鹽酸氨基葡萄糖治療膝骨關節炎的隨機對照研究_《華西醫學》

作者：

蘇江 , 張晶 , 吳侗 ,  周彬

四川省醫學科學院·四川省人民醫院風濕免疫科（成都，610072）;

關鍵詞：

骨關節炎，膝鹽酸氨基葡萄糖碳酸鈣D3片塞來昔布

視頻：

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目的　評價鹽酸氨基葡萄糖治療膝骨關節炎的療效。方法　將2012年1月－5月收治的150例膝骨關節炎患者隨機分為A、B、C組。A組給予鹽酸氨基葡萄糖治療，B組給予碳酸鈣D3片治療，C組給予鹽酸氨基葡萄糖聯合碳酸鈣D3片治療，療程8周。3組患者膝關節疼痛發作時服用塞來昔布并記錄用量。比較試驗前后3組患者骨關節炎指數評分（WOMAC）以及第1、8周塞來昔布用量變化情況。結果　3組患者WOMAC總分、疼痛程度評分、關節僵硬程度評分、日常活動困難程度評分改善值比較，差異均無統計學意義。經過8周治療，塞來昔布每周用量減少值A、B、C組分別為（0.41 ± 0.17）、（0.16 ± 0.22）、（0.46 ± 0.19）g，A、C組高于B組（P＜0.01），A、C組每周用量減少值差異無統計學意義（P＞0.05）。結論　短期使用鹽酸氨基葡萄糖治療膝骨關節炎，在關節疼痛、僵硬及功能改善方面并不優于碳酸鈣D3片，但可通過減少非甾體抗炎藥物用量，使患者獲益。

引用本文： 蘇江,張晶,吳侗,周彬. 鹽酸氨基葡萄糖治療膝骨關節炎的隨機對照研究. 華西醫學, 2012, 27(12): 1776-1779. doi: 復制

1.	Tat SK, Pelletier JP, Verges J, et al. Chondroitin and glucosamine sulfate in combination decrease the pro-resorptive properties of human osteoarthritis subchondral bone osteoblasts: a basic science study[J]. Arthritis Res Ther, 2007, 9(6): R117.
2.	Bruyere O, Reginster JY. Glucosamine and chondroitin sulfate as therapeutic agents for knee and hip osteoarthritis[J]. Drugs Aging, 2007, 24(7): 573-580.
3.	Richy F, Bruyere O, Ethgen O, et al. Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis[J]. Arch Intern Med, 2003, 163(13): 1514-1522.
4.	Towheed TE, Anastassiades T. Glucosamine therapy for osteoarthritis: an update[J]. J Rheumatol, 2007, 34(9): 1787-1790.
5.	Wandel S, Juni P, Tendal B, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis[J]. BMJ, 2010, 341: c4675.
6.	Bruyere O, Pavelka K, Rovati LC, et al. Total joint replacement after glucosamine sulphate treatment in knee osteoarthritis: results of a mean 8-year observation of patients from two previous 3-year, randomised, placebo-controlledtrials[J]. Osteoarthritis Cartilage, 2008, 16(2): 254-260.
7.	Sawitzke AD, Shi H, Finco MF, et al. The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the glucosamine/chondroitin arthritis intervention trial[J]. Arthritis Rheum, 2008, 58(10): 3183-3191.
8.	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.
9.	Cibere J, Thorne A, Kopec JA, et al. Glucosamine sulfate and cartilage typeⅡ collagen degradation in patients with knee osteoarthritis: randomized discontinuation trial results employing biomarkers[J]. J Rheumatol, 2005, 32(5): 896-902.
10.	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.
11.	Vlad SC, LaValley MP, McAlindon TE, et al. Glucosamine for pain in osteoarthritis: why do trial results differ?[J]. Arthritis Rheum, 2007, 56(7): 2267-2277.
12.	Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy inpatients with osteoarthritis of the hip or knee[J]. J Rheumatol, 1988, 15(12): 1833-1840.
13.	中華醫學會風濕病學分會. 骨關節炎診斷及治療指南[J]. 中華風濕病學雜志, 2010, 14(6): 416-419.
14.	Aghazadeh-Habashi A, Jamali F. The glucosamine controversy: a pharmacokinetic issue[J]. J Pharm Pharm Sci, 2011, 14(2): 264-273.
15.	Tat SK, Pelletier JP, Verges J, et al. Chondroitin and glucosamine sulfate in combination decrease the pro-resorptive properties of human osteoarthritis subchondral bone osteoblasts: a basic science study[J]. Arthritis Res Ther, 2007, 9(6): 117.
16.	Reginster JY, Richy F, Bruyere O. Glucosamine as a pain-modifying drug in osteorthritis. What’s new in 2006[J]. Rev Med Liege, 2006, 61(3): 169-172.
17.	Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis[J]. N Engl J Med, 2006, 354(8): 795-808.
18.	McAlindon T, Formica M, LaValley M, et al. Effectiveness of glucosamine for symptoms of knee osteoarthritis: results from an internet-based randomized double-blind controlled trial[J]. Am J Med, 2004, 117(9): 643-649.
19.	Towheed TE, Maxwell L, Anastassiades TP, et al. Glucosamine therapy for treating osteoarthritis[J]. Cochrane Database Syst Rev, 2005, 18(2): CD002946.
20.	Sawitzke AD, Shi H, Finco MF, et al. Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT[J]. Ann Rheum Dis, 2010, 69(8): 1459-1464.
21.	Block JA, Oegema TR, Sandy JD, et al. The effects of oral glucosamine on joint health: is a change in research approach needed?[J]. Osteoarthritis Cartilage, 2010, 18(1): 5-11.
22.	Ali AA, Lewis SM, Badgley HL, et al. Oral glucosamine increases expression of transforming growth factor beta1 (TGFbeta1) and connective tissue growth factor (CTGF) mRNA in rat cartilage and kidney: implications for human efficacy and toxicity[J]. Arch Biochem Biophys, 2011, 510(1): 11-18.
23.	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.

1. 　Tat SK, Pelletier JP, Verges J, et al. Chondroitin and glucosamine sulfate in combination decrease the pro-resorptive properties of human osteoarthritis subchondral bone osteoblasts: a basic science study[J]. Arthritis Res Ther, 2007, 9(6): R117.
2. 　Bruyere O, Reginster JY. Glucosamine and chondroitin sulfate as therapeutic agents for knee and hip osteoarthritis[J]. Drugs Aging, 2007, 24(7): 573-580.
3. 　Richy F, Bruyere O, Ethgen O, et al. Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis[J]. Arch Intern Med, 2003, 163(13): 1514-1522.
4. 　Towheed TE, Anastassiades T. Glucosamine therapy for osteoarthritis: an update[J]. J Rheumatol, 2007, 34(9): 1787-1790.
5. 　Wandel S, Juni P, Tendal B, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis[J]. BMJ, 2010, 341: c4675.
6. 　Bruyere O, Pavelka K, Rovati LC, et al. Total joint replacement after glucosamine sulphate treatment in knee osteoarthritis: results of a mean 8-year observation of patients from two previous 3-year, randomised, placebo-controlledtrials[J]. Osteoarthritis Cartilage, 2008, 16(2): 254-260.
7. 　Sawitzke AD, Shi H, Finco MF, et al. The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the glucosamine/chondroitin arthritis intervention trial[J]. Arthritis Rheum, 2008, 58(10): 3183-3191.
8. 　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.
9. 　Cibere J, Thorne A, Kopec JA, et al. Glucosamine sulfate and cartilage typeⅡ collagen degradation in patients with knee osteoarthritis: randomized discontinuation trial results employing biomarkers[J]. J Rheumatol, 2005, 32(5): 896-902.
10. 　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.
11. 　Vlad SC, LaValley MP, McAlindon TE, et al. Glucosamine for pain in osteoarthritis: why do trial results differ?[J]. Arthritis Rheum, 2007, 56(7): 2267-2277.
12. 　Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy inpatients with osteoarthritis of the hip or knee[J]. J Rheumatol, 1988, 15(12): 1833-1840.
13. 　中華醫學會風濕病學分會. 骨關節炎診斷及治療指南[J]. 中華風濕病學雜志, 2010, 14(6): 416-419.
14. 　Aghazadeh-Habashi A, Jamali F. The glucosamine controversy: a pharmacokinetic issue[J]. J Pharm Pharm Sci, 2011, 14(2): 264-273.
15. 　Tat SK, Pelletier JP, Verges J, et al. Chondroitin and glucosamine sulfate in combination decrease the pro-resorptive properties of human osteoarthritis subchondral bone osteoblasts: a basic science study[J]. Arthritis Res Ther, 2007, 9(6): 117.
16. 　Reginster JY, Richy F, Bruyere O. Glucosamine as a pain-modifying drug in osteorthritis. What’s new in 2006[J]. Rev Med Liege, 2006, 61(3): 169-172.
17. 　Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis[J]. N Engl J Med, 2006, 354(8): 795-808.
18. 　McAlindon T, Formica M, LaValley M, et al. Effectiveness of glucosamine for symptoms of knee osteoarthritis: results from an internet-based randomized double-blind controlled trial[J]. Am J Med, 2004, 117(9): 643-649.
19. 　Towheed TE, Maxwell L, Anastassiades TP, et al. Glucosamine therapy for treating osteoarthritis[J]. Cochrane Database Syst Rev, 2005, 18(2): CD002946.
20. 　Sawitzke AD, Shi H, Finco MF, et al. Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT[J]. Ann Rheum Dis, 2010, 69(8): 1459-1464.
21. 　Block JA, Oegema TR, Sandy JD, et al. The effects of oral glucosamine on joint health: is a change in research approach needed?[J]. Osteoarthritis Cartilage, 2010, 18(1): 5-11.
22. 　Ali AA, Lewis SM, Badgley HL, et al. Oral glucosamine increases expression of transforming growth factor beta1 (TGFbeta1) and connective tissue growth factor (CTGF) mRNA in rat cartilage and kidney: implications for human efficacy and toxicity[J]. Arch Biochem Biophys, 2011, 510(1): 11-18.
23. 　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.

《華西醫學》

鹽酸氨基葡萄糖治療膝骨關節炎的隨機對照研究

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《華西醫學》

鹽酸氨基葡萄糖治療膝骨關節炎的隨機對照研究

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