摘要
目的通过观察针刀干预对膝骨关节炎(KOA)兔行为学、髌韧带(PT)力学特性及膝关节软骨白介素4(IL-4)、基质金属蛋白酶-3(MMP-3)、聚集蛋白聚糖(Aggrecan)表达的影响,探讨针刀"调筋治骨"法治疗KOA的作用机制。方法将40只新西兰兔随机分为空白组、模型组、针刀组和电针组,每组10只。模型组、针刀组和电针组采用改良后Videman伸直位固定法建立兔KOA模型。针刀组和电针组造模后分别给予针刀、电针治疗。造模后及治疗后采用改良Lequesne MG的膝关节级别评估法对各组进行行为学评价。治疗后取材,应用Bose Electro Force 3300疲劳试验机对PT进行拉伸、应力松弛和蠕变力学测试,应用ELISA方法检查软骨细胞IL-4表达,应用Real-time PCR法检测MMP-3、Aggrecan m RNA表达水平。结果造模后,模型组Lequesne MG评分与空白组比较,差异具有统计学意义(P<0.01);针刀组、电针组Lequesne MG评分与模型组比较,差异均无统计学意义(P>0.05)。针刀组和电针组治疗后Lequesne MG评分与模型组比较,差异均有统计学意义(P<0.01,P<0.05);针刀组治疗后Lequesne MG评分与电针组比较,差异具有统计学意义(P<0.05)。模型组PT最大应力、最大位移、弹性模量及应力松弛率、蠕变率与空白组比较,差异均具有统计学意义(P<0.01,P<0.05)。针刀组治疗后PT最大应力、最大位移、弹性模量及应力松弛率、蠕变率与模型组比较,差异均有统计学意义(P<0.01,P<0.05);电针组治疗后弹性模量与模型组比较,差异有统计学意义(P<0.01)。模型组造模后IL-4含量、Aggrecan m RNA表达均显著下降,MMP-3 m RNA表达显著上升,与空白组比较差异均有统计学意义(P<0.01,P<0.05);针刀组及电针组治疗后IL-4含量较模型组明显升高(P<0.01,P<0.05),两组Aggrecan m RNA表达均有上升趋势,MMP-3 m RNA表达均有下降趋势,针刀组在调整Aggrecan、MMP-3 m RNA表达方面优于电针组,但与模型组比较差异均无统计学意义(P>0.05)。结论针刀治疗KOA的作用机制可能是通过改善韧带力学特性,调整关节内应力环境,通过IL-4力学信号通路,调整Aggrecan、MMP-3 m RNA表达,阻抑软骨退变,从而起到"调筋治骨"的治疗作用。
Objective To explore the mechanism of therapeutic action of needle knife ＂regulating sinews and treating bones＂ on knee osteoarthritis （KOA） by observing the effect of needle knife intervention on KOA rabbit behaviors, mechanical characteristics of pateUar ligament （PL）, and expressions of interleukin-4 （IL-4）, matrix metalloproteinase-3 （MMP-3） and aggrecan in knee cartilages. Methods Forty New Zealand rabbits were randomly allocated to blank, model, needle knife and electroacupuncture groups, 10 rabbits each. A rabbit model of KOA was made by the modified Videman method of immobilization in extension position. After model making, the needle knife and electroacupuncture groups received needle knife and electroacupuncture treatments, respectively. A behavioral assessment was made using the modified Lequesne MG knee grade evaluation method in every group after model making and treatment. The samples were taken after treatment. PL tension, stress relaxation and creep state were tested using a Bose Electro Force 3300 protracted test machine. Cartilage cell IL-4 expression was examined by ELISA. MMP-3 mRNA and aggrecan mRNA expressions were detected by real-time PCR. Results After model making, there was a statistically significant difference in the Lequesne MG score between the model and blank groups （P〈0.01）; there was no statistically significant difference in the Lequesne MG score between the needle knife or electroacupuncture group and the model group （P〉0.05）. There was a statistically significant post-treatment difference in the Lequesne MG score between the needle knife or electroacupuneture group and the model group （P〈0.01,P〈0.05） and between the needle knife and electroacupuncture groups （P〈0.05）. There were statistically significant post-treatment differences in PL maximum stress, maximum displacement, elastic modulus, stress relaxation rate and creep rate between the model and blank groups （P〈0.01,P〈0.05）. There were statistically significant post-treatment post-treatment differences in PL maximum stress, maximum displacement, elastic modulus, stress relaxation rate and creep rate between the needle knife and model groups （P〈0.01,P〈0.05）. There was a statistically significant post-treatment difference in elastic modulus between the electroacupuncture and model groups （P〈0.01）. The IL-4 content and aggrecan mRNA expression decreased significantly and MMP-3 mRNA expression increased significantly in the model group after model making and there were statistically significant differences compared with the blank group （P〈0.01,P〈0.05）. After treatment, the IL-4 content increased significantly in the needle knife and electroacupuncture groups compared with the model group （P〈0.01,P〈0.05） and aggrecan mRNA expression tended to increase in the two groups. The regulation of aggrecan mRNA and MMP-3 mRNA expressions was better in the needle knife group than in the electroacupuncture groups, but there was no statistically significant difference compared with the model group （P〉0.05）. Conclusion The mechanism of action of needle knife treatment on KOA may be that it improves ligament mechanical characteristics, regulates intra-articular stress environment, and modulates aggrecan mRNA and MMP-3 mRNA expressions and inhibits cartilage degeneration through IL-4 mechanical signal pathway, to produce the therapeutic effect of ＂regulating sinews and treating bones＂.
出处
《上海针灸杂志》
2015年第5期455-459,共5页
Shanghai Journal of Acupuncture and Moxibustion
基金
国家自然科学基金项目(81173333)
教育部博士点基金项目(20130013110008)
关键词
小针刀
骨关节炎
膝关节
髌韧带
白介素4
基质金属蛋白酶3
聚集蛋白聚糖
兔
Little needle knife
Osteoarthritis, knee joint
Patellar ligament
Interleukin-4
Matrix metalloproteinase-3
Aggrecan
Rabbit
