Randomized Controlled Trials on Treatment of Discogenic Low Back Pain by Glucosamine Hydrochloride_West China Medical Journal

Authors：

ZHANG Yun ¹ , ZENG Yu ² , FENG Jing ¹ ,  ZHANG Linhui ¹ , JIANG Ying ¹ , XUE Liang ¹ , LUO Yong ¹ , CHENG ShiYin ¹

1. Department of Traditional Chinese Medicine Orthopedics; 2. Department of Physiatry; Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, P. R. China;

Corresponding author：

ZHANG Linhui, Email: cry261979@126.com

Keywords：

盐酸氨基葡萄糖; 椎间盘源性腰痛; 非甾体抗炎药

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

目的　探讨单用和联用盐酸氨基葡萄糖与非甾体抗炎药（NSAID）在椎间盘源性腰痛（DLBP）治疗中的有效性。方法　 2011年1月－12月72例DLBP患者，男42例，女30例；年龄22～71岁；体重43～84 kg；病程0.5～10年。通过随机数字表的方法，将患者分为3组。A组给予盐酸氨基葡萄糖胶囊750 mg，2次/d，同时给予尼美舒利分散片100 mg，2次/d；B组给予盐酸氨基葡萄糖胶囊750 mg，2次/d；C组给予尼美舒利分散片100 mg，2次/d。3组均用药8周后停药，用药期间停用其他活血化瘀类药物及物理治疗。选取治疗前及治疗后第4、8、16周4个时间点，运用疼痛数字评价量表（NRS）、Oswestry功能障碍指数（ODI）、生活质量评价量表SF-36分别对3组患者的腰痛、腰部功能及生活质量进行评价。结果　63例获得随访，失访率12.5%。各组患者NRS评分、ODI评分、SF-36评分在治疗前后比较差异均有统计学意义（P＜0.05），A组疗效明显优于B、C两组，B组治疗后各项数据较治疗前明显改善（P＜0.05）。结论　单用盐酸氨基葡萄糖治疗DLBP有效，且在停药后，仍有一定疗效，联用NSAID效果更佳；远期疗效有待进一步随访。

Citation： ZHANG Yun,ZENG Yu,FENG Jing,ZHANG Linhui,JIANG Ying,XUE Liang,LUO Yong,CHENG ShiYin. Randomized Controlled Trials on Treatment of Discogenic Low Back Pain by Glucosamine Hydrochloride. West China Medical Journal, 2012, 27(12): 1818-1821. doi: Copy

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.	黄荷, 马玉桃, 廖志辉, 等. 身痛逐瘀汤结合臭氧消融术治疗椎间盘源性腰痛30例临床观察[J]. 新中医, 2011, 43(8): 61-62.
3.	石锐, 胡韬, 丁琛, 等. 盐酸氨基葡萄糖联合低剂量NSAIDS类药物与单纯用药治疗小关节骨关节炎伴下腰痛的随机对照研究[J]. 中国骨与关节外科, 2012, 5(1): 36-42.
4.	何传正, 唐海燕, 吴发庆. 椎间盘源性下腰痛的发生机制与治疗现状[J]. 吉林医学, 2010, 31(18): 2909-2910.
5.	刘延青. 重视椎间盘源性疼痛的诊疗[J]. 中国疼痛医学杂志, 2011, 17(5): 257.
6.	陈宁. 实用疼痛治疗手册[M]. 北京: 北京医科大学中国协和医科大学联合出版社, 1996: 35.
7.	郑光新, 赵晓鸥, 刘广林, 等. Oswestry功能障碍指数评定腰痛患者的可信性[J]. 中国脊柱脊髓杂志, 2002, 12(1): 13-15.
8.	李春波, 何燕玲. 健康状况调查问卷SF-36的介绍[J]. 国外医学·精神病学分册, 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.	叶君健, 宋继红, 姜小鹰, 等. 腰椎间盘突出症髓核组织磷脂酶A2表达的临床研究[J]. 中国骨与关节损伤杂志, 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.	叶伟, 马若凡, 丁悦, 等. IL-6对体外培养的兔软骨终板细胞生物学行为的影响[J]. 南方医科大学学报, 2007, 27(8): 1187.
23.	董振风, 黄秀芳, 董永东, 等. IL-8及TNF在突出椎间盘中的表达意义[J]. 潍坊医学院学报, 2008, 30(5): 447-448.
24.	姜世峰, 申才良. 腰椎Modic改变中炎性细胞因子的效应[J]. 中国组织工程研究, 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.	陈操, 史晨辉, 刘维钢. 炎性细胞因子与椎间盘退变相关性的研究进展[J]. 农垦医学, 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.	张施展, 蒋林. 盐酸氨基葡萄糖治疗腰椎关节突关节骨性关节炎的临床观察[J]. 华西医学, 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. 　黄荷, 马玉桃, 廖志辉, 等. 身痛逐瘀汤结合臭氧消融术治疗椎间盘源性腰痛30例临床观察[J]. 新中医, 2011, 43(8): 61-62.
3. 　石锐, 胡韬, 丁琛, 等. 盐酸氨基葡萄糖联合低剂量NSAIDS类药物与单纯用药治疗小关节骨关节炎伴下腰痛的随机对照研究[J]. 中国骨与关节外科, 2012, 5(1): 36-42.
4. 　何传正, 唐海燕, 吴发庆. 椎间盘源性下腰痛的发生机制与治疗现状[J]. 吉林医学, 2010, 31(18): 2909-2910.
5. 　刘延青. 重视椎间盘源性疼痛的诊疗[J]. 中国疼痛医学杂志, 2011, 17(5): 257.
6. 　陈宁. 实用疼痛治疗手册[M]. 北京: 北京医科大学中国协和医科大学联合出版社, 1996: 35.
7. 　郑光新, 赵晓鸥, 刘广林, 等. Oswestry功能障碍指数评定腰痛患者的可信性[J]. 中国脊柱脊髓杂志, 2002, 12(1): 13-15.
8. 　李春波, 何燕玲. 健康状况调查问卷SF-36的介绍[J]. 国外医学·精神病学分册, 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. 　叶君健, 宋继红, 姜小鹰, 等. 腰椎间盘突出症髓核组织磷脂酶A2表达的临床研究[J]. 中国骨与关节损伤杂志, 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. 　叶伟, 马若凡, 丁悦, 等. IL-6对体外培养的兔软骨终板细胞生物学行为的影响[J]. 南方医科大学学报, 2007, 27(8): 1187.
23. 　董振风, 黄秀芳, 董永东, 等. IL-8及TNF在突出椎间盘中的表达意义[J]. 潍坊医学院学报, 2008, 30(5): 447-448.
24. 　姜世峰, 申才良. 腰椎Modic改变中炎性细胞因子的效应[J]. 中国组织工程研究, 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. 　陈操, 史晨辉, 刘维钢. 炎性细胞因子与椎间盘退变相关性的研究进展[J]. 农垦医学, 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. 　张施展, 蒋林. 盐酸氨基葡萄糖治疗腰椎关节突关节骨性关节炎的临床观察[J]. 华西医学, 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.

West China Medical Journal

Randomized Controlled Trials on Treatment of Discogenic Low Back Pain by Glucosamine Hydrochloride

Abstract Full text Figures/Tables Video References Cited by

Format

Content