氨基葡萄糖聯合布洛芬與單用布洛芬治療髖關節骨關節炎前瞻性隨機對照臨床研究_《華西醫學》

作者：

曾偉南 ,  周宗科 , 李海 , 沈彬 , 楊靜 , 康鵬德 , 裴福興

四川大學華西醫院骨科（成都，610041）;

關鍵詞：

氨基葡萄糖布洛芬骨關節炎，髖

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目的　探討氨基葡萄糖聯合布洛芬治療髖關節骨關節炎的臨床療效。方法　2011年9月－2012年1月采用前瞻性隨機對照臨床試驗，將198例輕、中度髖關節骨關節炎患者隨機分入試驗組及對照組。試驗組采用氨基葡萄糖（750 mg， 2次/d口服，療程1個月）聯合布洛芬（0.3 g，2次/d口服，療程2周），對照組則單用布洛芬（0.3 g，2次/d口服，療程2周）；分別于服藥后0、2、4、8及12周時采用加拿大西安大略和麥克瑪斯特大學骨關節炎指數（WOMAC）進行療效評價。并對惡心、嘔吐、皮疹等藥物不良反應進行觀察。結果　試驗組與對照組WOMAC各項評分從第2周開始較0周明顯下降，而兩組患者間在0周及2周時WOMAC評分無統計學差異：0周總評分（45.3、45.0分，P=0.225），2周總評分（37.3、37.6分，P=0.329）。但對照組WOMAC各項評分從第4周開始逐漸呈現上升趨勢，而試驗組到第12周仍呈現持續性下降趨勢。總不良反應發生率為7.0%，其中試驗組總不良反應發生率為9.5%，但不良反應輕微，未予特殊處理而自行消失。結論　氨基葡萄糖聯合布洛芬可有效緩解早、中期髖關節骨關節炎各項臨床癥狀，療效確切，不良反應較少，且停藥后仍持續表現出治療效果。而單用布洛芬可短期緩解骨關節炎癥，但停藥后癥狀逐漸復現。

引用本文： 曾偉南,周宗科,李海,沈彬,楊靜,康鵬德,裴福興. 氨基葡萄糖聯合布洛芬與單用布洛芬治療髖關節骨關節炎前瞻性隨機對照臨床研究. 華西醫學, 2012, 27(12): 1805-1808. doi: 復制

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2.	Pallu S, Francin PJ, Guillaume C, et al. Obesity affects the chondrocyte responsiveness to leptin in patients with osteoarthritis [J]. Arthritis Res Ther, 2010, 12(3): 112.
3.	Muller-Fassbender H, Bach GL, Haase W, et al. Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee [J]. Osteoarthr Cartil,1994, 2(1): 61-69.
4.	Pavelka K, Gatterova J, Olejarova M, et al. Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3 year, randomized, placebo-controlled, double-blind study [J]. Arch Intern Med, 2002, 162(18): 2113-2123.
5.	Bassleer C, Rovati L, Franchimont P. Stimulation of proteoglycan production by glucosamine sulfate in chondrocytes isolated from human osteoarthritic articular cartilage in vitro [J]. Osteoarthr Cartil, 1998, 6(6): 427-434.
6.	中華醫學會風濕病學分會.骨關節炎診治指南[J]. 中華風濕病學雜志, 2003, 7(11): 702.
7.	Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patientrelevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee [J]. J Rheumatol 1988, 15(12):1833-1840.
8.	Reginster JY, Deroisy R, Rovati LC, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a andomized, placebo-controlled clinical trial [J]. Lancet, 2001, 357 (9252): 251-256.
9.	Uebelhart D, Malaise M, Marcolongo R, et al. Intermittent treatment of knee osteoarthritis with oral chondroitin sulfate: a one-year, randomized, double-blind, multicenter study versus placebo [J]. Osteoarthr Cartil, 2004, 12(4): 269-276.
10.	Michel BA, Stucki G, Frey D, et al. Chondroitins 4 and 6 sulfate in osteoarthritis of the knee: a randomized, controlled trial [J]. Arthritis Rheum, 2005, 52(3): 779-786.
11.	Shikhman AR, Amiel D, D’Lima D, et al. Chondroprotective activity of N-acetylglucosamine in rabbits with experimental osteoarthritis [J]. Ann Rheum Dis, 2005, 64(1): 89-94.
12.	Chan PS, Caron JP, Rosa GJ, et al. Glucosamine and chondroitin sulfate regulate gene expression and synthesis of nitric oxide and prostaglandin E2 in articular cartilage explants [J]. Osteoarthr Cartil, 2005, 13(5): 387-394.
13.	Largo R, Alvarez-Soria MA, Diez-Ortego I, et al. Glucosamine inhibits IL-1beta-induced N fkappa B activation in human osteoarthritic chondrocytes [J]. Osteoarthr Cartil, 2003, 11(4): 290-298.
14.	Raiss R. Effect of D-glucosamine sulfate on experimentally injured articular cartilage. Comparative morphometry of the ultrastructure of chondrocytes [J]. Fortschr Med, 1985, 103(24): 658-662.
15.	Varghese S, Theprungsirikul P, Sahani S, et al. Glucosamine modulates chondrocyte proliferation, matrix synthesis, and gene expression [J]. Osteoarthr Cartil, 2007, 15(1): 59-68.
16.	Cibere J, Kopec JA, Thorne A, et al. Randomized, double-blind, placebo-controlled glucosamine discontinuation trial in knee osteoarthritis [J]. Arthritis Rheum, 2004, 51(5): 738-745.
17.	Hughes R, Carr A. A randomized double-blind, placebo-controlled trial of glucosamine sulphate as an analgesic in osteoarthritis of the knee [J]. Rheumatology (Oxford), 2002, 41(3): 279-284.
18.	Cibere J, Thorne A, Kopec JA, et al. Glucosamine sulfate and cartilage type II collagen degradation in patients with knee osteoarthritis: randomized discontinuation trial results employing biomarkers [J]. J Rheumatol, 2005, 32(5): 896-902.
19.	Aghazadeh-Habashi A, Jamali F. The glucosamine controversy: a pharmacokinetic issue [J]. J Pharm Pharm Sci, 2011, 14(2): 264-273.
20.	Laverty S, Sandy JD, Celeste C, et al. Synovial ?uid levels and serum pharmaco-kinetics in a large animal model following treatment with oral glucosamine at clinically relevant doses [J]. Arthritis Rheum, 2005, 52(1): 181-191.
21.	Biggee BA, Blinn CM, McAlindon TE, et al. Low levels of human serum glucosamine after ingestion of glucosamine sulphate relative to capability for peripheral effectiveness [J]. Ann Rheum Dis, 2006, 65(2): 222-226.
22.	Glucosamine: reports of allergic skin reactions [R]. Austalian adverse drug reaction bulletin, 2005, 24 (6): 231.
23.	邱貴興, 翁習生, 張克, 等. 鹽酸/硫酸氨基葡萄糖治療骨關節炎的平行對照臨床研究 [J].中華醫學雜志, 2005, 85 (43): 3067-3070.

1. 　中華醫學會骨科學分會. 骨關節炎診治指南(2007年版) [J]. 中華關節外科雜志，2007, 1(4):281- 285.
2. 　Pallu S, Francin PJ, Guillaume C, et al. Obesity affects the chondrocyte responsiveness to leptin in patients with osteoarthritis [J]. Arthritis Res Ther, 2010, 12(3): 112.
3. 　Muller-Fassbender H, Bach GL, Haase W, et al. Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee [J]. Osteoarthr Cartil,1994, 2(1): 61-69.
4. 　Pavelka K, Gatterova J, Olejarova M, et al. Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3 year, randomized, placebo-controlled, double-blind study [J]. Arch Intern Med, 2002, 162(18): 2113-2123.
5. 　Bassleer C, Rovati L, Franchimont P. Stimulation of proteoglycan production by glucosamine sulfate in chondrocytes isolated from human osteoarthritic articular cartilage in vitro [J]. Osteoarthr Cartil, 1998, 6(6): 427-434.
6. 　中華醫學會風濕病學分會.骨關節炎診治指南[J]. 中華風濕病學雜志, 2003, 7(11): 702.
7. 　Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patientrelevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee [J]. J Rheumatol 1988, 15(12):1833-1840.
8. 　Reginster JY, Deroisy R, Rovati LC, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a andomized, placebo-controlled clinical trial [J]. Lancet, 2001, 357 (9252): 251-256.
9. 　Uebelhart D, Malaise M, Marcolongo R, et al. Intermittent treatment of knee osteoarthritis with oral chondroitin sulfate: a one-year, randomized, double-blind, multicenter study versus placebo [J]. Osteoarthr Cartil, 2004, 12(4): 269-276.
10. 　Michel BA, Stucki G, Frey D, et al. Chondroitins 4 and 6 sulfate in osteoarthritis of the knee: a randomized, controlled trial [J]. Arthritis Rheum, 2005, 52(3): 779-786.
11. 　Shikhman AR, Amiel D, D’Lima D, et al. Chondroprotective activity of N-acetylglucosamine in rabbits with experimental osteoarthritis [J]. Ann Rheum Dis, 2005, 64(1): 89-94.
12. 　Chan PS, Caron JP, Rosa GJ, et al. Glucosamine and chondroitin sulfate regulate gene expression and synthesis of nitric oxide and prostaglandin E2 in articular cartilage explants [J]. Osteoarthr Cartil, 2005, 13(5): 387-394.
13. 　Largo R, Alvarez-Soria MA, Diez-Ortego I, et al. Glucosamine inhibits IL-1beta-induced N fkappa B activation in human osteoarthritic chondrocytes [J]. Osteoarthr Cartil, 2003, 11(4): 290-298.
14. 　Raiss R. Effect of D-glucosamine sulfate on experimentally injured articular cartilage. Comparative morphometry of the ultrastructure of chondrocytes [J]. Fortschr Med, 1985, 103(24): 658-662.
15. 　Varghese S, Theprungsirikul P, Sahani S, et al. Glucosamine modulates chondrocyte proliferation, matrix synthesis, and gene expression [J]. Osteoarthr Cartil, 2007, 15(1): 59-68.
16. 　Cibere J, Kopec JA, Thorne A, et al. Randomized, double-blind, placebo-controlled glucosamine discontinuation trial in knee osteoarthritis [J]. Arthritis Rheum, 2004, 51(5): 738-745.
17. 　Hughes R, Carr A. A randomized double-blind, placebo-controlled trial of glucosamine sulphate as an analgesic in osteoarthritis of the knee [J]. Rheumatology (Oxford), 2002, 41(3): 279-284.
18. 　Cibere J, Thorne A, Kopec JA, et al. Glucosamine sulfate and cartilage type II collagen degradation in patients with knee osteoarthritis: randomized discontinuation trial results employing biomarkers [J]. J Rheumatol, 2005, 32(5): 896-902.
19. 　Aghazadeh-Habashi A, Jamali F. The glucosamine controversy: a pharmacokinetic issue [J]. J Pharm Pharm Sci, 2011, 14(2): 264-273.
20. 　Laverty S, Sandy JD, Celeste C, et al. Synovial ?uid levels and serum pharmaco-kinetics in a large animal model following treatment with oral glucosamine at clinically relevant doses [J]. Arthritis Rheum, 2005, 52(1): 181-191.
21. 　Biggee BA, Blinn CM, McAlindon TE, et al. Low levels of human serum glucosamine after ingestion of glucosamine sulphate relative to capability for peripheral effectiveness [J]. Ann Rheum Dis, 2006, 65(2): 222-226.
22. 　Glucosamine: reports of allergic skin reactions [R]. Austalian adverse drug reaction bulletin, 2005, 24 (6): 231.
23. 　邱貴興, 翁習生, 張克, 等. 鹽酸/硫酸氨基葡萄糖治療骨關節炎的平行對照臨床研究 [J].中華醫學雜志, 2005, 85 (43): 3067-3070.

《華西醫學》

氨基葡萄糖聯合布洛芬與單用布洛芬治療髖關節骨關節炎前瞻性隨機對照臨床研究

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《華西醫學》

氨基葡萄糖聯合布洛芬與單用布洛芬治療髖關節骨關節炎前瞻性隨機對照臨床研究

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