中药“艾辛痛方”外用治疗膝骨性关节炎临床观察及对细胞因子IL-17调节作用初探
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摘要
目的:观察中药"艾辛痛方"外用治疗膝关节骨性关节炎的临床疗效,并探讨白细胞介素17(IL-17)的调节作用。方法:纳入膝关节骨性关节炎患者20例,给予"艾辛痛方"外敷膝关节治疗7～14 d,配合电磁波治疗仪(TDP)照射。通过观察临床症状和膝围大小,利用疼痛视觉VAS评分、骨科学会JOA积分和奎森功能演算指数(Lequesne指数)综合评价临床疗效,采用ELISA检测治疗前后IL-17变化。结果:20例受试者临床治愈总有效率90%,治疗后VAS和Lequesne指数均较治疗前下降,JOA积分升高,膝围缩小且与IL-17呈正向线性相关,IL-17较前降低。结论:中药"艾辛痛方"外用治疗膝骨性关节炎可有效缓解膝关节疼痛,减轻膝关节肿胀,其作用机制与下调IL-17有关。
Objective: Observation of the traditional Chinese medicine "Aixintong Fang"external treatment of knee osteoarthritis,and to explore the regulating effect of Cytokine Interleukin-17( IL-17). Methods: The 20 knee osteoarthritis patients with external treatment of traditional Chinese Medicine " Aixintong Fang" once a day with electromagnetic wave therapy instrument( TDP),continuous treatment of 7 to 14 days. Observing the clinical symptoms of knee joint and the size of the knee circumference,using Visual Analogue Score( VAS),Japanese Orthopaedic Association score( JOA score) and Lequesne index comprehensive evaluation of clinical therapeutic effect. Using Elisa test before and after treatment in the peripheral blood of Cytokine IL-17.Results: In the 20 subjects,the total effective rate was 90%. VAS score and Lequesne index after treatment than before treatment significantly decreased. JOA score significantly increased. Swelling of the knee circumference relatively narrow before treatment and with IL-17 was positively linear correlation. IL-17 is lower than before treatment. Conclusion: " Aixintong Fang" external treatment can reduce the pain of knee osteoarthritis,and reduce swelling in the knee joint. The mechanism may be relate to the reduction f observing Cytokine IL-17.
Objective: Observation of the traditional Chinese medicine "Aixintong Fang"external treatment of knee osteoarthritis,and to explore the regulating effect of Cytokine Interleukin-17( IL-17). Methods: The 20 knee osteoarthritis patients with external treatment of traditional Chinese Medicine " Aixintong Fang" once a day with electromagnetic wave therapy instrument( TDP),continuous treatment of 7 to 14 days. Observing the clinical symptoms of knee joint and the size of the knee circumference,using Visual Analogue Score( VAS),Japanese Orthopaedic Association score( JOA score) and Lequesne index comprehensive evaluation of clinical therapeutic effect. Using Elisa test before and after treatment in the peripheral blood of Cytokine IL-17.Results: In the 20 subjects,the total effective rate was 90%. VAS score and Lequesne index after treatment than before treatment significantly decreased. JOA score significantly increased. Swelling of the knee circumference relatively narrow before treatment and with IL-17 was positively linear correlation. IL-17 is lower than before treatment. Conclusion: " Aixintong Fang" external treatment can reduce the pain of knee osteoarthritis,and reduce swelling in the knee joint. The mechanism may be relate to the reduction f observing Cytokine IL-17.
引文
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[13]郭敏,彭丽,郭静.当归饮子对慢性荨麻疹小鼠外周血清IL-17、IL-23水平的抑制作用[J].中华中医药杂志,2017,32(9):4121-4123.
[14]安莉萍,袁丽,傅卫燕.当归拈痛汤加味膏剂对AA大鼠抗炎镇痛作用的实验研究[J].新疆中医药,2012,30(2):3-5.
[15]WOJDASIEWICZ P,PONIATOWSKI LA,SZUKIEWICZ D.The role of inflammatory and anti-inflammatory cytokines in the pathogenesis of osteoarthritis[J].Cytokine,2014,66(2):127-132.
[16]MLADENOVIC Z, SAUREL AS, BERENBAUM F, et al.Potential role of hyaluronic acid on bone in osteoarthritis:matrix metalloproteinases,aggrecanases, and RANKL expression are partially prevented by hyaluronic acid in interleukin 1-stimulated osteoblasts[J].J Rheumatol,2014,41(5):945-54.
[17]LEE SY,KWOK SK,SON HJ,et al. IL-17-mediated Bcl-2expression regulates survival of fibroblast-like synoviocytes in rheumatoid arthritis through STAT3 activation[J]. Arthritis Res Ther,2013,15(1):R31.
[18]ZHENG CS,YE HZ,XU XJ,et al.Computational pharmacology study of Tougu Xiaotong Granule in preventing and treating knee osteoarthritis[J].Chinese Journal of Integrative Medicine,2009,15(5):371-376.
[2]KELLGREN JH,LAWRENCE JS. Radiological assessment of osteo arthrosis[J].Ann Rheum Dis,1957,16(4):494-502.
[3]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:349-353.
[4]中华医学会.临床诊疗指南·风湿病分册[M].北京:人民卫生出版社,2005:16-20.
[5]骨痹的诊断依据、证候分类、疗效评定——中华人民共和国中医药行业标准《中医内科病证诊断疗效标准》(ZY/T001. 1-94)[J].辽宁中医药大学学报,2017,19(1):224.
[6]LEQUESNE MG,SAMSON M. Indices of severity in osteoarthritis for weight bearing joint[J].J Rheumatoi Suppl,1991(27):16-18.
[7]YONENOBU K,ABUMI K,NAGATA K,et al.Interobserver and intraobserver reliability of the Japanese Orthopaedic Association scoring system for evaluation of cervical compression myelopathy[J].Spine,2001,26(17):1890-1894.
[8]SILVERWOOD V,BLAGOJEVIC-BUCKNALL M,JINKS C,et al. Current evidence on risk factors for knee osteoarthritis in older adults:a systematic review and meta-analysis[J]. Osteoarthritis Cartilage,2015,23(4):507-15.
[9]刘献祥.中医药治疗膝骨性关节炎的研究现状[J].中医正骨,2012,24(1):3-7.
[10]洪敏,罗小宁,王素梅.外敷药治疗腰椎间盘突出症40例[J],中医外治杂志,2005,14(2).
[11]万毅,余炜.艾叶二氧化碳超临界萃取物巴布剂对类风湿关节炎大鼠的治疗作用[J].浙江中医药大学学报,2013,37(7):839-844.
[12]李杨,明海霞.单叶细辛对寒饮射肺证模型大鼠HYP、IL-17及IL-6动态表达的实验研究[J].中医研究,2015,28(6):58-60.
[13]郭敏,彭丽,郭静.当归饮子对慢性荨麻疹小鼠外周血清IL-17、IL-23水平的抑制作用[J].中华中医药杂志,2017,32(9):4121-4123.
[14]安莉萍,袁丽,傅卫燕.当归拈痛汤加味膏剂对AA大鼠抗炎镇痛作用的实验研究[J].新疆中医药,2012,30(2):3-5.
[15]WOJDASIEWICZ P,PONIATOWSKI LA,SZUKIEWICZ D.The role of inflammatory and anti-inflammatory cytokines in the pathogenesis of osteoarthritis[J].Cytokine,2014,66(2):127-132.
[16]MLADENOVIC Z, SAUREL AS, BERENBAUM F, et al.Potential role of hyaluronic acid on bone in osteoarthritis:matrix metalloproteinases,aggrecanases, and RANKL expression are partially prevented by hyaluronic acid in interleukin 1-stimulated osteoblasts[J].J Rheumatol,2014,41(5):945-54.
[17]LEE SY,KWOK SK,SON HJ,et al. IL-17-mediated Bcl-2expression regulates survival of fibroblast-like synoviocytes in rheumatoid arthritis through STAT3 activation[J]. Arthritis Res Ther,2013,15(1):R31.
[18]ZHENG CS,YE HZ,XU XJ,et al.Computational pharmacology study of Tougu Xiaotong Granule in preventing and treating knee osteoarthritis[J].Chinese Journal of Integrative Medicine,2009,15(5):371-376.