目的:探讨补肾生骨汤调节miR-135b-5p/Runt相关基因2(RUNX2)信号轴对股骨头无菌性坏死(ONFH)大鼠的影响.方法:将SD大鼠随机分为假手术(Sham)组、ONFH组、低/中/高剂量补肾生骨汤(0.13,0.26,0.52 g/mL,L/M/H-补肾生骨汤)组、H-补肾生骨汤+miR-135b-5p agomir 组、H-补肾生骨汤+agomir-NC组,采用液氮冷冻法制备ONFH大鼠模型;苏木精-伊红(HE)染色观察股骨头组织病理改变;检测血浆中纤维蛋白原(FIB)、血管内皮生长因子(VEGF)、一氧化氮合成酶(NOS)、骨钙素(BGP)水平;RT-qPCR仪、Western Blot法分别检测股骨头组织中miR-135b-5p、RUNX2表达水平;双荧光素酶实验分析miR-135b-5p与RUNX2的靶向关系.结果:与Sham组比较,ONFH组股骨头组织发生区域性缺损,骨小梁稀疏、行走不规则,空骨陷窝增多明显;血浆中FIB表达升高,VEGF、NOS、BGP表达降低(P＜0.05);经L/M/H-补肾生骨汤干预后,上述情况均改善,且经H-补肾生骨汤干预改善更明显;在H-补肾生骨汤干预的基础上增加miR-135b-5p agomir干预后,H-补肾生骨汤干预的改善作用被削弱.与Sham组比较,ONFH组股骨头组织中miR-135b-5p表达升高,RUNX2表达降低(P＜0.05);经H-补肾生骨汤干预后,miR-135b-5p表达降低,RUNX2表达升高(P＜0.05);在H-补肾生骨汤干预的基础上增加miR-135b-5p agomir干预后,miR-135b-5p表达升高,RUNX2表达降低(P＜0.05).双荧光素酶实验结果显示,miR-135b-5p与RUNX2存在靶向关系.结论:补肾生骨汤能促进ONFH大鼠股骨头组织修复,可能与下调miR-135b-5p进而靶向上调RUNX2有关.

Objective:To analyze the healing effect of paeoniflorin on the wound of rats and regulation of NGF/Akt/GSK3β pathway on rats with diabetic foot.Methods:60 rats were randomly divided into normal control group, model group, low, medium and high dose paeoniflorin groups, 12 rats in each group. Diabetic foot model was established by intraperitoneal injection of streptozotocin (STZ) and electrothermal scald. Paeoniflorin groups were injected intraperitoneally with 20 mg/kg, 40 mg/kg and 80 mg/kg paeoniflorin, once a day for 21 days. The wound healing rate of the rats was measured. The fasting blood glucose was measured by blood glucose meter, HbAlc, TC, LDL-C and TG were measured by automatic biochemical analyzer. Serum CRP, IL-6, IL-1β and TNF-α were measured by ELISA. The histopathological changes of the wound were examined by HE staining, the levels of NGF, Akt and GSK3 β mRNA in skin tissue were measured by real-time quantitative polymerase chain reaction (RTq-PCR), the protein and phosphorylation levels of NGF, Akt and GSK3 β were determined by Western blot.Results:Compared with the model group, the healing rate the rats' wounded surface in the low, medium and high dose groups of paeoniflorin was increased ( P<0.05). The levels of fasting blood glucose, HbAlc, TC, LDL-C, TG levels and serum CRP, IL-6, IL-1β, TNF-α was decreased ( P<0.05). The expression of rat skin tissue NGF mRNA (0.83±0.12, 3.17±0.11, 4.54±0.25 vs. 0.31±0.06), Akt mRNA (1.71±0.14, 2.96±0.27, 4.10±0.34 vs. 0.97±0.20) increased ( P<0.05), expression of GSK3β mRNA (4.28±0.35, 2.82±0.14, 1.22±0.33 vs. 7.62±0.43) decreased ( P<0.05), expression of NGF (0.46±0.02, 0.70±0.04, 0.87±0.04 vs. 0.30±0.06), Akt (0.51±0.09, 0.63±0.03, 0.79±0.06 vs.0.41±0.05),p-NGF/NGF (0.47±0.06, 0.61±0.04, 0.83±0.07 vs. 0.25±0.03), p-Akt/Akt(0.54±0.08, 0.83±0.11,0.96±0.07 vs. 0.13±0.05) was increased( P<0.05), the expression of GSK3β (0.67±0.05, 0.54±0.04,0.45±0.03 vs. 0.86±0.05), and the ratio of p-GSK3β/GSK3β (0.78±0.09, 0.64±0.07, 0.42±0.07 vs. 0.97±0.05) was decreased ( P<0.05), and the changes of each index were dependent on the dose of paeoniflorin. Conclusion:Paeoniflorin can regulate the level of blood glucose and blood lipid, inhibit the level of serum inflammatory factors and promote the healing of the wound in diabetic foot rats, and its mechanism may be related to the regulation of NGF/Akt/GSK3β pathway.

目的:探讨活血通络法治疗儿童股骨头坏死的疗效。方法:观察26例儿童股骨头缺血性坏死患者使用中药的3、6、12月治疗效果。结果:第3、6、12月疗效不同(P<0.05),有效率分别为65.4%,80.7%,88.5%,有效率总体在提高,不同临床分期疗效不同(P<0.05)。结论:活血通络法对儿童股骨头缺血性坏死有较好的治疗作用。

目的:探讨活血祛痛汤配合针灸和推拿治疗腰椎间盘突出症的临床疗效机理.方法:将符合入选标准的80例腰椎间盘突出病人随机分为治疗组(中药组)40例,对照组(西药组)40例,分别给予活血祛癌汤口服配合针灸和推拿,塞来昔布片口服配合针灸和推拿.在治疗前后对症状积分,2组于治疗2周后评价其临床疗效.疗效判定标准参照<中医病症诊断疗效标准>及采用日本矫形外科学会(JOA)下腰痛疗效评定标准(15分法).结果:(1)治疗2周后疾病疗效评价:治疗组与对照组无统计学意义,印两组问疗效无差别.(2)治疗2周后主要症状疗效评价:2组治疗前后自身比较均有改善,差异有统计学意义.(3)2组均无明显不良反应.结论:活血祛痛汤配合针灸和推拿具抗疼痛作用、抗炎作用、抗粘连作用、改善微循环作用、消除水肿作用,恢复脊柱的生物力学平衡和生物化学平衡.

目的:观察活血祛痛汤配合针灸和推拿治疗腰椎间盘突出症的临床疗效。方法:将符合入选标准的286例腰椎间盘突出病人给予活血祛痛汤口服配合针灸和推拿,在治疗前后对症状积分,治疗2周后评价其临床疗效(疗效判定标准参照《中医病证诊断疗效标准》疗效评定标准)。结果:(1)治疗2周后疾病疗效评价:治疗前后自身症状、体征比较均有改善,差异有统计学意义;(2)均无明显不良反应。结论:活血祛痛汤配合针灸和推拿治疗腰椎间盘突出症有一定疗效。