摘要【目的】探讨关节腔注射玻璃酸钠对肩周炎患者血清肿瘤坏死因子-α(TNF-α)、环氧合酶(COX-2)表达及疼痛视觉模拟评分(VAS)的影响。【方法】将2017年3月至2020年3月于本院疼痛科就诊的160例肩周炎患者按随机数表法分为对照组(n=80)、观察组(n=80)。对照组施以常规治疗,观察组在对照组基础上加行关节腔内玻璃酸钠注射治疗。治疗1个月后,比较两组临床疗效(有效率),治疗前后的TNF-α、COX-2、VAS评分及肩关节主动关节活动度(Active Range Of Motion,AROM)的变化。【结果】观察组临床有效率优于对照组(85.00% vs 62.50%,χ2=10.460,P<0.05),观察组COX-2水平、VAS评分较对照组改善明显[(12.47±2.33)pg/mL vs (16.67±3.43)pg/mL、(1.42±1.10)分 vs (2.34±1.31)分,P<0.05];观察组肩关节前屈、后伸、外展的AROM较对照组改善明显[(161.14±18.33)° vs (145.67±14.45)°、(50.25±6.57)° vs (38.64±7.40)°、(133.20±14.37)° vs( 124.36±14.07)°,P<0.05]。两组TNF-α水平比较差异无显著性[(29.32±10.10)pg/mL vs (31.64±9.31)pg/mL,P>0.05]。【结论】关节腔内玻璃酸钠注射治疗可有效抑制肩周炎患者的炎症反应,改善其疼痛症状及关节活动功能障碍。
Abstract：【Objective】To investigate the effect of intra-articular injection of sodium hyaluronate on serum tumor necrosis factor in patients with scapulohumeral periarthritis- α(TNF-α),Cyclooxygenase-2 (COX-2) expression and pain visual analogue scale (VAS). 【Methods】A total of 160 patients with Scapulohumeral Periarthritis treated in the pain department of our hospital from March 2017 to March 2020 was randomly divided into control group (n=80) and observation group (n=80). The control group was treated with routine treatment, and the observation group was treated with intra-articular sodium hyaluronate injection on the basis of the control group. After one month of treatment, the clinical efficacy (effective rate) and TNF -α, COX-2, VAS score and active range of motion (AROM) of shoulder jointbefore and after treatment were compared between the two groups.【Results】The clinical effective rate of the observation group was better than that of the control group (85.00% vs 62.50%), χ2=10.460, P<0.05), the scores of COX-2 and VAS in the observation group were significantly improved compared with those in the control group [(12.47±2.33) pg/mL vs (16.67±3.43)pg/mL, (1.42±1.10)score vs (2.34±1.31)score, P<0.05]; The AROM of shoulder flexion, extension and abduction in the observation group was significantly improved compared with that in the control group [(161.14±18.33)° vs (145.67±14.45)°, (50.25±6.57)° vs (38.64±7.40)°, (133.20±14.37)° vs (124.36±14.07)°, P<0.05]. There was no significant difference TNF-αof two groups [(29.32±10.10)pg/mL vs (31.64±9.31)pg/mL,P>0.05]. 【Conclusion】Intra-articular sodium hyaluronate injection can effectively inhibit the inflammatory response, improve the pain symptoms and joint activity dysfunction in patients with scapulohumeral periarthritis.
蔺广生, 杨王李. 关节腔注射玻璃酸钠对肩周炎患者血清TNF-α、COX-2表达及VAS评分的影响[J]. 医学临床研究, 2021, 38(8): 1152-1155.
LIN Guang-sheng, YANG Wang-li. Effect of Intra-articular Injection of Sodium Hyaluronate on Serum TNF- α ,COX-2 expression and VAS scorein Patients with Scapulohumeral Periarthritis. JOURNAL OF CLINICAL RESEARCH, 2021, 38(8): 1152-1155.
[1] 黄健琳. 导引配合温针灸治疗肩周炎疼痛和活动受限的临床研究[J].辽宁中医杂志, 2018, 45(4):801-804. [2] 孙开秀. 玻璃酸钠关节腔内注射联合医用臭氧痛点阻滞治疗肩周炎的疗效分析[J].中国伤残医学, 2018, 26(18):75-76. [3] 罗文涓, 杨剑, 敖妙,等. PRRSV诱导猪体内肺泡巨噬细胞炎症模型的建立[J].南方农业学报, 2018, 49(1):155-163. [4] 张振伟, 柯玉海, 陈培莲. 老年肩关节疾患的鉴别与微创治疗[J].老年医学与保健, 2018, 24(5):484-486. [5] 孙莹, 花佳佳, 施加加.作业活动训练对慢性肩周炎患者运动功能及日常活动能力恢复的影响[J].中华物理医学与康复杂志,2019,41(2):135-138. [6] SUN Y, LIU S, CHEN S, CHEN J. The effect of corticosteroid injection into rotator interval for early frozen shoulder: A randomized controlled trial[J].Am J Sports Med,2018,46(3):663-670. [7] 汪金华,马永多.滋阴健肾方治疗肝肾阴虚型痛风性关节炎的疗效及对血清中炎性标志物水平的影响[J].中华中医药学刊,2019,37(9):2233-2237. [8] 周昊, 卞菊花, 马辉,等. 药物注射联合针刀治疗肩周炎临床疗效及安全性分析[J].基因组学与应用生物学, 2019, 38(5):2432-2436. [9] KIM K H, SUH J W, OH K Y. The effect of intra-articular hyaluronate and tramadol injection on patients with adhesive capsulitis of the shoulder[J].J Back Musculoskelet Rehabil,2017,30(4):913-920. [10] 殷建权, 李立红, 李红.中药生物发酵温灸膏治疗瘀滞型肩周炎对肩关节活动功能和炎症反应水平的影响[J].中华中医药学刊,2019,37(8):1929-1931. [11] HASAN A, AKHTER N, AL-ROUB A, et al. TNF-α in combination with palmitate enhances IL-8 production via the MyD88- independent TLR4 signaling pathway: potential relevance to metabolic inflammation[J].Int J Mol Sci,2019,20(17):4112. [12] ZHENG Y, COMAILLS V, BURR R, et al. COX-2 mediates tumor-stromal prolactin signaling to initiate tumorigenesis[J].Proc Natl Acad Sci USA,2019,116(12):5223-5232. [13] KIM K H,SUH J W,OH K Y. The effect of intra-articular hyaluronate and tramadol injection on patients with adhesive capsulitis of the shoulder[J].J Back Musculoskelet Rehabil,2017, 30(4): 913-920.
2021, Vol. 38 
