目的 探讨加味独活寄生合剂治疗膝骨关节炎的可能作用机制.方法 46只雄性新西兰大白兔随机分为空白组(8只)、常规模型组(19只)和3MA自噬抑制剂造模组(19只).常规模型组使用高分子树脂石膏绷带固定兔右侧后肢建立膝骨关节炎模型,3MA自噬抑制剂造模组在上述造模基础上加用自噬抑制剂3MA关节腔注射造模,造模周期为6周,两个造模组均造模成功各16只.将常规造模组分为模型组和加味独活寄生合剂组,3MA自噬抑制剂组分为3MA组和3MA+加味独活寄生合剂组,每组8只.加味独活寄生合剂组和3MA+加味独活寄生合剂组均给予加味独活寄生合剂单次生药量为2.26 g/kg灌胃,其余各组予以3.4 ml/kg蒸馏水灌胃,每日2次,持续4周.给药结束后观察各组兔膝关节软骨大体情况,苏木素-伊红(HE)染色检测软骨组织病理学变化,并分别通过Pelletier评分、Mankin评分进行量化评估;检测各组兔关节软骨组织中自噬相关蛋白[自噬相关基因7(ATG7)、自噬关键分子酵母Atg6同系物1(Beclin-1)、微管相关蛋白1轻链3(LC3)]及凋亡相关蛋白[B淋巴细胞瘤-2(Bcl-2)、半胱氨酸蛋白酶3(Caspase3)]mRNA及蛋白表达水平.结果 与空白组比较,模型组兔膝关节软骨病理损伤明显,Pelletier评分及Mankin评分升高,软骨组织中 Beclin-1、LC3、ATG7、Bcl-2、Caspase-3 mRNA表达均升高,Beclin-1、LC3、ATG7、Caspase-3蛋白表达升高(P＜0.05或P＜0.01).与模型组比较,加味独活寄生合剂组关节软骨损伤改善,Pelletier评分及Mankin评分降低,软骨组织中Beclin-1、LC3、ATG7、Bcl-2 mRNA及蛋白表达升高,Caspase-3 mRNA及蛋白表达降低(P＜0.05或P＜0.01).与加味独活寄生合剂组比较,3MA+加味独活寄生合剂组Pelletier评分、Mankin评分升高,软骨组织中Beclin-1、LC3、ATG7、Bcl-2 mRNA及蛋白表达降低,Caspase-3 mRNA表达升高(P＜0.05或P＜0.01).结论 加味独活寄生合剂对膝骨关节兔的关节软骨具有保护作用,其机制可能是通过诱导软骨组织自噬、抑制细胞凋亡实现的.

骨关节炎为临床常见的慢性筋骨退行性疾病,也是致残的主要原因之一,由于发病率高且发病机制仍未阐明,如何防治该病成为亟待解决的难题.自噬是细胞维持代谢平衡以及细胞器更新的重要自我平衡机制,随着相关研究的不断深入,发现自噬在骨关节炎的进展过程中有不可忽视的作用.中医学在防治骨关节疾病中有着显著疗效,随着中医药现代化进程的推进,不断涌现的研究证实中药可通过调控细胞自噬水平发挥治疗OA的作用.本文就中药通过调控自噬治疗骨关节炎的相关研究进行综述,以期为后续中药防治骨关节炎的深入研究提供思路.

目的:探究补肾活血汤配合冲击波对腰椎间盘突出症(LDH)的临床疗效.方法:选择60例腰椎间盘突出症患者随机分为2组(30例/组),研究组采用口服补肾活血汤配合体外冲击波治疗,对照组单用冲击波治疗,治疗28d.治疗28d后观察两组视觉疼痛评分指数(VAS)、日本骨科协会功能障碍评分(JOA)、中医病证诊断疗效、治疗前后血清肿瘤坏死因子(TNF-α)以及白细胞介素6(IL-6)水平.结果:①治疗28d后,两组视觉模拟评分(VAS)较治疗前均降低,其中治疗组评分低于对照组(P＜0.05);功能障碍评分(JOA)较治疗前均升高,其中治疗组评分高于对照组(P＜O.05);中医病证诊断疗效均有改善,其中治疗组总有效率优于对照组(P＜0.05).②治疗后,两组患者的血清TNF-α、IL-6水平较治疗前明显改善(P＜0.05),其中研究组改善情况明显优于对照组(P＜0.05)结论:补肾活血汤配合体外冲击波可能通过帮助抑制炎症因子(如TNF-α、IL-6等)来减轻患者疼痛,促进恢复腰部功能进而治疗腰椎间盘突出症.

Objective: To explore the mechanism of the action of Huoxue Huayu Lishui prescription on acute ankle joint injury. Methods: Forty-eight SPF rats were randomly divided into blank group, model group, Shujin Huoluo capsule group, low, medium and high dose groups for promoting blood circulation and removing blood stasis. The blank group was not modeled, and the other groups were modeled. Each group of 8 animals, the Shujin Huoluo capsule group was given 0.2g/ml mixed liquid by gavage, and the low, medium and high blood circulation and blood stasis Lishui prescription group was given 1.03g/ml, 2.06g/ml, 4.12g/ml decoction For the stomach, the normal group was given 1.5ml/100g, once a day for 1 week. The expression of NF-κB P65 and transforming growth factor kinase 1 (TAK1) protein in the soft tissue around the ankle joint of rats was detected by sports protein immunoblotting method, and the mRNA expression of NF-κB P65 and TAK1 was detected by PCR technology. Results: One day after modeling, the expressions of P65 and TAK1 mRNA and protein in the model group, the positive drug group, and low, medium and high doses of Huoxue Huayu Lishui Recipe were significantly different from those of the blank control group (P<0.05).After taking the medicine for 7 days, compared with the model group, the expressions of P65 and TAK1 mRNA and protein in the Shujin Huoluo capsule group and the low, medium and high dose Huoxue Huayu Lishui Recipe group were all decreased (P<0.05).After 7 days of taking the medicine, compared with the Shujin Huoxue Capsule group, there was no difference in P65 protein in the low-dose Huoxue Huayu Lishui Recipe group. The expression of P65 protein in the middle and high groups and the Shujin Huoxue Capsule group were all decreased (P<0.05). Compared with the Shujin Huoxue Capsule group, the expressions of TAK1 protein, P65 and TAK1 mRNA in the low, medium, and high groups and the Shujin Huoxue Capsule group were all decreased (P<0.05).The results suggest that Huoxue Huayu Lishui Recipe can inhibit the expression of NF-κB P65 and TAK1 protein in ankle joint injury. Conclusion: Huoxue Huayu Lishui prescription may regulate the expression of NF-κB P65 and TAK1 in ankle joint injury of NF-κB rats, so as to improve the clinical symptoms of local swelling and pain in the ankle joint.

目的:使用贝叶斯网状meta分析方法综合比较3种常用中药注射液(正清风痛宁注射液、参麦注射液、鹿瓜多肽注射液)治疗膝骨关节炎的疗效.方法:从数据库知网、维普、万方、CBM和PubMed中检索发表的使用正清风痛宁注射液、参麦注射液、鹿瓜多肽注射液中任意一种治疗膝骨关节炎的临床随机对照试验文献(建库至2020年2月份).结合纳入标准对获得的文献进行遴选、质量评价及提取相关数据后,RevMan5.3及R 3.53软件完成数据分析.结果:最终纳入合计720例患者的9个随机对照试验,网状meta结果显示:3种中药注射液的疗效大致相等,概率排序图显示正清风痛宁注射液疗效可能是最好的.结论:3种常用中药注射液均能有效治疗膝骨关节炎,正清风痛宁注射液可能是其中最有效的.本次研究纳入的文献结局指标较为单一,仍需谨慎地对待本次研究结果,建议以后对于此类治疗开展更多高质量、长期随访的研究,为这些治疗措施的推广提供坚实的证据支持.

目的:系统评价脉冲射频治疗（pulsed radiofrequency,PRF）膝骨关节炎的疗效及安全性的影响。方法:计算机检索数据库,搜索脉冲射频治疗膝骨关节炎的随机对照实验（Randomized controlled experiment,RCT）,检索时限均为建库至2020年4月5日。2名研究者进行文献查重审核和资料提取,并评价纳入研究的偏倚风险后,采用RevMan5.3软件进行数据分析。结果:共纳入13项RCT,共计853例膝骨关节炎患者。实验组治疗膝骨关节炎的总体有效率、VAS评分、WOMAC评分、Lysholm评分均优于对照组,有统计学意义（P＜0.05）。结论:脉冲射频治疗膝骨关节炎有临床疗效,且优于一些常规治疗。

目的:系统评价独活寄生汤治疗膝骨关节炎的疗效及对膝关节液炎症因子的影响.方法:计算机检索数据库,搜索中药复方联合独活寄生汤治疗膝骨关节炎的随机对照实验(RCT).2名研究者进行文献查重审核和资料提取,并评价纳入研究的偏倚风险后,采用RevMan5.3软件进行数据分析.结果:共纳入16项RCT,1432名膝骨关节炎患者.实验组治疗膝骨关节炎的总体有效率、降低关节液中炎症因子效果均优于对照组,有统计学意义.结论:独活寄生汤治疗膝骨关节炎有较好的临床疗效,且能降低膝骨关节炎患者膝关节局部炎症因子,推荐临床使用.

Objective: To evaluate the efficacy and safety of Duhuo Jisheng Decoction combined with western medicine in the treatment of knee osteoarthritis. Methods: The databases of CNKI, VIP, CBM, WANFANG DATA and PubMed were electronically to collect randomized controlled trials(RCTs) of the treatment of knee osteoarthritis with Duhuo Jisheng Decoction combined with western medicine. After literature was strictly screened and the study quality was evaluated according to relevant procedures, the Meta analysis was performed by RevMan5.3 software. Resluts: A total of 15 RCTs were included.The result of meta-analysis showed that:compared with the western medicine alone, Duhuo Jisheng Tang combined with western medicine could significantly improve the efficacy(RR=1.25, 95％CI(1.18, 1.32), p<0.00001),the posttreatment pain visual analogue scale scores(MD=-0.85, 95％CI(-1.00, -0.71),p<0.00001)、the western ontario and mcmaster universities arthritis index scores(MD=-7.76, 95％CI(-10.37, -5.15), p<0.00001) and matrix metalloproteinase3(MD=-11.72, 95％CI(-17.39, -6.05), p<0.0001) were lower in treatment group compared to control group. There was no statistical difference in the incidence of adverse reactions between the 2groups. Conclusions: The current evidence shows that Duhuo Jisheng Decoction combined with western medicine can further improve the clinical efficacy for knee osteoarthritis.

目的:为临床使用冲击波治疗膝关节骨性关节炎(KOA)提供循证医学证据.方法:2名研究员独立检索常用数据库知网、维普、万方、Sinomed、PubMed中以冲击波治疗KOA为随机对照研究的文献.采用Jadad评分表进行文献质量评价,RevMan5.3软件进行Meta分析.结果:15个随机对照试验,包含1248例患者最终被纳入.Meta分析结果显示:冲击波治疗膝骨关节炎临床有效率可靠[RR=1.12,95％CI(1.03,1.20),P=0.005],对于KOA患者的疼痛视觉模拟评分(VAS)[MD=-1.73,95％C I(-2.31,-1.14),P<0.00001]、Lequesne骨关节炎严重度指数[MD=-1.60,95％C I(-2.55,-0.64),P=0.001]及关节炎指数评分(WOMAC)[MD=-6.03,95％CI(-9.49,-2.57),P=0.0006]三大评分方面均有一定的改善,无危急不良反应事件.结论:现阶段证据表明,冲击波对于KOA患者疼痛等相关症状具有可靠疗效,临床推荐使用.

目的:使用荟萃分析的方法探究独活寄生汤联合常规西药治疗膝骨关节炎(knee osteoarthritis,KOA)的疗效与安全性.方法:2名研究者在以下5个数据库:知网、维普、万方、CBM、PubMed中检索以独活寄生汤联合西药治疗KOA的相关文献.文献筛选、评价研究质量后提取数据进行Meta分析,统计分析由RevMan5.3软件进行.结果:纳入涉及1376例患者的15个随机对照试验.Meta分析结果显示:独活寄生汤联用西药治疗膝骨关节炎临床有效率较单独使用相同品种的西药明显提高[RR=1.25,95％CI(1.18,1.32),P<0.00001],在降低患者疼痛视觉模拟量表(VAS)评分[MD=-0.85,95％CI(-1.00,-0.71),P<0.00001]、骨关节炎指数(WOMAC)评分[MD=-7.76,95％CI(-10.37,-5.15),P<0.00001]及关节液中基质金属蛋白-3(MMP-3)水平[MD=-11.72,95％CI(-17.39,-6.05),P<0.0001]方面优于对照组,无明显不良症状.结论:现阶段证据表明,独活寄生汤联合常规西药治疗KOA较单纯使用西药更能改善患者症状,提高临床疗效.

急性踝关节扭伤以踝关节周围韧带损伤为特征,是骨科常见疾病,预后的好坏对患者日常生活影响大.廖怀章教授治疗急性踝关节损伤予以活血利水治法,取得了满意疗效,对其治疗急性踝关节扭伤的临床经验进行了介绍.