富血小板血浆联合几丁糖治疗膝骨性关节炎的效果及机制分析

岳媛; 严加林; 张前西

doi:10.7619/jcmp.20232903

富血小板血浆联合几丁糖治疗膝骨性关节炎的效果及机制分析

Effect of platelet-rich plasma combined with chitosan in the treatment of knee osteoarthritis and its mechanism

摘要

摘要:
目的分析富血小板血浆(PRP)联合几丁糖治疗膝骨性关节炎(KOA)的效果及对成骨细胞、破骨细胞、炎症因子的影响。
方法选取94例KOA患者作为研究对象，采用随机数字表法分为对照组与观察组，每组47例。2组患者均接受关节镜清理术治疗，对照组术后给予几丁糖治疗，观察组术后给予关节内注射PRP联合几丁糖治疗。比较2组临床疗效和术后恢复指标，并比较2组治疗前后西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分、Lysholm膝关节功能评分、膝骨性关节炎严重度指数(ISOA)评分、成骨细胞及破骨细胞相关指标Ⅰ型前胶原羧基末端肽(PⅠCP)、骨钙素(BGP)、骨碱性磷酸酶(BALP)、Ⅰ型胶原交联羧基端肽(CTX)、抗酒石酸酸性磷酸酶(TRACP5b)水平、炎症指标肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、超敏C反应蛋白(hs-CRP)水平。
结果观察组总有效率为95.74%(45/47), 高于对照组的80.85%(38/47), 差异有统计学意义(P < 0.05); 观察组完全负重活动时间早于对照组，差异有统计学意义(P < 0.05); 治疗6周时，观察组WOMAC量表各维度(疼痛、关节僵硬、躯体功能)评分、ISOA评分低于对照组, Lysholm膝关节功能评分高于对照组，差异有统计学意义(P < 0.05); 治疗6周时，观察组PⅠCP、BGP、BALP水平高于对照组, CTX、TRACP5b、TNF-α、IL-1β、hs-CRP水平低于对照组，差异有统计学意义(P < 0.05)。
结论 PRP联合几丁糖能够有效降低KOA患者破骨细胞水平，促进成骨细胞恢复，恢复成骨细胞-破骨细胞平衡，抑制炎症反应，改善膝关节功能，提升临床疗效。

Abstract:
Objective To analyze the effect of platelet-rich plasma (PRP) combined with chitosan in the treatment of knee osteoarthritis (KOA) and its impacts on osteoblast, osteoclast and inflammatory factors.
Methods A total of 94 patients with KOA were selected as study objects, and were divided into control group and observation group according to random number table method, with 47 cases in each group. The patients in both groups were treated with arthroscopic debridement. The control group was given chitosan treatment after operation, and the observation group was given intra-articular injection of PRP combined with chitosan treatment after operation. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm knee joint function score, knee osteoarthritis severity index (ISOA) score and osteoblast and osteoclast related indexesprocollagen type Ⅰ carboxy-terminal peptide (PⅠCP), osteocalcin (BGP), bone alkaline phosphatase (BALP), collagen type Ⅰ cross-linked carboxy-terminal peptide (CTX), and tartrate-resistant acid phosphatase (TRACP5b)levels and inflammatory markerstumor necrosis factor-α (TNF-α), interleukin-1β(IL-1β), and high-sensitivity C-reactive protein (hs-CRP)of the two groups before and after treatment were recorded and compared.
Results The total effective rate in the observation group was higher than that in the control group 95.74% (45/47) versus 80.85% (38/47), P < 0.05. The total weight-bearing activity time in the observation group was earilier than that in the control group (P < 0.05). After six weeks of treatment, the each item score of WOMAC Scale (pain, joint stiffness, physical function) and ISOA score of the observation group were lower than those of the control group, and the Lysholm knee joint function scores were higher than those of the control group (P < 0.05). After 6 weeks of treatment, the levels of PⅠCP, BGP and BALP in the observation group were higher than those in the control group, while the levels of CTX, TRACP5b, TNF-α, IL-1β and hs-CRP in the observation group were lower than those in control group (P < 0.05).
Conclusion PRP combined with chitosan can effectively reduce the level of osteoclasts in KOA patients, promote the recovery of osteoblasts, restore the osteogenic and osteoclast balance, inhibit inflammation, and improve clinical efficacy.

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