目的 探討復(fù)方南星止痛膏聯(lián)合依托考昔治療寒濕痹阻型膝骨關(guān)節(jié)炎的臨床療效。方法 選取2022年3月—2024年5月南京中醫(yī)藥大學(xué)附屬醫(yī)院收治的80例寒濕痹阻型膝骨關(guān)節(jié)炎患者，按照隨機(jī)數(shù)字表法分為對(duì)照組和治療組，每組40例。對(duì)照組口服依托考昔片，60 mg/次，1次/d。治療組在對(duì)照組的治療基礎(chǔ)上給予復(fù)方南星止痛膏，選最痛部位，1貼/次，1次/隔日。兩組用藥28 d。觀察兩組臨床療效，比較兩組治療前后骨關(guān)節(jié)炎指數(shù)（WOMAC）評(píng)分、視覺(jué)模擬疼痛評(píng)分（VAS）、12條目簡(jiǎn)短生命質(zhì)量評(píng)分量表（SF 12）評(píng)分、中醫(yī)癥狀評(píng)分、骨轉(zhuǎn)換標(biāo)志物和血清炎癥因子水平的變化情況。結(jié)果 治療后，治療組總有效率為95.00%，明顯高于對(duì)照組的77.50%（P＜0.05）。治療后，兩組患者WOMAC評(píng)分、VAS評(píng)分明顯低于治療前，而SF-12生活質(zhì)量評(píng)分高于治療前（P＜0.05）；治療后，治療組WOMAC評(píng)分、VAS評(píng)分低于對(duì)照組，SF-12生活質(zhì)量評(píng)分高于對(duì)照組（P＜0.05）。治療后，兩組患者關(guān)節(jié)疼痛、局部腫脹、關(guān)節(jié)活動(dòng)度、腰膝酸軟、關(guān)節(jié)重著、遇寒加重和僵硬體評(píng)分明顯低于治療前（P＜0.05），且治療組患者中醫(yī)癥狀評(píng)分明顯低于對(duì)照組（P＜0.05）。治療后，兩組患者總I型膠原氨基端延長(zhǎng)肽（TPINP）、I型膠原羧基端肽B特殊序列（β-CTX）、骨鈣素N端中分子（N-MID）水平明顯低于治療前（P＜0.05）；且治療組患者TPINP、β-CTX及N-MID水平明顯低于對(duì)照組（P＜0.05）。治療后，兩組腫瘤壞死因子（TNF-α）、白細(xì)胞介素-1（IL-1）、轉(zhuǎn)化生長(zhǎng)因子-β（TGF-β1）、基質(zhì)金屬蛋白酶13（MMP13）水平明顯低于治療前（P＜0.05）；且治療組患者TNF-α、IL-1、TGF-β1及MMP13水平明顯低于對(duì)照組（P＜0.05）。結(jié)論 復(fù)方南星止痛膏聯(lián)合依托考昔治療寒濕痹阻型膝骨關(guān)節(jié)炎患者效果明顯，能夠明顯改善患者的關(guān)節(jié)功能，緩解疼痛，提高患者生活質(zhì)量，改善骨代謝和降低炎癥反應(yīng)，值得借鑒與應(yīng)用。

Objective To explore the therapeutic effect of Compound Nanxing Zhitong Ointment combined with etoricoxib in treatment of cold-dampness arthralgia type knee osteoarthritis. Methods A total of 80 patients with cold-dampness arthralgia type knee osteoarthritis admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from March 2022 to May 2024 were selected and divided into control group and treatment group according to random number table method, with 40 cases in each group. Patients in control group were po administered with Etoricoxib Tablets, 60 mg/time, once daily. Patients in treatment group were given Compound Nanxing Zhitong Ointment on basis of the control group, selected the most painful part, 1 patch/time, 1 time/every other day. Both groups were treated for 28 d. The clinical effects of two groups were observed, and the changes of WOMAC score, VAS score, SF 12 score, TCM symptom score, bone turnover markers and serum inflammatory factors before and after treatment were compared between two groups. Results After treatment, the total effective rate of treatment group was 95.00%, which was significantly higher than that of control group (77.50%, P < 0.05). After treatment, WOMAC scores and VAS scores were significantly lower than before treatment, but SF-12 quality of life scores were higher than that before treatment (P < 0.05). After treatment, WOMAC scores and VAS scores in treatment group were lower than those in control group, and SF-12 quality of life scores were higher than those in control group (P < 0.05). After treatment, the scores of joint pain, local swelling, joint range of motion, waist and knee tenderness, joint heavy, cold aggravation, and stiffness in two groups were significantly lower than those before treatment (P < 0.05), and the scores of TCM symptoms in treatment group were significantly lower than those in control group (P < 0.05). After treatment, the levels of TPINP, β-CTX, and N-MID in two groups were significantly lower than those before treatment (P < 0.05). The levels of TPINP, β-CTX, and N-MID in treatment group were significantly lower than those in control group (P < 0.05). After treatment, the levels of TNF-α, IL-1, TGF-β1, and MMP13 in two groups were significantly lower than those before treatment (P < 0.05). The levels of TNF-α, IL-1, TGF-β1, and MMP13 in treatment group were significantly lower than those in control group (P < 0.05). Conclusion Compound Nanxing Zhitong Ointment combined with etoricoxib has obvious effect in treatment of cold-dampness arthralgia type knee osteoarthritis, and can significantly improve the joint function of patients, relieve pain, improve the life quality and bone metabolism of patients, and reduce inflammatory response, which is worth learning and applying.

R977

江蘇省自然科學(xué)基金面上項(xiàng)目（BK20181501）