鹽酸氨基葡萄糖治療椎間盤源性腰痛的隨機對照研究_《華西醫學》

作者：

張允 ¹ , 曾喻 ² , 馮靜 ¹ ,  張林輝 ¹ , 姜迎 ¹ , 薛亮 ¹ , 羅勇 ¹ , 陳世寅 ¹

四川省醫學科學院·四川省人民醫院（成都，610072）1中醫骨科，2康復科;

關鍵詞：

鹽酸氨基葡萄糖椎間盤源性腰痛非甾體抗炎藥

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目的　探討單用和聯用鹽酸氨基葡萄糖與非甾體抗炎藥（NSAID）在椎間盤源性腰痛（DLBP）治療中的有效性。方法　 2011年1月－12月72例DLBP患者，男42例，女30例；年齡22～71歲；體重43～84 kg；病程0.5～10年。通過隨機數字表的方法，將患者分為3組。A組給予鹽酸氨基葡萄糖膠囊750 mg，2次/d，同時給予尼美舒利分散片100 mg，2次/d；B組給予鹽酸氨基葡萄糖膠囊750 mg，2次/d；C組給予尼美舒利分散片100 mg，2次/d。3組均用藥8周后停藥，用藥期間停用其他活血化瘀類藥物及物理治療。選取治療前及治療后第4、8、16周4個時間點，運用疼痛數字評價量表（NRS）、Oswestry功能障礙指數（ODI）、生活質量評價量表SF-36分別對3組患者的腰痛、腰部功能及生活質量進行評價。結果　63例獲得隨訪，失訪率12.5%。各組患者NRS評分、ODI評分、SF-36評分在治療前后比較差異均有統計學意義（P＜0.05），A組療效明顯優于B、C兩組，B組治療后各項數據較治療前明顯改善（P＜0.05）。結論　單用鹽酸氨基葡萄糖治療DLBP有效，且在停藥后，仍有一定療效，聯用NSAID效果更佳；遠期療效有待進一步隨訪。

引用本文： 張允,曾喻,馮靜,張林輝,姜迎,薛亮,羅勇,陳世寅. 鹽酸氨基葡萄糖治療椎間盤源性腰痛的隨機對照研究. 華西醫學, 2012, 27(12): 1818-1821. doi: 復制

1.	Peng B, Wu W, Hou S, et al. The pathogenesis of discogenic low back pain[J]. J Bone Joint Surg Br, 2005, 87(1): 62-67.
2.	黃荷, 馬玉桃, 廖志輝, 等. 身痛逐瘀湯結合臭氧消融術治療椎間盤源性腰痛30例臨床觀察[J]. 新中醫, 2011, 43(8): 61-62.
3.	石銳, 胡韜, 丁琛, 等. 鹽酸氨基葡萄糖聯合低劑量NSAIDS類藥物與單純用藥治療小關節骨關節炎伴下腰痛的隨機對照研究[J]. 中國骨與關節外科, 2012, 5(1): 36-42.
4.	何傳正, 唐海燕, 吳發慶. 椎間盤源性下腰痛的發生機制與治療現狀[J]. 吉林醫學, 2010, 31(18): 2909-2910.
5.	劉延青. 重視椎間盤源性疼痛的診療[J]. 中國疼痛醫學雜志, 2011, 17(5): 257.
6.	陳寧. 實用疼痛治療手冊[M]. 北京: 北京醫科大學中國協和醫科大學聯合出版社, 1996: 35.
7.	鄭光新, 趙曉鷗, 劉廣林, 等. Oswestry功能障礙指數評定腰痛患者的可信性[J]. 中國脊柱脊髓雜志, 2002, 12(1): 13-15.
8.	李春波, 何燕玲. 健康狀況調查問卷SF-36的介紹[J]. 國外醫學·精神病學分冊, 2002, 29(2): 116-119.
9.	Smith LJ, Fazzalari NL. The elastic fibre network of the human lumbar anulus fibrosus: architecture, mechanical function and potential role in the progression of intervertebral disc degeneration[J]. Eur Spine J, 2009, 18(4): 439-448.
10.	Wang DL, Jiang SD, Dai LY. Biologic response of the intervertebral disc to static and dynamic compression in vitro[J]. Spine (Phila Pa 1976), 2007, 32(23): 2521-2528.
11.	Hadjipavlou AG, Tzermiadianos MN, Bogduk N, et al. The pathophysiology of disc degeneration: a critical review[J]. J Bone Joint Surg Br, 2008, 90(10): 1261-1270.
12.	Schumann B, Bolm-Audorff U, Bergmann A, et al. Lifestyle factors and lumbar disc disease: results of a German multi-center case-control study (EPILIFT)[J]. Arthritis Res Ther, 2010, 12(5): R193.
13.	Goupille P, Mulleman D, Chevalier X. Is interleukin-1 a good target for therapeutic intervention in intervertebral disc degeneration: lessons from the osteoarthritic experience[J]. Arthritis Res Ther, 2007, 9(6): 110.
14.	Solovieva S, Leino-Arjas P, Saarela J, et al. Possible association of interleukin 1 gene locus polymorphisms with low back pain[J]. Pain, 2004, 109(1-2): 8-19.
15.	Brisby H. Pathology and possible mechanisms of nervous system response to disc degeneration[J]. J Bone Joint Surg Am, 2006, 88(Suppl 2): 68-71.
16.	Igarashi A, Kikuchi S, Konno S. Correlation between inflammatory cytokines released from the lumbar facet joint tissue and symptoms in degenerative lumbar spinal disorders[J]. J Orthop Sci, 2007, 12(2): 154-160.
17.	Saal JS, Franson RC, Dobrow R, et al. High levels of inflammatory phospholipase A2 activity in lumbar disc herniations[J]. Spine (Phila Pa 1976), 1990, 15(7): 674-678.
18.	葉君健, 宋繼紅, 姜小鷹, 等. 腰椎間盤突出癥髓核組織磷脂酶A2表達的臨床研究[J]. 中國骨與關節損傷雜志, 2006, 21(4): 259-261.
19.	Le Maitre CL, Freemont AJ, Hoyland JA. The role of interleukin-1 in the pathogenesis of human intervertebral disc degeneration[J]. Arthritis Res Ther, 2005, 7(4): R732-R745.
20.	Thomas B, Thirion S, Humbert L, et al. Differentiation regulates interleukin-1beta-induced cyclo-oxygenase-2 in human articular chondrocytes: role of p38 mitogen-activated protein kinase[J]. Biochem J, 2002, 362(Pt 2): 367-373.
21.	Le M, Pockert A, Buttle DJ, et al. Matrix synthesis and degradation in human intervertebral disc degeneration[J]. Biochem Soc Trans, 2007, 35(Pt 4): 652-655.
22.	葉偉, 馬若凡, 丁悅, 等. IL-6對體外培養的兔軟骨終板細胞生物學行為的影響[J]. 南方醫科大學學報, 2007, 27(8): 1187.
23.	董振風, 黃秀芳, 董永東, 等. IL-8及TNF在突出椎間盤中的表達意義[J]. 濰坊醫學院學報, 2008, 30(5): 447-448.
24.	姜世峰, 申才良. 腰椎Modic改變中炎性細胞因子的效應[J]. 中國組織工程研究, 2012, 16(17): 3213-3217.
25.	Lotz JC, Ulrich JA. Innervation, inflammation, and hypermobility May characterize pathologic disc degeneration: review of animal model data[J]. J Bone Joint Surg Am, 2006, 88(Suppl 2): 76-82.
26.	Furusawa N, Baba H, Miyoshi N, et al. Herniation of cervical intervertebral disc: immunohistochemical examination and measurement of nitric oxide production[J]. Spine (Phila Pa 1976), 2001, 26(10): 1110-1116.
27.	陳操, 史晨輝, 劉維鋼. 炎性細胞因子與椎間盤退變相關性的研究進展[J]. 農墾醫學, 2009, 31(6): 550-552.
28.	Abe Y, Akeda K, An HS, et al. Proinflammatory cytokines stimulate the expression of nerve growth factor by human intervertebral disc cells[J]. Spine (Phila Pa 1976), 2007, 32(6): 635-642.
29.	張施展, 蔣林. 鹽酸氨基葡萄糖治療腰椎關節突關節骨性關節炎的臨床觀察[J]. 華西醫學, 2011, 26(12): 1832-1835.
30.	Houpt JB, Mcmillan R, Wein C, et al. Effect of glucosamine hydrochloride in the treatment of pain of osteoarthritis of the knee[J]. J Rheumatol, 1999, 26(11): 2423-2430.
31.	Nakamura H, Shibakawa A, Tanaka M, et al. Effects of glucosamine hydrochloride on the production of prostaglandin E2, nitric oxide and metalloproteases by chondrocytes and synoviocytes in osteoarthritis[J]. Clin Exp Rheumatol, 2004, 22(3): 293-299.
32.	Walsh AJ, O’neill CW, Lotz JC. Glucosamine HCl alters production of inflammatory mediators by rat intervertebral disc cells in vitro[J]. Spine J, 2007, 7(5): 601-608.
33.	Zhuang Y, Huang B, Li CQ, et al. Construction of tissue-engineered composite intervertebral disc and preliminary morphological and biochemical evaluation[J]. Biochem Biophys Res Commun, 2011, 407(2): 327-332.
34.	Gatti JC. Glucosamine treatment for osteoarthritis[J]. Am Fam Physician, 2006, 73(7): 1189.
35.	Liu W, Liu G, Pei F, et al. Kashin-Beck disease in Sichuan, China: report of a pilot open therapeutic trial[J]. J Clin Rheumatol, 2012, 18(1): 8-14.
36.	Bruyere O, Pavelka K, Rovati LC, et al. Glucosamine sulfate reduces osteoarthritis progression in postmenopausal women with knee osteoarthritis: evidence from two 3-year studies[J]. Menopause, 2004, 11(2): 138-143.
37.	Russell AL. Focusing on glucosamine sulfate[J]. Can Fam Physician, 2004, 50: 980-981.
38.	Henrotin Y, Mobasheri A, Marty M. Is there any scientific evidence for the use of glucosamine in the management of human osteoarthritis?[J]. Arthritis Res Ther, 2012, 14(1): 201.

1. 　Peng B, Wu W, Hou S, et al. The pathogenesis of discogenic low back pain[J]. J Bone Joint Surg Br, 2005, 87(1): 62-67.
2. 　黃荷, 馬玉桃, 廖志輝, 等. 身痛逐瘀湯結合臭氧消融術治療椎間盤源性腰痛30例臨床觀察[J]. 新中醫, 2011, 43(8): 61-62.
3. 　石銳, 胡韜, 丁琛, 等. 鹽酸氨基葡萄糖聯合低劑量NSAIDS類藥物與單純用藥治療小關節骨關節炎伴下腰痛的隨機對照研究[J]. 中國骨與關節外科, 2012, 5(1): 36-42.
4. 　何傳正, 唐海燕, 吳發慶. 椎間盤源性下腰痛的發生機制與治療現狀[J]. 吉林醫學, 2010, 31(18): 2909-2910.
5. 　劉延青. 重視椎間盤源性疼痛的診療[J]. 中國疼痛醫學雜志, 2011, 17(5): 257.
6. 　陳寧. 實用疼痛治療手冊[M]. 北京: 北京醫科大學中國協和醫科大學聯合出版社, 1996: 35.
7. 　鄭光新, 趙曉鷗, 劉廣林, 等. Oswestry功能障礙指數評定腰痛患者的可信性[J]. 中國脊柱脊髓雜志, 2002, 12(1): 13-15.
8. 　李春波, 何燕玲. 健康狀況調查問卷SF-36的介紹[J]. 國外醫學·精神病學分冊, 2002, 29(2): 116-119.
9. 　Smith LJ, Fazzalari NL. The elastic fibre network of the human lumbar anulus fibrosus: architecture, mechanical function and potential role in the progression of intervertebral disc degeneration[J]. Eur Spine J, 2009, 18(4): 439-448.
10. 　Wang DL, Jiang SD, Dai LY. Biologic response of the intervertebral disc to static and dynamic compression in vitro[J]. Spine (Phila Pa 1976), 2007, 32(23): 2521-2528.
11. 　Hadjipavlou AG, Tzermiadianos MN, Bogduk N, et al. The pathophysiology of disc degeneration: a critical review[J]. J Bone Joint Surg Br, 2008, 90(10): 1261-1270.
12. 　Schumann B, Bolm-Audorff U, Bergmann A, et al. Lifestyle factors and lumbar disc disease: results of a German multi-center case-control study (EPILIFT)[J]. Arthritis Res Ther, 2010, 12(5): R193.
13. 　Goupille P, Mulleman D, Chevalier X. Is interleukin-1 a good target for therapeutic intervention in intervertebral disc degeneration: lessons from the osteoarthritic experience[J]. Arthritis Res Ther, 2007, 9(6): 110.
14. 　Solovieva S, Leino-Arjas P, Saarela J, et al. Possible association of interleukin 1 gene locus polymorphisms with low back pain[J]. Pain, 2004, 109(1-2): 8-19.
15. 　Brisby H. Pathology and possible mechanisms of nervous system response to disc degeneration[J]. J Bone Joint Surg Am, 2006, 88(Suppl 2): 68-71.
16. 　Igarashi A, Kikuchi S, Konno S. Correlation between inflammatory cytokines released from the lumbar facet joint tissue and symptoms in degenerative lumbar spinal disorders[J]. J Orthop Sci, 2007, 12(2): 154-160.
17. 　Saal JS, Franson RC, Dobrow R, et al. High levels of inflammatory phospholipase A2 activity in lumbar disc herniations[J]. Spine (Phila Pa 1976), 1990, 15(7): 674-678.
18. 　葉君健, 宋繼紅, 姜小鷹, 等. 腰椎間盤突出癥髓核組織磷脂酶A2表達的臨床研究[J]. 中國骨與關節損傷雜志, 2006, 21(4): 259-261.
19. 　Le Maitre CL, Freemont AJ, Hoyland JA. The role of interleukin-1 in the pathogenesis of human intervertebral disc degeneration[J]. Arthritis Res Ther, 2005, 7(4): R732-R745.
20. 　Thomas B, Thirion S, Humbert L, et al. Differentiation regulates interleukin-1beta-induced cyclo-oxygenase-2 in human articular chondrocytes: role of p38 mitogen-activated protein kinase[J]. Biochem J, 2002, 362(Pt 2): 367-373.
21. 　Le M, Pockert A, Buttle DJ, et al. Matrix synthesis and degradation in human intervertebral disc degeneration[J]. Biochem Soc Trans, 2007, 35(Pt 4): 652-655.
22. 　葉偉, 馬若凡, 丁悅, 等. IL-6對體外培養的兔軟骨終板細胞生物學行為的影響[J]. 南方醫科大學學報, 2007, 27(8): 1187.
23. 　董振風, 黃秀芳, 董永東, 等. IL-8及TNF在突出椎間盤中的表達意義[J]. 濰坊醫學院學報, 2008, 30(5): 447-448.
24. 　姜世峰, 申才良. 腰椎Modic改變中炎性細胞因子的效應[J]. 中國組織工程研究, 2012, 16(17): 3213-3217.
25. 　Lotz JC, Ulrich JA. Innervation, inflammation, and hypermobility May characterize pathologic disc degeneration: review of animal model data[J]. J Bone Joint Surg Am, 2006, 88(Suppl 2): 76-82.
26. 　Furusawa N, Baba H, Miyoshi N, et al. Herniation of cervical intervertebral disc: immunohistochemical examination and measurement of nitric oxide production[J]. Spine (Phila Pa 1976), 2001, 26(10): 1110-1116.
27. 　陳操, 史晨輝, 劉維鋼. 炎性細胞因子與椎間盤退變相關性的研究進展[J]. 農墾醫學, 2009, 31(6): 550-552.
28. 　Abe Y, Akeda K, An HS, et al. Proinflammatory cytokines stimulate the expression of nerve growth factor by human intervertebral disc cells[J]. Spine (Phila Pa 1976), 2007, 32(6): 635-642.
29. 　張施展, 蔣林. 鹽酸氨基葡萄糖治療腰椎關節突關節骨性關節炎的臨床觀察[J]. 華西醫學, 2011, 26(12): 1832-1835.
30. 　Houpt JB, Mcmillan R, Wein C, et al. Effect of glucosamine hydrochloride in the treatment of pain of osteoarthritis of the knee[J]. J Rheumatol, 1999, 26(11): 2423-2430.
31. 　Nakamura H, Shibakawa A, Tanaka M, et al. Effects of glucosamine hydrochloride on the production of prostaglandin E2, nitric oxide and metalloproteases by chondrocytes and synoviocytes in osteoarthritis[J]. Clin Exp Rheumatol, 2004, 22(3): 293-299.
32. 　Walsh AJ, O’neill CW, Lotz JC. Glucosamine HCl alters production of inflammatory mediators by rat intervertebral disc cells in vitro[J]. Spine J, 2007, 7(5): 601-608.
33. 　Zhuang Y, Huang B, Li CQ, et al. Construction of tissue-engineered composite intervertebral disc and preliminary morphological and biochemical evaluation[J]. Biochem Biophys Res Commun, 2011, 407(2): 327-332.
34. 　Gatti JC. Glucosamine treatment for osteoarthritis[J]. Am Fam Physician, 2006, 73(7): 1189.
35. 　Liu W, Liu G, Pei F, et al. Kashin-Beck disease in Sichuan, China: report of a pilot open therapeutic trial[J]. J Clin Rheumatol, 2012, 18(1): 8-14.
36. 　Bruyere O, Pavelka K, Rovati LC, et al. Glucosamine sulfate reduces osteoarthritis progression in postmenopausal women with knee osteoarthritis: evidence from two 3-year studies[J]. Menopause, 2004, 11(2): 138-143.
37. 　Russell AL. Focusing on glucosamine sulfate[J]. Can Fam Physician, 2004, 50: 980-981.
38. 　Henrotin Y, Mobasheri A, Marty M. Is there any scientific evidence for the use of glucosamine in the management of human osteoarthritis?[J]. Arthritis Res Ther, 2012, 14(1): 201.

《華西醫學》

鹽酸氨基葡萄糖治療椎間盤源性腰痛的隨機對照研究

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《華西醫學》

鹽酸氨基葡萄糖治療椎間盤源性腰痛的隨機對照研究

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