次 20 mg，连续注射 5 周;试验组患者给予木瓜壳寡糖复合营养素口服，每日 2 次，每次 13 g，连续服用 15 周。观察 2 组患者干预前后 Le-quesne 指数评分及膝骨关节滑膜厚度、滑膜积液量和滑膜血流的变化情况。结果2 组患者不同时间 Lequesne 指数评分比较差异有统计学意义(P 0.05);试验组干预第 10 周、第 15 周 Lequesne指数评分均明显低于对照组(P 均 0.05)。2 组患者不同时间左、右膝骨关节滑膜厚度比较差异均有统计学意义(P 均 0.05);试验组干预第 10 周、15 周右膝骨关节滑膜厚度均明显小于对照组(P 均 0.05)。2 组患者不同时间左、右膝骨关节滑膜积液量比较差异均有统计学意义(P 均 0.05);试验组干预第 5 周、第 10 周、第 15 周右膝骨关节滑膜积液量均明显少于对照组(P 均 0.05)。2 组患者不同时间膝骨关节滑膜血流比较差异有统计学意义(P 0.05)，但 2 组干预后各时间点膝骨关节滑膜血流比较差异均无统计学意义(P 均 0.05)。结论口服木瓜壳寡糖复合营养素与关节腔内注射玻璃酸钠均可改善膝骨关节炎患者病情，但口服木瓜壳寡糖复合营养素改善膝骨关节疼痛、肿胀、功能及减少膝骨关节滑膜厚度、滑膜积液量的效果均优于关节腔内注射玻璃酸钠，且改善患者膝骨关节滑膜血流的情况不弱于关节腔内注射玻璃酸钠。关键词 膝骨关节炎;木瓜壳寡糖复合营养素;Lequesne 指数评分;膝骨关节 B 超doi:10 3969/j issn 1008 8849 2022 22 010 中图分类号 6843 文献标识码 A 文章编号 1008 8849(2022)22 3117 05 作者简介 刘志英，女，在读硕士研究生，研究方向为临床营养。通信作者 雷敏，E mail:leimin8 sina com 基金项目 河北省卫生和计划生育委员会重点科技研究计划项目(20200072)Intervention of papaya chitosan oligosaccharide compound nutrient on knee osteoarthritisLIU Zhiying1，ZHAI Junxia2，BAI Weixia1，DI Hailing1，YU Dan1，HUANG Xiaodan1，XUE Sujuan1，LEI Min1(1 The Third Hospital of Hebei Medical University，Shijiazhuang 050051，Hebei，China;2 Hebei Medical InformationInstitute，Shijiazhuang 050021，Hebei，China)Abstract:Objective It is to explore the efficacy of papaya chitosan oligosaccharide compound nutrient in the treatmentof patients with knee osteoarthritis Methods Ninety-five patients with knee osteoarthritis treated in the Third Hospital ofHebei Medical University from May 2020 to December 2021 were selected and divided into 2 groups according to the ran-dom number table method，and 1 case was shed in the test group during the follow-up，and finally 46 cases in the controlgroup and 48 cases in the test group completed the study The patients in the control group were given intraarticular injec-tion of sodium hyaluronate once a week，20 mg each time，for 5 weeks;The patients in the test group were given papayachitosan oligosaccharide compound nutrient orally，twice a day，13 1 g each time，for 15 weeks The changes of Lequesneindex score，synovial thickness，synovial effusion and synovial blood flow of knee joint were observed before and after theintervention esults There were statistically significant differences in Lequesne index scores among different times in thetwo group(all P 0 05);The scores of Lequesne index in the test group at the 10 th and 15 th week of intervention weresignificantly lower than those in the control group(all P 0 05)The synovial thickness of the left and right knee joints at7113现代中西医结合杂志 Modern Journal of Integrated Traditional Chinese and Western Medicine 2022 Nov，31(22)different times was significantly different in the two groups(all P 0 05);The synovial thickness of the right knee joint inthe test group was significantly thicker than that in the control group at the 10th and 15th week of intervention(all P 0.05)There were significant differences in the amount of synovial effusion of left and right knee joints among differenttimes in the two groups(all P 0 05);The amount of synovial effusion of right knee joint in the test group at the 5 th，10th and 15 th week of intervention was significantly lower than that in the control group(all P 0 05)There was statisti-cally significant difference in the blood flow of knee joint synovium among different time points in the two groups(all P 0.05)，but there was no statistically significant difference in the blood flow of knee joint synovium at different time pointsbetween the two groups after intervention(all P 0 05)Conclusion Both oral papaya chitosan complex nutrient and in-tra-articular injection of sodium vitrate could improve the condition of patients with knee osteoarthritis，but oral papaya chi-tosan complex nutrient was more effective than intra-articular injection of sodium vitrate in improving knee osteoarthritispain，swelling，function and reducing knee osteoarthritis synovial thickness and synovial fluid volume，and was not less ef-fective in improving synovial blood flowKeywords:knee osteoarthritis;papaya chitosan complex nutrient;Lequesne index;ultrasound of knee bone and joint膝骨关节炎(knee osteoarthritis，KOA)是由多因素导致的，以关节软骨破坏、软骨下骨硬化或囊性变、关节边缘骨质增生等为病理特征的一种严重影响中老年人生活质量的慢性退行性疾病。KOA 在骨关节疾病中有很高的发病率，据统计，我 国19952017 年的 KOA 患病率高达 18%1，中老年人群中症状性 KOA 患病率为 8 1%2，而因 KOA导致的全膝关节置换年度总费用高达 129 48 亿元3。KOA 的发生发展过程较为复杂，多因素共同参与关节组织结构以及功能的异常改变。临床上针对早中期的 KOA 患者，常采用药物治疗或关节腔内注射玻璃酸钠，药物治疗常伴有胃肠道和心血管不良事件等严重的不良反应4。中国骨关节炎诊疗指南(2021 年版)5 中推荐将关节腔注射玻璃酸钠用于治疗骨关节炎，其可短期缓解疼痛并改善关节功能，但在软骨保护、延缓疾病进程方面尚存争议。近年来，疗效安全、靶点确切的营养素受到了诸多重视。已有研究发现，木瓜、壳寡糖在控制骨关节炎的发生发展方面发挥了重要作用6 7。本研究观察了木瓜壳寡糖复合营养素对 KOA 的干预作用，从而为探究出一种改善 KOA 的新方法提供依据。1资料与方法1.1纳入标准年龄 50 75 岁;符合中华医学会骨科学分会骨关节炎诊疗指南(2018 年版)8 中关于 KOA 的诊断标准;Kellgren Law-rence 分级为和级;所有研究对象及家属自愿参加本研究，并签署书面知情同意书。1.2排除标准合并其他可能影响膝骨关节的疾病者;近 2 年有膝关节的重