Page 86 - 南京医科大学自然版

南京医科大学学报（自然科学版） 第44卷第8期
·1114 · Journal of Nanjing Medical University（Natural Sciences） 2024年8月

·临床研究·

几丁糖联合小剂量糖皮质激素关节腔注射治疗早中期膝骨关

节炎的临床疗效分析

刘久翔 ，吕天润 ，曹 亮 ，黄晓文 ，鲁 璐 2*
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南京医科大学第一附属医院骨科，江苏 南京 210029；南京中医药大学附属医院风湿免疫科，江苏 南京 210029
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［摘 要］ 目的：探讨几丁糖联合小剂量糖皮质激素关节腔注射治疗早中期膝骨关节炎的临床疗效。方法：回顾性分析2021年
6 月—2022 年 12 月在南京医科大学第一附属医院骨科门诊就诊并随访的膝骨关节炎患者共 164 例。按治疗方式分为 3 组：
A 组（对照组，口服给药）55 例，B 组（几丁糖关节腔注射+口服给药）53 例，C 组（几丁糖联合小剂量糖皮质激素关节腔注射给
药）56例。比较3组治疗前后的疼痛视觉模拟评分（visual analogue scale，VAS）、Lysholm 评分、美国特种外科医院（Hospital for
Special Surgery，HSS）评分和关节液炎性细胞因子白介素（interleukin，IL）⁃1、IL⁃6和肿瘤坏死因子（tumor necrosis factor，TNF）⁃α
水平的变化，并对临床疗效进行评价。结果：所有病例均获得随访，随访时间7~12个月，无失访病例。每组治疗后的VAS评
分、Lysholm评分、HSS评分和关节液炎性细胞因子IL⁃1、IL⁃6和TNF⁃α水平均优于治疗前，差异有统计学意义（P < 0.05）。治疗
前VAS评分、Lysholm评分、HSS评分和关节液炎性细胞因子IL⁃1、IL⁃6和TNF⁃α水平在3组间的差异无统计学意义（P > 0.05）；
但治疗后各项指标在3组间的差异有统计学意义（P < 0.05）；两两比较显示，C组优于A、B两组，B组优于A组，差异均有统计
学意义（P < 0.05）。3组临床疗效评价比较，差异有统计学意义（P < 0.05）。结论：几丁糖联合小剂量糖皮质激素关节腔注射治
疗早中期膝骨关节炎临床疗效显著，具有创伤小，起效迅速，疗效持久的特点，同时避免了外用或口服非甾体类抗炎药的不良
反应，作为一线治疗方案，建议在临床推广和使用。
［关键词］ 骨关节炎；几丁糖；小剂量糖皮质激素；关节腔注射
［中图分类号］ R684.3 ［文献标志码］ A ［文章编号］ 1007⁃4368（2024）08⁃1114⁃07
doi：10.7655/NYDXBNSN240265

Analysis of the clinical efficacy of intra⁃articular injection of chitosan combined with low⁃
dose corticosteroids in the treatment of knee osteoarthritis in the early and middle stages

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LIU Jiuxiang ，LÜ Tianrun ，CAO Liang ，HUANG Xiaowen ，LU Lu 2*
1 Department of Orthopedics Surgery，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029；
Department of Rheumatology，Affiliated Hospital of Nanjing University of Chinese Medicine，Nanjing 210029，China
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［Abstract］ Objective：To investigate the clinical efficacy of intra ⁃ articular injection of chitosan combined with low ⁃ dose
corticosteroids in the treatment of knee osteoarthritis（KOA）in the early and middle stages. Methods：A retrospective analysis was
conducted on 164 patients with KOA who visited and were followed up at the outpatient department of orthopedics at the First
Affiliated Hospital of Nanjing Medical University from June 2021 to December 2022. Based on the treatment methods，patients were
divided into three groups：Group A（control group，oral administration）consisted of 55 patients，Group B（intra⁃articular injection of
chitosan+oral administration）had 53 patients，Group C（intra⁃articular injection of chitosan combined with low⁃dose glucocorticoids）
included 56 patients. Variations in pain visual analogue scale（VAS），Lysholm score，Hospital for Special Surgery（HSS）score，and the
levels of inflammatory cytokines in the synovial fluid（interleukin⁃1，IL⁃1；interleukin⁃6，IL⁃6；tumor necrosis factor⁃alpha，TNF⁃α）
were compared before and after treatment. Clinical efficacy was also evaluated. Results：All cases were followed up for 7-12 months
and no cases were lost. Post⁃treatment VAS scores，Lysholm scores，HSS scores，and the levels of synovial fluid inflammatory cytokines
（IL⁃1，IL⁃6，and TNF⁃α）were all significantly improved compared to pre⁃treatment levels in each group（P < 0.05）. There were no

［基金项目］ 江苏省中医药管理局（QN202209）
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通信作者（Corresponding author），E⁃mail：lulu1986_16@163.com