1.上海市黄浦区香山中医医院(上海 200020)
杨佳裕,女,硕士,副主任医师,主要从事脊柱、骨关节病的中医药治疗与研究工作
孙波,主任医师;E-mail:sunbosy@126.com
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杨佳裕,丁韵蓉,刘光明,等.施氏吊伤膏改善膝关节滑膜炎的实验研究[J].上海中医药杂志,2022,56(11):63-70.
YANG Jiayu,DING Yunrong,LIU Guangming,et al.Experimental study on improving synovitis in knee osteoarthritis with Shi’s Diaoshang Ointment[J].Shanghai Journal of Traditional Chinese Medicine,2022,56(11):63-70.
杨佳裕,丁韵蓉,刘光明,等.施氏吊伤膏改善膝关节滑膜炎的实验研究[J].上海中医药杂志,2022,56(11):63-70. DOI: 10.16305/j.1007-1334.2022.2204024.
YANG Jiayu,DING Yunrong,LIU Guangming,et al.Experimental study on improving synovitis in knee osteoarthritis with Shi’s Diaoshang Ointment[J].Shanghai Journal of Traditional Chinese Medicine,2022,56(11):63-70. DOI: 10.16305/j.1007-1334.2022.2204024.
目的,2,对施氏吊伤膏改善膝关节滑膜炎的疗效与作用机制进行初步探索研究。,方法,2,将40只雄性新西兰兔随机分为空白组、模型组、实验组(施氏吊伤膏组)、对照组(复方紫荆消伤膏组),每组10只。空白组正常喂养,其余3组,分别于造模第1、4、7、12天按0.2 mL/kg对兔右膝关节注射4%木瓜蛋白酶和0.03 mol/L的L-半胱氨酸混合溶液(2∶1),进行膝关节滑膜炎模型制备,造模成功后,对兔右侧下肢膝关节周围进行脱毛处理。实验组:将吊伤膏涂于3 cm×6 cm纱布上,厚度为2 mm,敷于受累关节;对照组:将复方紫荆消伤膏剪成3 cm×6 cm小片,敷于受累关节;模型组:予凡士林涂于3 cm×6 cm纱布上,厚度为2 mm,敷于受累关节;空白组:予同样规格大小的医用纱布敷于相应关节,再用医用胶布进行八字缠绕。常规每日敷药5 h,连续干预14 d。干预治疗时定期监测实验兔右膝肤温;干预治疗14 d后检测各组兔膝关节滑液中炎症因子[肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、前列腺素E,2,(PGE,2,)])水平;制作滑膜组织病理切片,并分别用HE染色法观察滑膜组织的病理变化、免疫荧光法检测水通道蛋白1、4(AQP1、AQP 4)的表达;部分兔膝关节采用核磁共振(MRI)观察。,结果,2,实验组膏药对滑膜炎兔患膝肤温的改善时-效关系上优于对照组。干预治疗后实验组和对照组兔患膝关节滑液中炎症因子TNF-α、IL-1β、PGE,2,差异无统计学意义(,P,>,0.05)。4组兔患膝滑膜病理切片HE染色评分差异有统计学意义(,P,<,0.05)。膏药干预治疗后,与模型组相比,对照组和实验组滑膜组织中的AQP1、AQP4表达明显降低,差异有统计学意义(,P,<,0.05);对照组滑膜组织中的AQP1含量与空白组差异无统计学意义(,P,>,0.05);实验组滑膜组织中的AQP4含量与对照组差异无统计学意义(,P,>,0.05)。实验组MRI图像中关节腔积液少于其他组。,结论,2,施氏吊伤膏在对滑膜炎兔患膝肤温的改善时-效关系上优于对照组膏药。施氏吊伤膏能从改善患膝肤温,减少滑液中炎症因子的表达,降低模型兔滑膜组织中AQP1、AQP 4表达,减少膝关节积液等方面改善膝关节滑膜炎症状。
Objective,2,To explore the therapeutic effect and mechanism of Shi’s Diaoshang Ointment on improving synovitis in knee osteoarthritis (KOA).,Methods,2,Forty male New Zealand rabbits were randomly divided into a blank group, a model group, an experimental group (Shi’s Diaoshang Ointment group) and a control group (compound Zijing Xiaoshang Ointment group), with 10 rabbits in each group. The rabbits in the blank group were fed normally, and the rabbits in the other three groups were injected with a mixed solution of 4% papain and 0.03 mol/L L-cysteine (2∶1) at a dosage of 0.2 mL/kg on the 1st, 4th, 7th and 12th day respectively to make the synovitis model of the knee joint. After the model was successfully prepared, the rabbits were depilated around the right lower limb knee joint. In the experimental group: a 3 cm × 6 cm gauze was smeared with 2 mm thickness of Diaoshang Ointment and applied to the affected joints; In the control group: Compound Zijing Xiaoshang Ointment was cut into 3 cm × 6 cm pieces and applied to the affected joints; In the model group: a 3 cm × 6 cm gauze was coated with 2 mm thickness of Vaseline and applied to the affected joints; In the blank group: A medical gauze of the same size was applied to the corresponding joint, and then eight-character winding was used to wrap the joint with medical adhesive tape. The dressing was routinely applied for 5 hours every day for 14 consecutive days. The skin temperature of the right knee of experimental rabbits was monitored regularly during intervention. The inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), prostaglandin E,2, (PGE,2,)] in knee synovial fluid of rabbits were detected after 14 days of intervention. The pathological changes of synovial tissue were observed by HE staining, and the content of aquaporin-1 and 4 (AQP1, AQP4) was detected by immunofluorescence. Some rabbit knee joints were observed via nuclear magnetic resonance imaging (MRI).,Results,2,The ointment used in the experimental group was superior to compound Zijing Xiaoshang Ointment used in the control group in improving the time-effect relationship of knee skin temperature in synovitis rabbits. There was no significant difference in levels of TNF-α, IL-1β, PGE,2, in synovial fluid between the experimental group and the control group (,P,>,0.05). There were significant differences in HE staining scores of pathological sections of synovium obtained from rabbits’ affected joints in four groups (,P,<,0.05). After intervention, the content of AQP1 and AQP4 in synovium decreased significantly; The differences in the content of AQP1 and AQP4 were significant between the control group and the model group and also between the experimental group and the model group (,P,<,0.05); There was no significant difference in the content of AQP1 between the control group and the blank group (,P,>,0.05); There was no significant difference in the content of AQP4 between the experimental group and the control group (,P,>,0.05). The articular cavity effusion in MRI images was less in the experimental group than that in other groups.,Conclusions,2,Shi’s Diaoshang Ointment had better time-effect relationship of improving skin temperature of affected knees of synovitis rabbits than compound Zijing Xiaoshang Ointment used in the control group. Shi’s Diaoshang Ointment can improve synovitis in KOA by improving skin temperature, reducing the expression of inflammatory factors in synovial fluid, lowering the content of AQP1 and AQP4 in synovial tissue of model rabbits, and reducing articular cavity effusion.
膝骨关节炎膝关节滑膜炎施氏吊伤膏水通道蛋白外治法中药复方机制研究
knee osteoarthritisknee synovitisShi’s Diaoshang Ointmentaquaporinexternal therapyTCM compound formulamechanism research
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