补肾活血汤治疗膝骨性关节炎的临床观察及机制探讨
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摘要
目的：
观察补肾活血汤治疗肾虚血瘀型膝关节骨性关节炎(KOA)的临床疗效及其用药前后KOA患者膝关节液中一氧化氮(NO)、白细胞介素1β(IL-1β)、转化生长因子β1(TGF-β1)水平的变化。本实验通过前瞻性的研究,借助统计学方法,进一步探讨补肾活血法治疗肾虚血瘀型KOA的作用机理。
方法：
研究对象为我院骨科门诊患者,按膝骨性关节炎的中西医诊断标准、纳入标准及排除标准,纳入肾虚血瘀型膝骨性关节炎病人30例,予服用补肾活血汤,连续治疗2个疗程(6周),观察治疗前后患者膝关节Lysholm评分情况、X线摄片变化及不良反应。并按实验室检测指标规定要求于治疗前、治疗后分别抽取关节液(-20℃低温保存),采用比色法检测NO,双抗体夹心法检测IL-1β, TGF-β1,所得数据用SPSS13.0 for Windows软件进行统计学处理。
结果：
患者膝关节Lysholm评分呈上升趋势,患者膝部症状、体征及膝关节活动功能均明显改善,治疗前后X线片显示无明显改变,未发现不良反应；治疗1个疗程患者膝关节液中NO及EL-1β水平均明显下降,TGF-β1的水平均明显升高;治疗2个疗程患者膝关节液中NO及DL-β1水平均继续下降,TGF-β1的水平均继续上升。结论：补肾活血汤可改善膝骨性关节炎患者的临床症状、体征及膝关节活动功能；降低患者膝关节液中NO、IL-1β的水平,提高关节液中TGF-β1的水平,说明IL-1β、NO、TGF-β1可能与骨性关节炎的发病有关。补肾活血汤在一定程度上可能是通过影响关节液中TGF-β1水平变化而起效的。
Objective:To observe the therapeutic effect and the levels of nitric oxide (NO), interleukin-1β(IL-1β), transforming growth factorβ1 (TGF-β1) in synovial fluid before and after treatment on knee osteoarthritis(OA) with Bushen Huoxue decoction, we investigated the further mechanism by tonifying kidney and invigorating the circulation of blood for the knee osteoarthritis using prospective study and statistics methods.
Methods:Object of study for the Orthopedic outpatient patients, according to knee osteoarthritis in the Western diagnostic criteria, inclusion criteria and exclusion criteria into kidney deficiency and blood stasis-type osteoarthritis of the knee.30 patients taking the benefits to Bushen Huoxue Decoction, continuous treatment of 2 courses (6 weeks) were observed before and after treatment in patients with Lysholm knee score situation, X-ray changes and adverse reactions. Laboratory testing of indicators in accordance with the provisions required in the treatment before and after treatment, respectively, synovial fluid extraction (-20℃cold storage), using colorimetric detection of NO, double-antibody sandwich assay IL-1β, TGF-β1, the data used SPSS13.0 for Windows software for statistical analysis.
Results:Lysholm knee score showed an upward trend, the patient knee symptoms, signs and knee function were significantly improved,X-ray film before and after treatment showed no significant changes and found no adverse reaction; the levels of NO and IL-1βwere significantly decreased, TGF-β1 were significantly higher after a course of treatment; the levels of NO and IL-1βwere continued to decline and TGF-β1 continue to rise on average after two courses of treatment.
Conclusion:Bushen Huoxue Decoction can improve knee osteoarthritis in patients with clinical symptoms, signs and knee function; lower the levels of NO, IL-1β, increased the levels of TGF-β1 in synovial fluid. it may be inferred that the levels of IL-1β, NO, TGF-β1 are related to the pathogenesis of osteoarthritis. In a certain extent, Bushen Huoxue Decoction may take effect by affecting the levels on IL-1β, NO and TGF-β1 in synovial fluid.
观察补肾活血汤治疗肾虚血瘀型膝关节骨性关节炎(KOA)的临床疗效及其用药前后KOA患者膝关节液中一氧化氮(NO)、白细胞介素1β(IL-1β)、转化生长因子β1(TGF-β1)水平的变化。本实验通过前瞻性的研究,借助统计学方法,进一步探讨补肾活血法治疗肾虚血瘀型KOA的作用机理。
方法：
研究对象为我院骨科门诊患者,按膝骨性关节炎的中西医诊断标准、纳入标准及排除标准,纳入肾虚血瘀型膝骨性关节炎病人30例,予服用补肾活血汤,连续治疗2个疗程(6周),观察治疗前后患者膝关节Lysholm评分情况、X线摄片变化及不良反应。并按实验室检测指标规定要求于治疗前、治疗后分别抽取关节液(-20℃低温保存),采用比色法检测NO,双抗体夹心法检测IL-1β, TGF-β1,所得数据用SPSS13.0 for Windows软件进行统计学处理。
结果：
患者膝关节Lysholm评分呈上升趋势,患者膝部症状、体征及膝关节活动功能均明显改善,治疗前后X线片显示无明显改变,未发现不良反应；治疗1个疗程患者膝关节液中NO及EL-1β水平均明显下降,TGF-β1的水平均明显升高;治疗2个疗程患者膝关节液中NO及DL-β1水平均继续下降,TGF-β1的水平均继续上升。结论：补肾活血汤可改善膝骨性关节炎患者的临床症状、体征及膝关节活动功能；降低患者膝关节液中NO、IL-1β的水平,提高关节液中TGF-β1的水平,说明IL-1β、NO、TGF-β1可能与骨性关节炎的发病有关。补肾活血汤在一定程度上可能是通过影响关节液中TGF-β1水平变化而起效的。
Objective:To observe the therapeutic effect and the levels of nitric oxide (NO), interleukin-1β(IL-1β), transforming growth factorβ1 (TGF-β1) in synovial fluid before and after treatment on knee osteoarthritis(OA) with Bushen Huoxue decoction, we investigated the further mechanism by tonifying kidney and invigorating the circulation of blood for the knee osteoarthritis using prospective study and statistics methods.
Methods:Object of study for the Orthopedic outpatient patients, according to knee osteoarthritis in the Western diagnostic criteria, inclusion criteria and exclusion criteria into kidney deficiency and blood stasis-type osteoarthritis of the knee.30 patients taking the benefits to Bushen Huoxue Decoction, continuous treatment of 2 courses (6 weeks) were observed before and after treatment in patients with Lysholm knee score situation, X-ray changes and adverse reactions. Laboratory testing of indicators in accordance with the provisions required in the treatment before and after treatment, respectively, synovial fluid extraction (-20℃cold storage), using colorimetric detection of NO, double-antibody sandwich assay IL-1β, TGF-β1, the data used SPSS13.0 for Windows software for statistical analysis.
Results:Lysholm knee score showed an upward trend, the patient knee symptoms, signs and knee function were significantly improved,X-ray film before and after treatment showed no significant changes and found no adverse reaction; the levels of NO and IL-1βwere significantly decreased, TGF-β1 were significantly higher after a course of treatment; the levels of NO and IL-1βwere continued to decline and TGF-β1 continue to rise on average after two courses of treatment.
Conclusion:Bushen Huoxue Decoction can improve knee osteoarthritis in patients with clinical symptoms, signs and knee function; lower the levels of NO, IL-1β, increased the levels of TGF-β1 in synovial fluid. it may be inferred that the levels of IL-1β, NO, TGF-β1 are related to the pathogenesis of osteoarthritis. In a certain extent, Bushen Huoxue Decoction may take effect by affecting the levels on IL-1β, NO and TGF-β1 in synovial fluid.
引文
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[8]金大地,孙炜,王吉兴.一氧化氮合酶抑制剂对骨性关节炎的潜在治疗意义[J].中华骨科杂志,2002：22(6)：367.
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[10]周琦石,郑晓辉,王海彬,等.补肾益气行血方(骨炎定)对人类骨关节炎软骨细胞Ⅱ型胶原和一氧化氮合酶的影响[J].中医药通报,2007,6(4)：50-56.
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[1]周斌,樊粤光,曾意荣.中药关节康治疗膝骨性关节炎的临床研究[J].广州中医药大学学报2006,23(6)：476-480.
[2]曾意荣,樊粤光.刘少军等补肾活血中药治疗肾虚血瘀型膝骨性关节炎的临床研究[J].广州中医药大学学报,2007,24(4).276-278.
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[12]杨平林,刘德玉,贺西京,等.补肾活血中药对膝骨性关节炎家兔血清、滑膜及关节软骨氧化氮水平的影响[J].中国骨伤,2003,16(11)：667.
[13]周琦石,郑晓辉,王海彬,等.补肾益气行血方(骨炎定)对人类骨关节炎软骨细胞Ⅱ型胶原和一氧化氮合酶的影响[J].中医药通报,2007,6(4)：50-56.
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[17]余丹丹.骨性关节炎实验研究进展[J]中医正骨2002,12(12)：50-521.
[18]唐勇,姜杰,孟辉,等.补肾益气活血方对兔实验性膝骨关节炎软骨细胞bFGF-mRNA表达的影响[J].云南中医学院学报,2005,28(4)：24-26.
[19]郭礼跃,胡慧华,米健国.古方稀莶丸对膝骨性关节炎模型家兔关节液中IL-1b、TNFα含量及关节软骨细胞形态学的影响[J].中国骨伤2006,19(6)：377-378.
[20]苏友新,陈顺有,林清坚,等.壮骨健膝方对膝骨性关节炎患者关节滑液细胞因子、NO的影响[J].福建中医学院学报,2006,16(2)：38-40.
[21]马少云,陈利新,曹建斌,等.膝OA中医证型与一氧化氮、白介素1b、转化生长因子b1的关系研究[J].中医正骨2008,20(4)：3-4.
[22]安莉萍,卫荣,魏晓丽,刘渊.益肾通痹方对膝关节骨性关节炎兔血清和膝关节腔液中炎性细胞因子和一氧化氮含量的影响[J].中国临床康复,2006,10(15)：79-81.
[2]牛维,王斌.中药免煎颗粒补肾活血方治疗膝关节骨性关节炎临床疗效观察[J].中国医药学,2003,18(5)：317.
[3]周斌,樊粤光,曾意荣.中药关节康治疗膝骨性关节炎的临床研究[J].广州中医药大学学报,2006,23(6)：476-480.
[4]曾意荣,樊粤光.刘少军等补肾活血中药治疗肾虚血瘀型膝骨性关节炎的临床研究[J].广州中医药大学学报,2007,24(4)：276-278.
[5]胡劲松,曾一林.退行性骨关节病的发病机理研究[J].中医正骨,1999,11(12)：49-50.
[6]徐传毅,樊粤光,宁显明.肾虚血瘀与膝骨性关节炎关系初探[J].新中医,2002,34(3)：7-9.
[7]贺宪,魏春山,蔡智刚.膝骨性关节炎的病机和防治机制探讨[J].山东中医杂志,2005,24(2)：73-75.
[8]金大地,孙炜,王吉兴.一氧化氮合酶抑制剂对骨性关节炎的潜在治疗意义[J].中华骨科杂志,2002：22(6)：367.
[9]高石军,陈百成,汤慧华,等.一氧化氮在骨性关节炎发病机制中的作用[J].中华骨科杂志,1999,19(7)：411.
[10]周琦石,郑晓辉,王海彬,等.补肾益气行血方(骨炎定)对人类骨关节炎软骨细胞Ⅱ型胶原和一氧化氮合酶的影响[J].中医药通报,2007,6(4)：50-56.
[11]杨平林,刘德玉,贺西京,等.补肾活血中药对膝骨性关节炎家兔血清、滑膜及关节软骨一氧化氮水平的影响[J].中国骨伤,2003,16(11)：667.
[12]苏友新,陈顺有,林清坚,等.壮骨健膝方对膝骨性关节炎患者关节滑液细胞因子、NO的影响[J].福建中医学院学报,2006,16(2)：38-40.
[13]余丹丹.骨性关节炎实验研究进展[J].中医正骨,2002,12(12)：50-521.
[14]Kardel R, Ulfgren AK, Reinholt FP, etal. Inflammatory cell and cytokine patterns in patients with painful clicking and osteoarthritis in the tempermandibular joint [J].International Journal of Oral and Maxillofacial Surgery.2003.32(4):390-396.
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