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1Study on the clinical significance of bone metabolism types in young adult patients with ankylosing spondylitis

李涯松,张莹莹,邹玉琼

目的探讨青壮年活动期强直性脊柱炎(AS)骨代谢类型与骨密度之间的关系,为临床青壮年AS骨密度下降者的预防及治疗提供依据.方法纳入2015年2月-2020年11月在浙江省人民医院就诊的AS患者103例,分析不同骨代谢类型与骨密度的相关性.结果入组的103例AS患者,骨密度正常组49例,骨密度低下组54例.骨密度低下组患者Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、N端骨钙素(OC)、总Ⅰ型胶原氨基端前肽(P1NP)的均值均显著高于骨密度正常组(均P＜0.001).骨密度低下组又分为低中转换组(28例)和高转换组(26例).高转换组的股骨颈骨密度T值为-1.56±0.82,显著性低于中低转换组(-1.01±0.92,P=0.029).2组腰椎的骨密度T值比较差异无统计学意义(P=0.080).对于不同骨代谢类型治疗前后比较发现:在中低转换组,治疗后股骨颈骨密度值[(0.92±0.09)g/cm2]较治疗前[(0.89±0.08)g/cm2]显著改善(P=0.022);而在高转换组,治疗后股骨颈骨密度值较治疗前差异无统计学意义(P=0.080).结论青壮年AS骨密度下降患者血清β-CTX、OC、P1NP明显升高,表现为高转换骨丢失;中低转换的骨密度下降患者通过积极基础病炎症控制,骨密度可以得到有效提升;但是,高转换骨密度下降患者治疗后骨量无显著提升,应探索更为有效的治疗方案.

2021Chinese Journal of General Practice（2021）引用：1

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2Effect of serum containing Yishen Juanbi method on OPG/RANKL/RANK signaling pathway in osteoblasts and osteoclasts of rats

Li-ying SHEN,Ya-song LI,Ying-ying ZHANG,Yu-qiong ZOU,Gui-feng HAO,Tian-le WANG

目的探讨益肾蠲痹法含药血清对骨代谢信号通路的影响.方法正常SD大鼠随机分为对照组和益肾蠲痹组,分别经生理盐水和益肾蠲痹汤灌胃给药,获取含药血清;分离大鼠成骨细胞和破骨细胞,利用碱性磷酸酶和Van kossa染色鉴定成骨细胞,TRAP和甲苯胺蓝染色鉴定破骨细胞;将成骨和破骨细胞各分为4组:对照组、益肾蠲痹法含药血清低、中和高浓度组;通过免疫印迹检测成骨细胞骨保护蛋白(OPG)、核因子κB受体活化因子配体(RANKL)和破骨细胞核因子κB受体活化因子(RANK)的表达.结果低、中、高浓度含药血清诱导成骨细胞OPG的表达分别为对照组的97％ (P =0.710)、122％ (P =0.005)和155％ (P ＜0.001),RANKL表达分别为对照组的81％ (P ＜0.001)、63％ (P ＜0.001)和53％ (P＜0.001),表明OPG和RANKL表达与含药血清浓度分别呈正、负相关;含药血清使破骨细胞RANK表达分别调节对照组的75％(P＜0.001)、50％(P＜0.001)和46％(P＜0.001),表明RANK表达与含药血清剂量呈负相关.结论益肾蠲痹法含药血清通过调节OPG/RANKL/RANK信号轴可能在抗骨丢失过程中发挥作用.

2020Chinese Journal of General Practice（2020）引用：47

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3Effect of serum containing Yishen Juanbi Decoction on proliferation of rat osteoblasts and osteoclasts

张莹莹,李涯松,邹玉琼,郝桂锋,陈彦霞,王丽娟

目的通过研究益肾蠲痹汤的含药血清对大鼠成骨细胞、破骨细胞增殖的影响,评价益肾蠲痹法对强直性脊柱炎骨代谢异常的治疗作用.方法 SD正常大鼠(SPF级)经灌胃给药益肾蠲痹汤,收集大鼠含药血清.分离大鼠成骨细胞和破骨细胞,通过Van kossa染色和碱性磷酸酶染色鉴定成骨细胞,TRAP染色、甲苯胺蓝染色鉴定破骨细胞.将体外培养的成骨细胞和破骨细胞,分别分为6组:空白对照组,益肾蠲痹汤大、中、小剂量含药血清组,双氯芬酸对照组和阿仑膦酸盐对照组.使用CCK-8法测定成骨细胞、破骨细胞的生长曲线,收集并测定成骨细胞培养液上清碱性磷酸酶活性.结果含有益肾蠲痹汤药物的血清加入体外培养成骨细胞后,成骨细胞的生长曲线呈明显上升趋势,加药后细胞培养上清中碱性磷酸酶浓度增加,提示成骨细胞分泌碱性磷酸酶活性增强.生长曲线上升趋势及分泌碱性磷酸酶活性随含药血清浓度增加而作用增强.体外培养破骨细胞加入益肾蠲痹汤含药血清后,细胞增殖曲线呈下降趋势,曲线下降趋势亦随含药血清浓度升高而幅度增大.结论益肾蠲痹汤具有促进成骨细胞增殖及提高成骨细胞活性,同时,对破骨细胞增殖有抑制作用,作用强度随药物浓度增加而增强.因此,预期益肾蠲痹汤对强直性脊柱炎骨代谢异常具有治疗作用.

2016Chinese Journal of General Practice（2016）引用：6

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4Two Years Follow-up on Treatment of Ankylosing Spondylitis with Yishen Jianbi

李涯松,张莹莹,黄燕静,应奇峰,邹玉琼

Objectives: To investigate the effect of treatment of ankylosing spondylitis(AS) with Yishen Jianbi.Methods: 162 patients with AS were randomly divided into two groups: the treatment group with 98 patients and the control group with 64 patients.Patients in the treatment group were treated both regular medicine and Yishen Jianbi,then Compared the Bath index,ESR(erythrocyte sedimentation rate),CRP(C-neactveprotein),and BMD(bone mineral density) value between the initial status and 6 months later after the treatment.And after that,we compare those value differences after 1 year follow-up visit and 2 years follow-up visit respectively.Results: 6 months after treatment began,Bath ankylosing spondylitis disease activity index(BASDAI),Bath ankylosing spondylitis function index(BASFI),ESR and CRP in the treatment group were significantly decreased,and had a statistical significance compared with the control group(P0.05) After observed 1 year and 2 years,Bath ankylosing spondylitis measurement index(BASMI) was decreased and BMD was improved in the treatment group compared with the control group.Both them had a statistical significance compared with the control group(P0.05).We found the more differences in efficacy with the time.Conclusion: Yishen Jianbi has an exact curative effect on AS patients.The short term effect are the anti-inflammatory while long term express as improving the bone metabolism and preventing spinal column and arthrosis from ankylosing.

2013引用：23

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5Analysis on the features and relevant factors of bone loss with 156 patients in Ankylosing Spondylitis

张莹莹,邹玉琼,应奇峰,李涯松

目的探讨强直性脊柱炎(AS)患者的骨丢失特点及相关因素.方法收集156例AS确诊患者,测定患者Bath指数、血沉(ESR)、C反应蛋白(CRP)、骨密度、血清骨源性碱性磷酸酶(BAP)、抗酒石酸酸性磷酸酶5b(TRAP5b)及1,25-(HO)2VitD3浓度,分析骨代谢指标变化特点及与临床指标相关性.结果 AS患者的血清TRAP5b较正常组增高(P＜0.05),1,25-(HO)2VitD3浓度和BAP水平与正常组的差异均无统计学意义(均P ＞0.05).骨密度测定显示:骨质疏松、骨量减少和骨量正常者分别为49、51、56例,骨质疏松组ESR、CRP、TRAP5b均高于骨量减少和骨量正常组(P＜0.05或0.01);骨质疏松组的Bath疾病活动指数(BASDAI)、BAP均较正常组增高 (均P＜0.05),Bath功能指数(BASFI)较骨量减少组增高(P＜0.05).TRAP5b与CRP、BASFI、BASDAI呈正相关(均P＜0.05). 结论 AS患者普遍存在骨代谢异常,表现为高转换骨丢失,并与CRP、BASDAI、BASFI呈正相关,提示骨丢失是AS病情活动的临床表现之一.

2011ZHEJIANG MEDICAL JOURNAL（2011）引用：3

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6类风湿性关节炎患者合并肺部病变的HRCT表现及临床特点

李涯松,邹玉琼,丁小南,张莹莹,应振华

类风湿性关节炎(RA)是一种以对称性、多个外周小关节累及为主要临床表现的风湿性疾病.然而有研究发现,约50%的RA患者可表现为不同程度的关节外系统的累及,其中肺部累及较为常见,成为影响RA患者生存率的重要因素之一[1].现笔者对近年来收治的RA患者肺部高分辨率CT(HRCT)的表现进行了回顾性分析,以期为临床诊疗提供帮助.

2010ZHEJIANG MEDICAL JOURNAL（2010）

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7Clinical Study on Treatment of Ankylosing Spondylitis with Yishen Juanbi Pill

LI Ya-song,ZHANG Ying-ying,ZOU Yu-qiong,YING Zhen-hua

Objectives:To investigate the effect of treatment of ankylosing spondylitis(AS) with Yishen Juanbi pill.Methods:105 patients with AS were randomly divided into two groups:the treatment group with 64 patients and the control group with 41 patients.Patients in the control group were treated with regular medicine,and Yishen Juanbi pill was added to the treatment group.The Bath index,erythrocyte sedimentation rate(ESR),C-neactveprotein(CRP) were tested before the treatment began and 3 months later,and BMD(bone mineral density) were measured before the treatment began and 6 months later.Results:3 months after treatment began,Bath ankylosing spondylitis disease activity index(BASDAI),Bath ankylosing spondylitis function index(BASFI),ESR and CRP in the treatment group were significantly decreased,and had a statistical significance compared with the control group(P0.05).There also a larger reduction of Bath ankylosing spondylitis measurement index(BASMI) in the treatment group compared with the control group,but there was no statistical significance(P0.05).The incidence of lumbar BMD reduction in AS patients is 56.7%.There was significant improvement of the lumbar BMD reduction in the treatment group(P0.05).Conclusion:Yishen Juanbi pill has an exact curative effect on AS patients.The effect mechanism is the significant anti-inflammatory and analgesic effect and reducing spinal bone loss.

2009CHINESE ARCHIVES OF TRADITIONAL CHINESE MEDICINE（2009）引用：24

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8甘草酸对雷公藤多甙治疗类风湿性关节炎增效减毒作用的实验研究

李涯松,杨洁红,樊守艳,张莹莹

1 实验材料雷公藤多甙(TG)、甘草酸(GA):均由浙江中医药大学生化分离工程实验室制备,含量均在90％以上.

2008CHINESE JOURNAL OF TRADITIONAL MEDICAL SCIENCE AND TECHNOLOGY（2008）引用：5

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