痛风性关节炎作为临床常见病,以高尿酸高嘌呤为病理基础,进而晶体沉积形成关节炎症,临床治疗常以清热解毒、祛湿利水为治疗大法.通过"六经治痹"理论,总结痛风性关节炎在特殊三经位置上的病理特点及治疗法则,以期为痹症理论提供新视角.

Background. Knee osteoarthritis (KOA) is a common degenerative joint disease. In this study, we aimed to identify new biomarkers of KOA to improve the accuracy of diagnosis and treatment. Methods. GSE98918 and GSE51588 were downloaded from the Gene Expression Omnibus database as training sets, with a total of 74 samples. Gene differences were analyzed by Gene Ontology, Kyoto Encyclopedia of Genes and Genomes pathway, and Disease Ontology enrichment analyses for the differentially expressed genes (DEGs), and GSEA enrichment analysis was carried out for the training gene set. Through least absolute shrinkage and selection operator regression analysis, the support vector machine recursive feature elimination algorithm, and gene expression screening, the range of DEGs was further reduced. Immune infiltration analysis was carried out, and the prediction results of the combined biomarker logistic regression model were verified with GSE55457. Results. In total, 84 DEGs were identified through differential gene expression analysis. The five biomarkers that were screened further showed significant differences in cartilage, subchondral bone, and synovial tissue. The diagnostic accuracy of the model synthesized using five biomarkers through logistic regression was better than that of a single biomarker and significantly better than that of a single clinical trait. Conclusions. CX3CR1, SLC7A5, ARL4C, TLR7, and MTHFD2 might be used as novel biomarkers to improve the accuracy of KOA disease diagnosis, monitor disease progression, and improve the efficacy of clinical treatment.

目的:通过Meta分析探索导致老年髋部骨折患者术后谵妄的危险因素.方法:在中国生物医学文献数据库、万方、知网、维普、Pubmed、Cochrane图书馆、Embase、Web of science中检索有关老年髋部骨折患者术后谵妄的相关研究,通过进行文献质量评价,应用RevMan 5.3分析软件进行敏感性和异质性分析,并采用固定效应或随机效应模型计算合并后的综合效应.结果:纳入14篇文献,Meta分析显示:年龄、术前认知功能受损、术前合并基础疾病≥3种、糖尿病史、术前白蛋白<35 g/L、 术前身体质量指数(Body Mass Index,BMI)<20 kg/m2、术前等待时间≥4 d、全身麻醉、手术时间是老年髋部骨折术后谵妄的危险因素,术前C-反应蛋白(C-reactive Protein,CRP)水平与老年髋部骨折术后谵妄的发生无明显相关性.

目的 揭示羌椒熏洗散对膝关节骨性关节炎(OA)的有效性和安全性,为其临床应用奠定理论基础.方法 开展多中心、随机、对照临床研究,采用随机方法,选取2020年12月至2022年3月在南充市中医医院、成都中医药大学附属医院、雅安市中医医院收治的OA患者150例分成试验组和对照组,每组75例.试验组外用羌椒熏洗散熏洗患膝,约30 min/次,2次/d;对照组口服盐酸氨基葡萄糖胶囊(1粒/次,2次/d)和美洛昔康片(1片/次,2次/d),两周为1个疗程.在治疗前后,通过疼痛视觉模拟评分(VAS)、美国纽约特种外科医院(HSS)膝关节评分及《中医病证诊断疗效标准》的相关内容,对治疗后两周的疗效和不良反应进行评估.结果 试验组显效25例、有效36例、无效14例,对照组显效23例、有效37例、无效15例.两组总有效率比较,差异无统计学意义(P>0.05).两组治疗前后,VAS评分、HSS膝关节评分组内比较差异有统计学意义(P<0.05),组间比较差异无统计学意义(P>0.05).本研究中无1例出现不良反应.结论 羌椒熏洗散在OA治疗上有效且安全,可提高患者生活质量.

目的 观察独活寄生汤调控Zinc-ZIP8-MTF1轴,探讨独活寄生汤治疗膝骨关节炎的作用机制.方法 选用54只小鼠,分为独活寄生汤组(DHJST组)、对照组(Model组)、空白组(Control组),每组18只,Model组、DHJST组构建小鼠膝骨关节炎模型,DHJST组予独活寄生汤,另两组予生理盐水,观察小鼠膝关节软骨病理改变,检测软骨细胞内Zn2+浓度及锌转运蛋白(ZIP8、ZNT9)、金属调节转录因子(MTF1)、基质金属蛋白酶-3(MMP3)、基质金属蛋白酶-13(MMP13)表达.结果 与Model组比较,DHJST组小鼠软骨组织病理学评分明显下降,软骨细胞内Zn2+含量大幅减少,软骨组织中ZIP8、ZNT9、MTF1、MMP3、MMP13 mRNA表达降低(P<0.05).结论 Zinc-ZIP8-MTF1轴在独活寄生汤治疗KOA的机制中发挥了一定作用,但独活寄生汤对Zn2+进出软骨细胞的关键环节没有明显影响.

AbstractBackground:As a classic prescription for treating knee osteoarthritis, Du-Huo-Ji-Sheng-decoction has been widely recognized for its clinical efficacy. The purpose of this systematic review and meta-analysis is to evaluate the effectiveness and safety of Du-Huo-Ji-Sheng-decoction in the treatment of knee osteoarthritis.Methods:The following databases will be searched from January 2011 to December 2020: PubMed, Embase, Web of Science, Cochrane Library, Chinese Biomedical Medical Database, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, and Wanfang Database. Statistical analysis will be processed by RevMan V.5.3 software.Results:This study will provide an assessment of the current state of DHJSD in the treatment of KOA, aiming to show the efficacy and safety of DHJSD.Conclusion:This study will provide evidence to judge whether DHJSD is an effective intervention for KOA.

目的 研究马钱子碱治疗早期膝骨关节炎(KOA)模型小鼠的作用机制.方法 随机将24只C57BL/6雄性小鼠分为4组:空白对照组(不采取任何干预措施)、模型组(构建KOA动物模型+腹腔注射等体积的生理盐水)、马钱子碱中剂量组(构建KOA动物模型+腹腔注射马钱子碱溶液,5 mg/kg)、马钱子碱高剂量组(构建KOA动物模型+腹腔注射马钱子碱溶液,10 mg/kg),药物干预4周后,取小鼠关节软骨.采用免疫荧光染色技术检测4组小鼠软骨细胞内Zn2+表达,采用RT-qPCR和蛋白质印迹技术分别检测4组小鼠软骨ZIP8、ZNT9、MTF1、Mt1、Mt2 mRNA和蛋白表达.结果 与空白对照组比较,模型组ZIP8、MTF1 mRNA和蛋白相对表达量明显增加(P<0.05).与模型组相比较,马钱子碱高、中剂量组ZIP8、MTF1 mRNA和蛋白表达明显降低(P<0.05).与模型组相比较,马钱子碱高、中剂量组ZNT9、Mt1、Mt2 mRNA和蛋白的相对表达量差异无统计学意义(P>0.05).荧光染色结果显示,与空白对照组相比,模型组软骨细胞内Zn2+表达明显增加,经马钱子碱药物干预后,马钱子碱高、中剂量组小鼠软骨细胞内Zn2+表达明显降低,且马钱子碱高剂量组降低更明显(P<0.05).结论 马钱子碱通过降低KOA小鼠ZIP8、MTF1 mRNA和蛋白表达来调控软骨细胞内Zn2+表达量,从而延缓早期KOA模型小鼠软骨退变.

Review question / Objective: We will use a systematic review and meta-analysis to evaluate the efficacy and safety of acupotomy combined with Massage in the treatment of cervical spondylotic. Condition being studied: It has been shown that acupotomy therapy is effective and can realive the pain of patients with cervical spondylotic radiculopathy. We will focuse on exploring the effectiveness of acupotomy combined with Massage for p a t i e n t s w i t h c e r v i c a l s p o n d y l o t i cINPLASY 1

目的 观察阴阳九针治疗膝骨关节炎(KOA)的临床疗效.方法 选取2021年1—7月于成都中医药大学附属医院骨科门诊就诊的K O A患者60例为研究对象,按照随机数字表法分为试验组和对照组,每组30例.试验组采用阴阳九针针法,手掌部施针,隔日1次,共治疗5次;对照组口服非甾体止疼药塞来昔布(西乐葆胶囊),用量为0.2 g/d,服用周期为10 d.结果 试验组临床总有效率为93.3％,对照组临床总有效率为90.0％,两组临床总有效率比较,差异无统计学意义(P>0.05).采用视觉模拟评分法(VAS)对两组患者疼痛程度进行评价,试验组VAS评分低于对照组,差异有统计学意义(P<0.05).结论 阴阳九针治疗KOA临床疗效较好,操作便捷,适用于大部分KOA患者.

目的 通过网络药理学和生物信息学方法探讨丹参治疗骨关节炎(O A)的潜在活性成分及作用机制.方法 通过检索中药系统药理学数据库和分析平台(TCMSP)中丹参成分,筛选丹参活性成分和作用靶点;检索DisGeNET、Drug bank、OMIM、TTD、Gene Cards、GAD、HPO、PharmGKB、Uniprot疾病数据库中OA相关靶点;检索GEO数据库,多基因芯片联合分析,筛选OA差异表达基因.构建丹参活性成分、丹参作用靶点及OA相关靶点间的相互关系网络,通过网络拓扑分析,筛选丹参治疗OA关键靶点,构建蛋白互作(PPI)网络;采用GO功能和KEGG信号通路富集,分析丹参治疗OA的作用机制,利用分子对接技术验证成分与靶点的结合作用.结果 共筛选出57个丹参活性成分,382个O A差异表达基因和68个丹参活性成分与O A共同靶点.结论 丹参治疗OA具有多成分、多靶点、多通路的潜在作用机制,为后续丹参与OA的实验和临床研究提供了思路.

Background: As a classic prescription for treating knee osteoarthritis, Du-Huo-Ji-Sheng-decoction has been widely recognized for its clinical efficacy. The purpose of this systematic review and meta-analysis is to evaluate the effectiveness and safety of Du-Huo-Ji-Sheng-decoction in the treatment of knee osteoarthritis. Methods: The following databases will be searched from January 2011 to December 2020: PubMed, Embase, Web of Science, Cochrane Library, Chinese Biomedical Medical Database, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, and Wanfang Database. Statistical analysis will be processed by RevMan V.5.3 software. Results: This study will provide an assessment of the current state of DHJSD in the treatment of KOA, aiming to show the efficacy and safety of DHJSD. Conclusion: This study will provide evidence to judge whether DHJSD is an effective intervention for KOA.

The current study was aimed to identify diagnostic gene signature for osteoarthritis (OA). The differentially expressed genes (DEGs) in synovial membrane samples and blood samples were respectively identified from the GEO dataset. The intersection DEGs between synovial membrane and blood were further screened out, followed by the functional annotation of these common DEGs. The optimal intersection gene biomarkers for OA diagnostics were determined. The GSE51588 dataset of articular cartilage was used for expression validation and further diagnostic analysis validation of identified gene biomarkers for OA diagnostics. There were 379 intersection DEGs were obtained between the synovial membrane and blood samples of OA. 22 DEGs had a diagnostic value for OA. After further screening, a total of 9 DEGs including TLR7, RTP4, CRIP1, ZNF688, TOP1, EIF1AY, RAB2A, ZNF281 and UIMC1 were identified for OA diagnostic. The identified DEGs could be considered as potential diagnostic biomarkers for OA.

文章通过检索2015-2019年口服独活寄生汤治疗膝骨关节炎(KOA)的相关文献,对文献进行研究综述,以期为今后中药汤剂治疗KOA提供更为有力的依据.独活寄生汤充分遵循了中医骨科治疗膝痹的经典治法——"祛风湿、止痹痛、补肝肾、益气血",其在治疗KOA上具有确切而显著的疗效,文中阐述了以独活寄生汤为主的各种方案对KOA治疗产生的不同疗效,建议在临床上采用多种手段治疗.

目的 探寻独活寄生汤含药血清对小鼠软骨细胞内锌离子及其转运蛋白ZIP8(Znic/ZIP8)的影响.方法 将软骨细胞随机分为:空白对照组(Control)、模型对照组(Model/ZnCl2)、Ad-Zip8组(Ad-Zip8)、Zip8-siRNA组(Zip8-siR-NA).分组后,培养体系内加入1ng/mL IL-1β,培养24h后,除空白对照组,其余各组加入100μmol/L ZnCl2,同时给予不同剂量(体积分数10％、5％、2.5％)独活寄生汤含药血清;继续培养48 h后采用荧光染色技术检测软骨细胞内Zn2浓度,提取细胞总RNA,去除gDNA,合成cDNA,采用qRT-PCR检测软骨细胞ZIP8基因的表达,采用蛋白质免疫印迹法(Western Blot)结合图像分析ZIP8蛋白表达.结果 独活寄生汤含药血清可以降低由IL-1β诱导的炎症状态下软骨细胞内Zn2+的浓度,并呈量-效关系;独活寄生汤含药血清对可降低Zip8mRNA/ZIP8蛋白的表达水平,但其作用强度不及Zip8-siRNA,但其无法抑制由Ad-Zip8引发的Zip8m RNA/ZIP8蛋白表达水平升高.结论 独活寄生汤含药血清可通过降低炎性状态的软骨细胞内Zn2浓度,下调ZIP8的转录和蛋白水平,以维持关节软骨细胞Zn2+的稳态.

目的 通过八段锦功法练习配合李氏杵针诊疗法探究对脊髓型颈椎病术后轴性症状患者康复治疗效果的影响.方法 采用单盲、随机、对照的研究方法,将符合纳入标准要求的30例脊髓型颈椎病术后轴性症状患者随机分为两组:治疗组15例、对照组15例.治疗组采用杵针配合八段锦进行系统治疗,而对照组采用口服塞来昔布胶囊进行治疗,均治疗4个疗程.比较治疗组与对照组治疗前后NDI评分和Tsuji评分.结果 治疗组治疗总有效率(93.3％)高于对照组治疗总有效率(80％);治疗前两组患者Tsuji、NDI评分相当(P＞0.05),治疗后各组评分均改善,且治疗组评分优于对照组(P＜0.05),差异具有统计学意义.结论 李氏杵针疗法配合八段锦功法练习在脊髓型颈椎病术后出现轴性症状的患者中应用价值高,临床疗效显著.该方法安全、有效、便捷,无治疗痛苦,有利于术后患者恢复,从而提高颈椎手术治疗的满意度,可在临床上广泛推广应用.

总结朱明双教授运用加味四妙散治疗痛风缓解期高尿酸血症的经验.朱教授认为,痛风缓解期高尿酸血症总以肝脾肾功能失调为本,湿热痰瘀胶结、脉络瘀阻为标.其中痰浊、瘀血既是病理产物,又是贯穿此期始终的病机关键,故主张在清热利湿基础上佐以山慈菇、海藻、威灵仙、水牛角等化痰散瘀之品,以及川乌、草乌、地龙、蜈蚣等祛风通络之药,并随症加减,疗效显著.附验案1则,以飨同道.

我们把由多种因素引起的关节软骨纤维化、溃疡、皲裂、脱失而导致的以关节疼痛为主要的推行性疾病称为骨关节炎.临床上以膝关节发病最常见,也最具代表性.推拿手法具有舒通筋脉、活血化瘀、滑利关节、缓解局部肌肉及韧带的疫挛、增强骨关节活动能力、改善病变部位血液循环等作用.推拿手法治疗膝骨关节炎在临床中运用广泛,疗效确切.本文就近年相关文献报道推拿手法治疗膝骨性关节炎的现状做一浅析,以期为临床诊疗提供参考.

目的 观察兔椎间盘退变组织中TGF-β1与Beclin1、LC3的表达.方法 制作新西兰大白兔腰椎间盘退变模型,HE染色检测兔椎间盘退变程度.RT-PCR检测TGF-β1与自噬基因LC3、Beclin1的表达.结果 与空白组比较,模型组HE染色显示椎间盘组织形态学评分明显增加(P＜0.05);RT-PCR显示TGF-β1与Beclin1、LC3基因表达明显上调(P＜0.01).结论 兔腰椎间盘退变组织中TGF-β1与Beclin1、LC3基因表达量增加.

斜外侧腰椎椎间融合术(oblique lateral interboy fusion,OLIF)是近年来脊柱外科领域发展迅速的腰椎融合技术,由于其手术创伤小,术中出血少,术后康复快,被越来越多得应用在腰椎疾病的治疗中.OLIF在理论上相对安全,但各种术中及术后并发症仍然屡见报道,考虑主要原因为术者在追求新技术的过程中对该技术的适应证、禁忌证、局部解剖、术中操作细节等方面缺乏充分的探讨与认识,导致与操作方法或解剖入路相关的并发症发生.深入地了解OLIF操作流程,掌握局部解剖层次,把握手术适应证与禁忌证等对于减少OLIF手术并发症,取得手术成功是十分重要的.

目的 观察推拿对兔腰椎间盘退变组织中TNF-α、IL-6、TGF-β1、CTGF的影响.方法 30只白兔随机分为空白组、模型组、推拿组,每组10只.采用经皮穿刺纤维环法将模型组和推拿组建立兔椎间盘退变模型,推拿组进行推拿手法干预.6周后取出椎间盘组织,采用HE染色检测椎间盘组织形态学变化;采用酶联免疫吸附法(ELISA法)检测TNF-α、IL-6、TGF-β1、CTGF的表达水平.结果 与空白组比较,模型组和推拿组的椎间盘组织形态学评分、TNF-α、IL-6、TGF-β1、CTGF表达均明显增加(P＜0.05);与模型组比较,推拿组TNF-α、IL-6、TGF-β1、CTGF表达均明显降低(P＜0.05).结论 推拿可能通过减少TNF-α、IL-6、TGF-β1、CTGF表达而改善椎间盘退变.