Exosomes isolated from platelet-rich plasma (PRP-exos) have been recently deemed as an optimized therapeutic strategy in diabetic foot ulcer (DFU) treatment. Herein, we aimed to explore whether MALAT1 participates in DFU wound healing by PRP-exos treatment and the related preliminary mechanism. Fibroblasts were isolated from healthy donors and DFU patients, and the expression of MALAT1, miR-374a-3p and DNMT3A were detected by RT-PCR. The effect of MALAT1 and miR-374a-3p on DFU fibroblast function was verified by gain/loss of function experiment. The targeted binding of MALAT and miRNA was verified by double luciferase reporter gene assay. PRP-exos were isolated from normal human blood and characterized, and then co-cultured with DFU fibroblasts. The MALAT1 expression was donwregulated while the miR-374a-5p expression was upregulated in DFU fibroblasts. Double luciferase reporter gene assay demonstrated the targeted binding of MALAT and miR-374a-5p. Overexpression of MALAT1 or knockdown of miR-374a-5p could increase viability and inhibit apoptosis and pyroptosis of DFU fibroblast. And overexpression of miR-374a-5p reversed the effect of PRR-exos or MALAT1 overexpression on cell viability, apoptosis and pyroptosis. Collectively, MALAT1 mediated signal axis participates in the role of PRP-exos in promoting DFU wound healing, which may help identify optimal targets and effective therapies for DFU treatment.

目的:系统评价中药复方治疗退行性腰椎管狭窄症(DLSS)的临床疗效及安全性.方法:计算机检索中国知网(CNKI)、万方数据(WANFANG DATA)、维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(SinoMed)、Pubmed、Web of science、Embase等数据库中有关中药复方治疗腰椎管狭窄症的临床随机对照试验(RCTs),检索时间从建库至2020年8月31日.根据Jadad评分对纳入文献进行质量评价,采用Review Manager 5.3分析软件对结局指标进行Meta分析.结果:纳入12篇RCTs,共1222例患者.Meta分析结果显示,治疗组在总有效率(RR=1.23,95％CI[1.16,1.30],P＜0.00001)、视觉模拟评分法(VAS)评分(MD=-1.88,95％CI[-2.51,-1.25],P＜0.00001)、日本骨科协会评估治疗分数(JOA)评分(MD=5.30,95％CI[3.46,7.13],P＜0.00001)、Oswestry 功能障碍指数(ODI)评分(MD=-8.88,95％CI[-17.06,-0.70],P=0.03)、全血高切黏度(MD=-0.76,95％CI[-1.09,-0.43],P＜0.00001)、全血低切黏度(MD=-1.45,95％CI[-2.29,-0.61],P=0.0007)、纤维蛋白原(MD)=-5.79,95％CI[-7.50,-4.07],P＜0.00001)、肿瘤坏死因子-α(TNF-α)(MD=-0.48,95％CI[-0.53,-0.44],P＜0.00001)、C-反应蛋白(CRP)(MD=-8.30,95％CI[-9.79,-6.81],P＜0.00001)方面均优于对照组,差异有统计学意义.在不良反应发生率方面,2组差异无统计学意义(RR=0.34,95％CI[0.06,1.89],P=0.22).结论:中药复方治疗PLSS疗效显著,且安全性较高.

椎间盘源性腰痛(Discogenic Low Back Pain,DLBP)是由于椎间盘内结构紊乱退变而引起的顽固性腰痛,其发病率高,占慢性下腰痛病因的39％,是引起慢性下腰痛最常见的疾病类型[1],多发于45～60岁人群.DLBP主要临床表现为反复发作的下腰痛,病程多持续半年以上,可伴有臀部、腹股沟区、大腿前外侧部位的疼痛和皮肤感觉异常,但下肢症状区域与神经根定位不符.患者脊柱对纵向负荷耐受力明显下降,久站、久坐、久行后出现疼痛加重,卧位休息后无法立刻缓解,无典型的下肢放射痛和神经根损害的症状与体征[2].李宇卫教授从事中医骨伤科临床、教学、科研工作30余年,期间勤求古训,衷中参西,学验颇丰,擅长以古方经方为基础,结合患者具体病情,加减化裁,保守治疗骨伤科疾病.笔者有幸跟师侍诊,受益匪浅,现将李宇卫教授治疗椎间盘源性腰痛的辨证立法及遣方用药思想总结如下.