摘要
背景:研究表明,软骨破坏是膝骨关节炎的主要病理特征,而关节软骨细胞外基质的均衡是维持关节软骨活性和功能的重要条件。目的:观察补肾通络方干预前后膝骨关节炎患者血清和关节液中基质金属蛋白酶1,3、基质金属蛋白酶抑制剂1及白细胞介素1β的含量变化。设计、时间及地点:分子生物学水平的随机对照观察,于2006-03/06在新疆医科大学附属中医医院完成。对象:收集于新疆医科大学附属中医医院行关节镜诊治的膝骨关节炎患者40例(40膝),按信封随机法分为补肾通络方组和对照组,每组20例。方法:补肾通络方组在关节镜检查清理术后第2日开始服用补肾通络方,每天1剂,早晚分服,15d为1个疗程,连续观察2个疗程。补肾通络方由熟地12g,山萸肉9g,杜仲12g,怀牛膝9g,寄生9g,防风10g,秦艽9g,独活9g,细辛3g,当归12g,地龙6g,甘草6g组成,同时根据患者中医证候类型在本方基础上进行加减。对照组仅行关节镜检查清理术。主要观察指标:分别于治疗前后采用酶联免疫吸附双抗体夹心法测定两组患者血清和关节液中基质金属蛋白酶1,3、基质金属蛋白酶抑制剂1及白细胞介素1β含量。结果:与治疗前相比,2个疗程后补肾通络方组患者的血清及关节液中基质金属蛋白酶1、基质金属蛋白酶抑制剂1和白细胞介素1β含量均明显下降(P<0.05);对照组仅关节液中白细胞介素1β含量下降(P<0.05)。结论:与单纯关节镜治疗相比,补肾通络方加关节镜治疗对膝骨关节炎患者软骨细胞外基质以及基质金属蛋白酶的调节作用更加广泛;补肾通络方对膝骨关节炎的防治作用可能是通过调控关节软骨细胞外基质的降解完成的。
BACKGROUND： Cartilage destruction is the principle pathological characteristic of knee osteoarthritis, the equilibrium of extracellular matrix of the articular chondrocytes is the important condition for maintaining the activity and function of articular cartilage.
OBJECTIVE： To observe the content changes of matrix metalloproteinase-1, matrix metalloproteinase-3, tissue inhibitor of matrix metalloprotease-1 and interleukin-lbeta （IL-1β ） in the synovial fluid and serum of patients with knee osteoarthritis before and after Bu Shen Tong Luo decoction intervetion.
DESIGN, TIME AND SETTING： Randomized controlled observation at molecular biological level was conducted at the Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University between March and June 2006.
PARTICIPANTS： Forty patients （40 knees） diagnosed and treated knee osteoarthritis with arthroscope in the Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University were randomized into Bu Shen Tong Luo decoction intervention group and control group, with 20 patients in each group.
METHODS： Patients in the intervention group began to take Bu Shen Tong Luo decoction in the morning and evening at day 2 after arthroscopic debridement, 1 share each day, a course of treatment was 15 days, they were observed for 2 continuous courses of treatment. Composition of Bu Shen Tong Luo： 12 g prepared rhizome of rehmannia, 9 g fructus corni, 12 g eucommia ulmoides, 9 g radix achyranthis bidentatae, 9 g Chinese taxillus herb, 10 g radix sileris, 9 g radix gentianae macrophyllae, 9 g radix angelicae pubescentis, 3 g manchurian wildginger, 12 g radix angelicae sinensis, 6 g earth worm, 6 g radix glycyrrhizae. The doses of the drugs were adjusted according to patient conditions. Patients in the control group were only performed arthroscopic debridement.
MAIN OUTCOME MEASURES： The content of matrix metalloproteinase-1, matrix metalloproteinase-3, tissue inhibitor of matrix metalloprotease-1 and IL-1β in the synovial fluid and serum were determined with ELISA before and after Bu Shen Tong Luo decoction intervetion.
RESULTS： The content of matrix metalloproteinase-1, matrix metalloproteinase-3, tissue inhibitor of matrix metalloprotease-1 and IL-1β in the synovial fluid and serum of patients in the intervention group decreased significantly compared to that before the treatment （P〈 0.05）, while in the control group only IL-1β in the synovial fluid decreased （P 〈 0.05）.
CONCLUSION： Compared to arthroscopic therapy, Bu Shen Tong Luo decoction plus arthroscopic therapy can more extensively adjust extracellular matrix of the articular chondrocytes and matrix metalloprotease in patients with knee osteoarthritis; and the effect of Bu Shen Tong Luo decoction on knee osteoarthritis may perform through regulating the degradation of extracellular matrix of the articular chondrocytes.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第28期5581-5585,共5页
Journal of Clinical Rehabilitative Tissue Engineering Research
