[2004]氨基葡萄糖治疗骨关节炎的现状

[]100727669(2004)07204552043(,510120)[]2004203222[]2004204230[](19672),,,,,,[]Phn:862202813322572Fax:[phone]E2mail:[e-mail]3[];;;[](OA),,,OA,OA,OA,,[]R977.4;R684.3[]A(osteoarthritis,OA)OA,()(ACR)(EULAR)[1]OA(symptom2modifyingdrugs)(structure2modifyingdrugs),,(NSAIDs)OA,,,,OA,1TOWHEED[2]Cochrane16OA(RCTs)OA,13RCTs12,4NSAIDsRCTs[3,1(piroxicam)]2NSAIDs,2,NSAIDs(0.86,95%CI0.581.14)[2,3]OAFORESTER[4](glu2cosaminesulfate,GS)OA,GS6wk51.2%,28.6%,P=0.034GS,4wk,GS,GSOAGS[5,6]2OA22[7,8]GSOAREGINSTERPAVELKA21220245aOA(ACR)(3a)GS(1500mgd-1)1,3aX,,,WOMAC(theWesternOntarioandMcMasterUni2554(ChinJNewDrugsClinRem),20047,237E2mail:[e-mail])LequesneREGIN2STER[7]1063a,-0.31mm,95%CI-0.48-0.13mm(),-0.40mm,95%CI-0.56-0.24mm;GS106,-0.06mm,95%CI-0.220.09mm,-0.07mm,95%CI-0.220.07mm,P0.0430.0033aGS(0.5mm)30%15%,WOMAC9.8%-11.7%(P=0.02),3a,GSPAVELKA[8]3a,-0.19mm,95%CI-0.29-0.09mm,GS,-0.04mm,95%CI-0.060.14mm,P=0.001GS,5%14%,P=0.05,GS20%25%,LequesneWOMAC,GSOA,OAGS1OA[9]OAXGS,6.2mmOAGS3a6.0%,14.9%(P=0.10),4.5mmOAGS3a6.2%,3.8%(P=0.70),OA,OA3a0.5mm0.42(0.171.01),GSOA3,,OAOAX,OA,PAVELKA[10]GS3a,-0.21mm,GS+0.15mm,P=0.003,3a-0.28mm,GS+0.21mm,P=0.014,,3a,,GS,GS,,GS,121486GS48GS,7[11](),1[12,13],,GSGSGS2[14]GS,,,,,,GS3GS()2,GS,GS,OTCRUSSELL[15]14GS,59%138%,41%108%,,654(ChinJNewDrugsClinRem),20047,237E2mail:[e-mail][16]OA,8wkWOMAC,49%,40%,P=0.58GSOAGS,,,[17]GSHOFFER[17]71.0gGS,3h(37517)mmolL-1,(33121)mmolL-1,P0.05GS(paracetamol)3h(29019)mmolL-1,(32519)mmolL-1,P0.05,,GS,GSOA,,RUSSELL[18]OA,3gGSOA[][1]PENDLETONA,ARDENN,DOUGADOSM,etal.EULARrecommendationsforthemanagementofkneeosteoarthritis:re2portofataskforceoftheStandingCommitteeforInternClinicalStudiesIncludingTheraputicTrials(ESCISIT)[J].AnnRhuemDis,2000,59(12):9362944.[2]TWOHEEDTE.Currentstatusofglucosaminetherapyinos2teoarthritis[J].ArthritisResearch,2003,49(4):6012604.[3]MATHESONAJ,PERRYCM.Glucosamine:areviewofitsuseinthemanagementofosteoarthritis[J].DrugsAging,2003,20(14):104121060.[4]FORESTERKK,SCHMIDK,ROVATILC,etal.Efficacyofglucosaminesulfateinosteoarthritisofthelumbarspine:aplacebo2controlled,randomized,doubl2blindstudy[J].ArthritisRheum,2000,43Suppl9:S335.[5]RINDONEJP,HILLERD,COLLACOTTE,etal.Random2izedcontrolledtrialofglucosaminefortreatingosteoarthritisoftheknee[J].WestJMed,2000,172(2):91294.[6]HUGHESR,CARRA.Arandomized,double2blind,placebo2controlledtrialofglucosaminesulphateasananalgesicinos2teoarthritisoftheknee[J].Rheumatology(Oxford),2002,41(3):2792284.[7]REGINSTERJY,DEROISYR,ROVATILC,etal.Long2termeffectsofglucosaminesulfateonosteoarthritisprogression:arandomized,placebo2controlledclinicaltrial[J].Lancet,2001,357(9252):2512256.[8]PAVELKAK,GATTEROVAJ,OLEJAROVAM,etal.Glu2cosaminesulfateuseanddelayofprogressionofkneeosteoarthri2tis:a32year,randomized,placebo2controlled,double2blindstudy[J].ArchInternMed,2002,162(18):211322123.[9]BRUYEREO,HONOREA,ETHGENO,etal.Correlationbetweenradiographicseverityofkneeosteoarthritisandfuturedis2easeprogression.Resultsfrom32yearprospective,placebo2con2trolledstudyevaluatingtheeffectofglucosaminesulfate[J].Os2teoarthritisCartilage,2003,11(1):125.[10]PAVELKAK,BRUYEREO,ROVATILC,etal.Reliefinmild2to2moderatepainisnotaconfounderinjointspacenarrowingassessmentoffullextensionkneeradiographsinrecentosteoarthri2tisstructure2modefyingdrugtrials[J].OsteoarhtritisCartilage,2003,11(10):7302737.[11]TWOHEEDTE,ANASTASSIADESTP.Glucosaminetherapyforosteoarthritis[J].JRheumatol,1999,26(11):2294-2297.[12]MONAUNIT,ZENTIMG,CRETTIA,etal.Effectsofglu2cosamineinfusiononinsulinsecretionandinsulinactioninhumans[J].Diabetes,2000,49(6):9262935.[13]CHANNN,BALDEWEGS,TANTM,etal.Glucosaminesul2fateandosteoarthritis[J].Lancet,2001,357(9272):161821619.[14]GOLDSTEINMR.Glucosaminesulfateandosteoarthritis[J].Lancet,2001,357(9268):161721618.[15]RUSSELLAS,AGHAZADEH2HABASHIA,JAMALIF.Ac2tiveingredientconsistencyofcommerciallyavailableglucosaminesulfateproduct[J].JRheumatol,2002,29(11):240722409.[16]HOUPTJB,McMILLANR,WEINC,etal.Effectofglu2cosaminehydrochlorideinthetreatmentofpainofosteoarthritisoftheknee[J].JRheumatol,1999,26(11):242322430.[17]HOFFERLJ,KAPLANLN,HAMADEHMJ,etal.Sulfatecouldmediatethetherapeuticeffectofglucosaminesulfate[J].Metabolism,2001,50(7):7672770.[18]RUSSELLAL.Glucoaminoglycan(GAG)deficiencyinprotectivebarrierasanunderlyingprimarycauseofulcerativecolitis,Crohnsdisease,interstitialcystitisandpossibleReiterssyndrome[J].MedHypotheses,1999,52(4):2972301.AnupdateonglucosaminetherapyonosteoarthritisDAILie3(DivisionofRheumatologyandImmunology,theSecondAffiliatedHospital,SunYat2senUniversi2ty,GuangzhouGUANGDONG510120,China)[KEYWORDS]osteoarthritis;randomizedcon2754(ChinJNewDrugsClinRem),20047,237E2mail:[e-mail][ABSTRACT]AIM:Osteoarthritis(OA)isthemostcommonformofarthritis.Thereisabsen