目的 探討祖師麻片聯(lián)合美洛昔康治療膝骨關(guān)節(jié)炎急性期的臨床效果。方法 選取2019年2月—2020年10月天津中醫(yī)藥大學第一附屬醫(yī)院收治的126例膝骨關(guān)節(jié)炎急性期患者，以隨機數(shù)字表法將其分成對照組（n=63）和治療組（n=63）。對照組口服美洛昔康片，7.5 mg/次，2次/d。治療組在對照組治療基礎(chǔ)上口服祖師麻片，0.9 g/次，3次/d。兩組均連續(xù)治療4周后評價其療效。觀察兩組的臨床療效，同時比較治療前后兩組膝關(guān)節(jié)疼痛視覺模擬量表（VAS）評分、晨僵時間、膝關(guān)節(jié)活動度、Lequesne指數(shù)總分、關(guān)節(jié)炎影響測量量表2-短卷（AIMS2-SF）總分、紅細胞沉降率（ESR）及血清C反應(yīng)蛋白（CRP）、白細胞介素（IL）-17、轉(zhuǎn)化生長因子（TGF）-β1水平和基質(zhì)金屬蛋白酶-3（MMP-3）與金屬蛋白酶組織抑制因子-1（TIMP-1）比值（MMP-3/TIMP-1）。結(jié)果 治療后，治療組總有效率為96.8%，較對照組87.3%顯著升高（P<0.05）。治療后，兩組膝VAS評分均顯著降低，晨僵時間均顯著縮短，膝關(guān)節(jié)主、被動活動度均顯著提高（P<0.05）；治療后，治療組膝關(guān)節(jié)疼痛VAS評分、晨僵時間及膝關(guān)節(jié)活動度改善均優(yōu)于對照組（P<0.05）。治療后，兩組Lequesne指數(shù)總分均顯著低于本組治療前，但AIMS2-SF總分均顯著高于本組治療前（P<0.05）；且治療后，治療組Lequesne指數(shù)總分和AIMS2-SF總分改善優(yōu)于對照組（P<0.05）。治療后，兩組患者ESR及血清CRP、IL-17、MMP-3/TIMP-1較本組治療前均顯著下降，但TGF-β1均顯著上升（P<0.05）；且治療后，治療組ESR及血清學指標改善優(yōu)于對照組（P<0.05）。結(jié)論 祖師麻片聯(lián)合美洛昔康治療膝骨關(guān)節(jié)炎急性期具有較好的療效，可安全有效地減輕患者膝關(guān)節(jié)疼痛，改善關(guān)節(jié)功能，抑制機體炎癥反應(yīng)，促進病情的穩(wěn)定，提高生活質(zhì)量，值得臨床推廣應(yīng)用。

Objective To investigate the clinical effect of Zushima Tablets combined with meloxicam in treatment of acute knee osteoarthritis.Methods A total of 126 patients with acute knee osteoarthritis admitted to the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from February 2019 to October 2020 were selected and divided into control group (n=63) and treatment group (n=63) by random number table method. Patients in the control group were po administered with Meloxicam Tablets, 7.5 mg/time, twice daily. Patients in the treatment group were po administered with Zushima Tablets on the basis of the control group, 0.9 g/time, three times daily. Both groups were evaluated after 4 weeks of continuous treatment. The clinical efficacy of the two groups was observed, and visual analog scale (VAS) score, morning stiffness time, range of motion of knee joint, total score of Lequesne index, total score of Arthritis Impact Scale 2-short volume (AIMS2-SF), erythrocyte sedification rate (ESR), serum C-reactive protein (CRP), interleukin (IL)-17, transformation growth factor (TGF)-β1, matrix metalloproteinase-3 (MMP-3) to tissue inhibitor of metalloproteinase-1 (TIMP-1) ratio (MMP-3/TIMP-1) between the two groups before and after treatment were compared. Results After treatment, the total effective rate of the treatment group was 96.8%, which was significantly higher than that of the control group (87.3%, P < 0.05). After treatment, knee VAS score was significantly decreased, morning stiffness time was significantly shortened, and the active and passive activity of knee joints were significantly increased in both groups (P < 0.05). After treatment, VAS score, morning stiffness time and range of motion of knee in the treatment group were better than those in the control group (P < 0.05). After treatment, the total Lequesne index scores of the two groups were significantly lower than before treatment, but the total AIMS2-SF scores were significantly higher than before treatment (P < 0.05). After treatment, the total score of Lequesne index and AIMS2-SF in the treatment group improved better than that in the control group (P < 0.05). After treatment, ESR, serum CRP, IL-17, and MMP-3/TIMP-1 in two groups were significantly decreased compared with before treatment, but TGF-β1 was significantly increased (P < 0.05). After treatment, the improvement of ESR and serological indexes in the treatment group was better than that in the control group (P < 0.05). Conclusion Zushima tablets combined with meloxicam has satisfactory overall efficacy in the treatment of acute knee osteoarthritis, and can safely and effectively relieve knee joint pain, improve joint function, inhibit body inflammation, promote stability of the disease, and improve the life quality, which is worthy of clinical promotion and application.

R977

天津市教委科研計劃項目[No.津教工（2016）3號]