关键词: 骨关节炎, 倍他米松, 地塞米松

Abstract: Objective  To observe the effect of intra-articular injection of different doses of betamethasone and dexamethasone palmitate on blood glucose, blood lipids and hypothalamus pituitary adrenal(HPA) axis.
Methods  A total of 60 patients aged 45~70 years with a body mass index(BMI) of 18.5~32.0 and visual analogue score(VAS) ≥7 who were planned to undergo intra-articular injection for  knee osteoarthritis(KOA) were enrolled in this study. They were divided into 4 groups according to random number table method, including BL group(compound betamethasone 3.5 mg), BH group(compound betamethasone 7 mg), DL group(dexamethasone palmitate 4 mg) and DH group(dexamethasone palmitate 8 mg). Each group was injected with corresponding doses of glucocorticoids(GCs). VAS scores of four groups before injection(T0) and at 2 d(T1), 4 d(T2), 6 d(T3), 14 d(T4) and 21 d(T5) after injection were recorded. The fasting and 2 h postprandial venous blood were collected from antecubital vein at T0, T1, T2, T3, T4 and T5. Fasting blood glucose(FBG), 2-hour postprandial blood glucose(2 hPG), total cholesterol(TC), triglyceride(TG), and adrenocorticotropic hormone(ACTH) were measured.
Results  Compared to T0, the VAS was decreased at T1, T2, T3, T4, and T5 in the four groups(P＜0.05), comparison between groups was statistically significant(P＜0.05); there was significant difference in the four groups(P＜0.05).  Compared to T0, the 2 hPG was increased at T1, T2, T3, and T4 in the four groups, and there was significant difference(P＜0.05). The 2 hPG was higher in BL group than in BH group, and higher in DL group than in DH group at T3, and there was significant difference(P＜0.05). The 2 hPG was higher in BH group than in BL group, and higher in DH group than in DL group at T4, and there was significant difference(P＜0.05). Compared to T0, the blood cortisol and ACTH were decreased at T1, T2, T3 and T4, suggesting significant difference(P＜0.05), and comparison between groups was statistically significant(P＜0.05).
Conclusion  Intra-articular injection of compound betamethasone (3.5 mg or 7 mg) and dexamethasone(4 mg and 8 mg) can relieve pain caused by KOA, affect the metabolism of 2 hPG within 2 weeks, has no significant effect on FBG and lipid metabolism, and inhibit HPA axis within 2 weeks.

Key words: osteoarthritis, betamethasone, dexamethasone