20 种常见骨关节炎保健品的功效回顾

骨关节炎(Osteoarthritis)是最常见的关节炎类型。医疗手段治疗重点在于缓解关节疼痛、肿胀和功能减退等,常规药物包括非甾体抗炎药(NSAIDS),对乙酰氨基酚(一类止痛药)和皮质类固醇注射剂(抗炎激素)。非医疗方法就涉及很多方面,包括生活方式的改变,如运动和控制体重等。

美国常见的 4 类非处方止痛药

《英国医学杂志》的综述文章

《英国医学杂志》(BMJ)2017 年 10 月刊发了一篇由澳大利亚悉尼大学 6 位研究人员撰写的综述文章 [来源],回顾了对 20 种骨关节炎保健品的 69 项研究,发现:

  • 有 7 种保健品对于短期缓解疼痛具有临床重要效果。
  • 有 6 种保健品对于缓解疼痛有统计显著效果、但临床重要性不明确。
  • 有两种保健品对于中期缓解疼痛有临床重要效果。
  • 没有保健品对于长期缓解疼痛有临床重要效果。

关于「临床重要效果」(clinically important effects)和「统计显著效果」(statistically significant improvements)的区别,可以阅读这篇文章:Statistical significance vs. clinical significance 。简单点说:

  • 「临床重要效果」指受测药物/保健品可能对患者的日常生活产生真实、能明显感觉到的变化。
  • 「统计显著效果」指双盲对照试验中,产生的差异「比较明显」,P 值 < 0.05,不大可能是因为巧合。

再简单点说,对于药物和保健品的功效,「临床重要效果」更重要。

七种短期缓解关节疼痛的保健品

在英国医学杂志发表的综述文章中,以下 7 种保健品缓解关节疼痛的功效具有「临床重要效果」。

水解胶原蛋白

水解胶原蛋白(Collagen Hydrolysate)对于骨关节炎的功效,德国和美国研究者 2006 年在《当代医学研究与见解》(Current Medical Research and Opinion)上发表过一篇回顾文章 [来源],发现:

These findings suggest mechanisms that might help patients affected by joint disorders such as OA. Four open-label and three double-blind studies were identified and reviewed; although many of these studies did not provide key information – such as the statistical significance of the findings – they showed collagen hydrolysate to be safe and to provide improvement in some measures of pain and function in some men and women with OA or other arthritic conditions.

就是说,虽然还有待更多的关键信息,但目前的很多研究表明,水解胶原蛋白安全,并且在一些患有骨关节炎或其他关节炎的男性和女性病人中,在一定程度上缓解了疼痛、改善了关节能力。

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百香果果皮精华

伊朗、美国和新西兰的研究者 2010 年发表在《营养研究》(Nutrition Research)论文显示 [来源],在针对 33 名膝关节炎患者的双盲试验中,每日服用 150 毫克百香果果皮精华(passion fruit peel extract)的患者,60 天后疼痛下降 18.6% 、关节僵硬缓解 18% 、关节功能改善 19.6% 。研究人员认为这可能是由于百香果果皮精华的抗氧化和消炎特性。遗憾的是我们并未找到哪里有卖,包括 Amazon ……

姜黄精华

印度研究者 2016 年发表在 Inflammopharmacology 上的论文显示 [来源],在针对 160 名膝关节炎患者的双盲试验中,服用姜黄精华(Curcuma Longa Extract)的患者在 60 天和 120 天后,相比对照试验组有明显的改善。研究者的结论是:姜黄精华能抑制发炎、并减轻氧化应激(oxidative stress)。

齿叶乳香精华

印度研究者 2004 年发表在 Phytomedicine 的论文显示 [来源],在针对 30 名膝关节炎患者的双盲试验中,服用齿叶乳香精华(Boswellia Serrata Extract)8 周后,患者疼痛缓解、 膝部屈伸(knee flexion)得以改善、可行走距离增加、膝关节肿胀的频率减少。除轻微的肠胃不适外,试验对象耐受良好、没有明显的副作用。

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姜黄素

姜黄素(Curcumin)是姜黄的有效成分,其功效参见上文「姜黄精华」。美国关节炎基金会(Arthritis Foundation)官网列举了几项相关的研究 [来源]

  • 多项研究表明姜黄素有抗炎功效、并修改人体的免疫功能反应。
  • 2006 年一项研究表明,相比于缓解炎症,姜黄素对于预防关节炎更有效。
  • 2010 年一项研究发现,100 名膝关节炎患者服用姜黄素保健品 Meriva 后疼痛和关节功能得到了长期改善。
  • 2012 年一项小规模的预备研究发现,类风湿关节炎患者使用姜黄素产品 BCM-95,其减缓关节疼痛及肿胀的效果好于非甾体抗炎药双氯芬酸(Diclofenac)。
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碧萝芷

据美国关节炎基金会官网的介绍 [来源],碧萝芷(Pycnogenol)含有原花青素(Procyandin),这是一种强效抗氧化剂,并且似乎能抑制人体内引起发炎的酶,包括 COX 1 和 COX 2 。 2007 年亚利桑那大学的一项小型研究发现碧萝芷缓解关节疼痛达到 43% 、缓解关节僵硬达到 25% 。 2008 年的两项研究表明,关节疼痛、僵硬、功能均有明显改善,效果持续到停用之后。不过,2012 年的一项回顾认为这些研究设计不合理、缺乏说服力。

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左旋肉碱

关于左旋肉碱(L-carnitine)和关节炎的研究似乎较少,我大致查了下只看到意大利研究者于 2014 年发表在 Life Sciences 上的论文 [来源],是小鼠的动物实验,表明左旋肉碱可能有减缓关节僵化的功效,有用于膝关节炎治疗的潜力。

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左旋肉碱还是一种常见的减肥保健品,我们在下面这篇文章里有介绍。

美国常见减肥药的功效|管住嘴、迈开腿!

另外六种可能缓解关节疼痛的保健品

在英国医学杂志发表的综述文章中,以下 7 种保健品缓解关节疼痛的功效具有「统计显著性」,其中葡萄糖胺和软骨素合并在一起介绍。另外,非变形第二型胶原蛋白(Undenatured Type II Collagen)除了短期缓解疼痛的「统计显著性」效果外,对于中期缓解疼痛有「临床重要效果」。

非变形第二型胶原蛋白

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鳄梨/大豆不皂化物

鳄梨/大豆不皂化物(Avocado-soybean unsaponifiables;ASU)是由鳄梨油和大豆提取物制成的补充剂。 NIH 的综述和 BMJ 的研究都认为,ASU 可能对骨关节炎症状有益。 Mayo Clinic 对骨关节炎的综述表示 [来源]:”It[ASU] acts as an anti-inflammatory, and some studies have shown it can slow or even prevent joint damage.” 它有抗炎的作用,有些研究发现它可以减缓甚至预防关节损伤。

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磺酰甲烷

甲磺酰甲烷(methylsulfonylmethane;MSM)已用于治疗关节炎相关病症。然而,目前关于 MSM 对骨关节炎疗效的证据仅限于临床试验报告和少数研究的元分析。 英国运动医学杂志的研究表明:MSM 在短期内改善骨关节功能有较大的临床影响。

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安必丁

安必丁(Diacerein)现在是药物,不是保健品。

葡萄糖胺和软骨素

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很受欢迎的 Move Free 维骨力,核心成分就是葡萄糖胺(Glucosamine)、软骨素(Chondroitin)和 MSM 。

Move Free 维骨力 5 种瓶装的功效和区别

S-腺苷甲硫氨酸

本项根据美国国家研究院的综述文章补充 [来源] 。 S-腺苷甲硫氨酸(SAMe)是人体自然产生的一种分子,不过保健品里的 SAMe 都是人工合成。 NIH 综述表示:目前没有足够的证据支持将 SAMe 用于膝关节或髋关节骨关节炎。 Mayo Clinic 对 SAMe 的综述说 [来源],有很多研究发现 SAMe 和非甾体抗炎药的功效类似,可以缓解疼痛、增强关节功能,并且副作用较少;但也有较少的研究中并未证实此种功效。换言之,其功效仍然有争议。

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SAMe 通常来说安全,常见副作用包括肠胃不适、口干、头痛、出汗、头晕等。

中期缓解关节疼痛的两种保健品

除了短期功效外,英国医学杂志发布的综述文章还讨论了中期功效,只有两种保健品具有「临床重要意义」,一是上面已经介绍过的非变形第二型胶原蛋白,还有一个是绿唇贻贝精华(green-lipped mussel extract)。

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绿唇贻贝是一种盛产于新西兰的贝类。美国关节炎基金会介绍 [来源],这些贝类富含 Omega-3,可能和鱼油含有同样的抗炎功效。一项 2006 年的回顾发现,在 5 项临床研究中,有两项发现绿唇贻贝精华对骨关节炎和类风湿性关节炎有益。 2008 年的一项骨关节炎研究回顾发现,在传统治疗手段中加入绿唇贻贝精华有益处。另外,非甾体抗炎药可能刺激肠胃,而绿唇贻贝精华反而可能有助于溃疡愈合。

美国药剂师推荐的骨骼和关节保健品》《美国药剂师推荐的关节炎和关节疼痛外用药》《美国常见保健品的功效与注意事项》 《【收藏】美国保健品推荐和攻略

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