独活寄生汤联合体外冲击波对膝骨关节炎患者IL-1β和SOD及MMP-3表达的影响

目的探讨独活寄生汤联合体外冲击波治疗对膝骨关节炎患者白细胞介素1β(IL-1β)、超氧化物歧化酶(SOD)和基质金属蛋白酶3(MMP-3)表达的影响。方法收集2013-09~2016-03该院门诊就诊的膝骨性关节炎(knee osteoarthritis,KOA)患者300例(300膝),按患者意愿随机分为三组,中药组100例予口服独活寄生汤治疗,冲击波组100例予体外冲击波治疗,联合组100例予独活寄生汤联合体外冲击波治疗。在治疗前和治疗2周、4周、6周、12周、24周后抽取患膝关节液,检测膝关节液中IL-1β、SOD和MMP-3表达情况。结果 (1)组内治疗前和治疗后IL-1β、SOD和MMP-3表达的比较:各组患者治疗2周、4周、6周、12周、24周后与治疗前相比,差异均有统计学意义(P0.05),认为三组均能下调KOA患者膝关节液中IL-1β和MMP-3表达,上调SOD表达。(2)组间各时间点IL-1β、SOD和MMP-3比较:治疗前各组两两比较差异均无统计学意义(P0.05);治疗2周、4周、6周、12周、24周后,中药组与冲击波组比较差异无统计学意义(P0.05),联合组与中药组、冲击波比较差异有统计学意义(P0.05),认为中药组和冲击波组下调膝关节液中IL-1β、MMP-3表达和上调SOD表达效果相当,联合组效果优于中药组和冲击波组。结论独活寄生汤联合体外冲击波治疗KOA具有下调膝关节液中IL-β和MMP-3表达,上调SOD表达的作用。     

体外冲击波疗法治疗老年膝骨性关节炎的研究进展

<正>膝骨性关节炎(KOA)是一种常见的老年人退行性病变,主要表现为膝关节的疼痛、活动受限以及关节畸形,严重影响着老年人的生活质量^[1,2]。KOA发病率随着年龄的增长而呈上升趋势,据统计,国外老年KOA的发病率为10.0%～16.0%,国内发病率为11.1%～21.9%^[3,4]。目前,老年KOA的发病机制尚不明确,治疗主要以缓解疼痛、改善关节功能、延缓疾病发展等为主,临床上仍缺少治愈的方法^[5,6]。     

中西医结合治疗老年腰椎骨性关节炎的临床研究

腰椎的骨性关节炎主要特征为关节软骨变性、破坏和骨质增生,是骨科临床上的常见病和多发病[1].随年龄的增大发病率增高,通常50岁以前男性比女性更易患病,但50岁以后女性患病增多[2],60岁以上者达78.5%[3].骨性关节炎常累及手、膝、髋、椎体等部位,严重影响患者的生活质量.     

冲击波治疗膝关节骨性关节炎的单盲平行模拟对照临床研究

目的研究冲击波对膝关节骨性关节炎的治疗效果和安全性。方法将72例膝关节退行性关节炎患者分为冲击波组37例，对照组35例。以直观模拟标度尺（VAS）测量值观察治疗前后患者膝关节的临床疼痛症状改善情况，通过Lequesne指数（Lequesnealgofunctionalindex）和KSKS（KneeSocietyKneeScore）评分对治疗前后的膝关节功能进行综合评价。结果冲击波组和对照组两组问患者的完成试验人数、年龄、性别、体重、身高、患膝数、VAS评分、Lequesne指数和KSKS评分无统计学差异。治疗后1、2和3个月后，冲击波组的VAS评分和Lequesne指数明显下降，KSKS评分明显升高，与对照组相比有统计学意义（P〈0．05）。结论冲击波疗法能够有效的减轻膝关节骨性关节炎患者的疼痛，改善其功能。     

中药熏蒸联合关节镜清理治疗膝关节骨性关节炎的疗效

<正>在中医理论中,膝关节骨性关节炎(KOA)属于痹证的相关范畴,内因为肝肾亏损,外因是风寒湿邪以及劳损,腰膝酸软以及风寒湿邪乘虚而入,静脉闭阻,继而生痛,经脉闭阻导致气血不入,不荣则痛〔1〕。有研究表明55岁人群KOA的发病率高达44%⁷5%,其中约10%的患者表现出多种运动功能障碍,关节镜清理虽然具有起效快等特点,但其复发率较高〔2,3〕。     

加味独活寄生合剂配合冲击波对老年膝骨性关节炎疼痛的影响

目的探讨加味独活寄生合剂配合冲击波治疗膝骨性关节炎(KOA)的临床疗效。方法将60例膝关节患者随机分为治疗组和对照组各30例,对照组予单纯体外冲击波治疗,2次/w,连续5 w;治疗组在对照组的基础上予加味独活寄生合剂口服,60 ml/次,2次/d。5 w后观察两组疗效。结果两组治疗前后视觉模拟评分法(VAS)评分均降低(P<0.05);治疗后两组VAS评分比较治疗组低于对照组(P<0.05);治疗组治疗后膝关节功能WOMAC评分优于对照组(P<0.05)。结论加味独活寄生合剂配合冲击波可减轻KOA患者疼痛,改善膝关节功能。     

针灸联合肌力强化训练治疗膝关节骨性关节炎的临床研究

目的临床观察针灸联合肌力强化训练治疗膝关节骨性关节炎的疗效。方法选取2012年1月~2O13年12月我院门诊或住院的68例膝关节骨性关节炎患者,随机分为对照组与治疗组,每组各34例。对照组西医玻璃酸钠注射液关节腔内注射25mg,1次/周,辅助以口服双氯灭痛75mg,1次/d;治疗组在西医玻璃酸钠注射液关节腔内注射及其口服双氯灭痛基础上,进行中医针灸联合肌力强化训练。各进行3个疗程,每个疗程7 d,观察两组疗效并记录数据。结果对照组总有效率为52.9%;治疗组总有效率为76.5%,治疗组疗效明显优于对照组,差异有统计学意义（P〈0.05）。结论针灸联合肌力强化训练治疗膝关节骨性关节炎是较单纯使用西医治疗疗效更为显著且安全有效的方法,值得临床推广使用。     

关节镜治疗膝关节骨性关节炎357例

膝关节骨性关节炎在老年人群中发病率高,已经成为影响老年人生活质量的重要因素。本文回顾性分析我院2006～2009年行关节镜治疗的膝关节炎患者,分析其疗效。1对象与方法1.1一般资料入组的357例膝关节骨性关节炎患者术前按美国风湿病协会标准确诊;所有病例均为单侧膝关节炎;其中男134例,女223例;年龄60～70〔(平均64±4.8)〕     

膝关节骨性关节炎治疗方法的研究进展

膝关节骨性关节炎是目前临床治疗的难题之一,其治疗方法虽多,但各种方法均有其适用范围和利弊,因此比较和分析各种治疗方法的特点和可行性,能有效地为临床研究提供一些参考和指引,以及适当地帮助临床医师找到治疗膝关节骨性关节炎中适合于不同患者的最佳治疗方案。     

独活寄生汤对胶原诱导性关节炎大鼠血清中炎症因子的影响

目的探讨独活寄生汤对胶原诱导性关节炎(CIA)大鼠血清中白细胞介素-10(IL-10)、白细胞介素-17(IL-17)、白细胞介素-37(IL-37)及干扰素-γ(IFN-γ)水平的影响。方法选择雄性Wistar大鼠60只,随机选取6只大鼠设为正常组,其余54只通过注射完全弗氏佐剂构建CIA模型。选择造模成功的大鼠30只,随机分为阳性对照组、塞来昔布组(以0. 05 g/ml予塞来昔布干预)和独活寄生汤高、中、低浓度组(分别以4. 40 g/ml、2. 20 g/ml和1. 10 g/ml独活寄生汤干预)。比较各组大鼠在干预后血清中IL-17、IFN-γ、IL-10和IL-37的水平。结果与正常组比较,阳性对照组IL-17、IFN-γ水平显著升高(P 0. 05)。与阳性对照组比较,塞来昔布组和独活寄生汤中浓度组IL-10、IL-37水平升高,IL-17、IFN-γ水平降低,差异有统计学意义(P 0. 05);但阳性对照组与独活寄生汤高浓度组和低浓度组比较差异无统计学意义(P 0. 05)。结论独活寄生汤对CIA大鼠关节炎症具有明显改善作用,其抗炎作用机制可能通过降低促炎因子IL-17、IFN-γ水平和升高抑炎因子IL-10、IL-37水平来实现。     

Correlation between serum leptin,cytokines, cartilage degradation and functional impact in obese knee osteoarthritis patients

Aim of the workThe aim of the present work was to correlate between serum level of leptin, matrix metalloproteinase-13 (MMP13), interleukin-1β (IL1β), tumour necrosis factor (TNF-α), nitric oxide (NO) and functional impact in obese patients with knee osteoarthritis (KOA).Patients and methodsThe study included 84 obese patients suffering from primary KOA. The knees were examined; pain assessed by visual analogue scale (VAS) and Lequesne’s index for functional impact calculated. Serum leptin, MMP13, IL1β, TNF-α and NO were assessed.ResultsThe mean age of the patients was 54.64 ± 7.7 years. They were 72 females and 12 males (F:M = 6:1) with a mean BMI of 35.29 ± 4.8. Sixty patients had knee effusion which was bilateral in 54 (64.3%), unilateral in 6 (7.2%) while 24 (28.6%) did not have any effusion. Knee deformities were present in 60 (71.4%) patients. Female patients were only significantly higher than males regarding Lequesne’s index (15.08 ± 4.4 vs 11 ± 3.4, p = 0.003). Patients with knee deformity had significantly higher VAS (9.12 ± 1.3 vs 6.96 ± 0.46, p = 0.001), IL1β (621.1 ± 98.8 vs 503.9 ± 74.6 pg/ml, p = 0.001), TNF-α (115.4 ± 29.1 vs 87.4 ± 4.4 pg/ml, p = 0.001), NO (67.32 ± 5.7 vs 59.2 ± 2.2 μmol/L, p = 0.001), MMP13 (33.98 ± 2.24 vs 30.1 ± 1.7 ng/ml, p = 0.012) and leptin (13.2 ± 1.6 vs 10.4 ± 0.6, p = 0.004) than those without. The VAS, Lequesne index, IL1β, TNF-α NO, MMP13 and leptin were significantly higher in patients with bilateral knee effusion (p < 0.0001 for all) compared to those with unilateral effusion or without. Leptin significantly correlated with BMI, VAS, Lequesne’s index, IL1β, TNFα, NO and MMP13 (p < 0.0001 for all).ConclusionLeptin plays a key role in obese patients with knee OA. It significantly correlates with knee pain, functional impairment, inflammatory cytokines and cartilage degradation.     

Effects of hyaluronan on nitric oxide levels and superoxide dismutase activities in synovial fluid in knee osteoarthritis

The aim of the present study was to evaluate the effects of hyaluronan (HA) on nitric oxide (NO) levels and superoxide dismutase (SOD) enzyme activities in synovial fluid (SF) in the treatment of patients with knee osteoarthritis (OA). SF samples were aspirated from OA patients before the commencement of the treatment (n = 23) and 6 weeks after they were treated with HA products. NO levels and SOD activities were compared between the pre- and post-treatment of OA patients and of the control group (n = 10). SF NO levels were significantly higher in patients with OA before the commencement of the treatment compared with the post-treatment (p < 0.001) and the control groups. The SF SOD activity of patients before the commencement of the treatment was lower than the values in the controls and post-treatment (p < 0.001). There is no significant correlation between SF NO and SOD levels and the radiographic changes of the OA knee according to Kellgren–Lawrence grading (p > 0.05). Also, the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) pain scores and physical function scores were gradually improved. These findings made us think that SF NO was a potent mediator in cartilage damage in OA, whereas SOD was an antioxidant mediator in the same process. Exogenous HA injections might reduce the NO levels and increase SOD activities in synovial fluid. These effects also do not seem to be dependent on the radiographic grading of the OA knee. More comprehensive studies are needed to clarify a possible clinical significance of this topic, and we suggest that this is an important area for further research into new treatment options.     

A comparative study of the efficacy of Chinese herbal medicine Duhuo Jisheng decoction combined with DMARDs vs isolated DMARDs for rheumatoid arthritis: A protocol for systematic review and meta analysis

Background:Rheumatoid arthritis (RA) is a chronic autoimmune system disease that mainly affects joints throughout the body, causing joint pain, deformity, and even disability. The use of Chinese herbal medicine (CHM) to treat RA has achieved certain effects, and Duohuo Jisheng decoction (DHJSD) is one of them. But there is no high-level evidence to support this result. The purpose of this work is to evaluate the effectiveness of DHJSD combined with DMARDs compared with isolated DMARDs for RA.Methods:We will search articles in 7 electronic databases including Chinese National Knowledge Infrastructure (CNKI), Wanfang Data (WF), Chinese Scientific Journals Database (VIP), Chinese databases SinoMed (CBM), PubMed, Embase, and Cochrane Library databases. All the publications, with no time restrictions, will be searched without any restriction of language and status, the time from the establishment of the database to October 2020. Two reviewers will independently assess the quality of the selected studies, NoteExpress and Excel software will be used to extract data, and the content will be stored in an electronic chart. Different researchers will separately screen the titles and abstracts of records acquired potential eligibility which comes from the electronic databases. Full-text screening and data extraction will be conducted afterward independently. Statistical analysis will be conducted using RevMan 5.4 software.Results:This study will evaluate the efficacy and safety of DHJSD combined with DMARDs compared with isolated DMARDs in the treatment of Rheumatoid arthritis, to provide high-quality, evidence-based clinical recommendations.Conclusion:This study will provide reliable evidence on whether Duhuo Jisheng decoction combined with DMARDs compared with isolated DMARDs is more effective in treating RA.Trial registration number:INPLASY2020100089.     

放射状体外冲击波穴位疗法对老年膝骨关节炎患者的疗效及作用机制

目的 探讨放射状体外冲击波穴位疗法在老年膝骨关节炎(KOA)患者治疗中的应用价值,并分析其作用机制.方法 选择上海中医药大学附属曙光医院2018年1月到2019年6月收治的108例老年KOA患者为研究对象,根据随机数表法将患者分为药物组和冲击波组,各54例.药物组采用药物治疗,冲击波组采用放射状体外冲击波穴位疗法.比较...     

坦索罗辛联合五淋化石丸在输尿管下段结石体外震波碎石术后辅助排石效果观察

目的探讨体外震波碎石术(ESWL)治疗输尿管下段结石后应用坦索罗辛联合五淋化石丸辅助排石的效果。方法对120例输尿管下段结石患者随机分为对照组(60例)和治疗组(60例),对照组ES-WL后应用五淋化石丸,1.25g/次,3次/d,未应用输尿管平滑肌松弛剂;治疗组ESWL后在对照组治疗方案的基础上予以口服α_1肾上腺索能受体阻滞剂坦索罗辛,0.4 mg/次,1次/d。观察两组的结石排出率、结石排出时间、并发症(肾绞痛、发热、血尿)发生率及药物的副作用并比较。每例患者观察时间不超过2周。结果治疗组排石率为88.3%,对照组为46.7%,治疗组高于对照组(P0.01)。肾绞痛、发热、血尿的发生率对照组分别为35.0%、20.0%、23.3%,治疗组分别为10.0%、6.7%、8.3%,治疗组低于对照组(P0.05)。治疗组除2例发生头晕外,无其他不良反应发生。结论坦索罗辛联合五淋化石丸能够发挥两者的协同作用,提高输尿管下段结石ESWL后的排石率,降低肾绞痛、发热、血尿及药物副作用的发生率,且安全有效,值得临床推广应用。     

VEGF通路对体外冲击波联合仙桃草治疗骨不连骨痂中成骨细胞增殖作用的影响

目的探讨血管内皮生长因子(vascular endothelial growth factor,VEGF)通路对体外冲击波联合仙桃草治疗兔桡骨骨不连骨痂中成骨细胞增殖作用的影响。方法制作100只兔桡骨骨不连模型,造模成功后随机分为四组:A组为体外冲击波联合仙桃草治疗组,B组为单纯仙桃草治疗组,C组为单纯体外冲击波治疗组,D组为完全对照组。于治疗后不同时相点(第1、2、4、8、12周)分别取材,H-E染色观察成骨细胞计数,免疫组织化学观察VEGF表达情况。结果体外冲击波联合仙桃草治疗组能够加速成骨细胞增殖并上调VEGF表达,与其他三组比较差异有统计学意义(P0.01)。其中,成骨细胞增殖与VEGF表达的变化曲线大致相同,于第2周后明显增多,第8周到达峰值,第12周时较前稍降低,但数量仍较多。结论体外冲击波联合仙桃草治疗骨不连效果安全可靠,其机制可能是通过对骨痂中VEGF细胞因子的影响,促进成骨细胞的增殖,来达到治疗骨不连的目的。     

益母草注射液对失血性休克大鼠多组织器官NO的影响

目的 观察益母草注射液(LHI)对失血性休克大鼠肝、肾、心肌、肺等组织器官一氧化氮(NO)含量及其合酶(NOS)活性的影响.方法 LHI组、休克组大鼠(均n=6)经颈总动脉放血至40 mmHg,复制失血性休克模型.维持低血压60 min后,LHI组缓慢输注LHI(5 g/ml,5 g/kg),再输入放出的全血及等量生...     

超声引导下干针与体外冲击波治疗在老年足底筋膜炎中的比较

目的 比较超声引导下干针与体外冲击波治疗(ESWT)对老年足底筋膜炎(PF)的临床疗效.方法 2018年8月-2020年2月,选取南通市第六人民医院疼痛科收治的58例老年PF患者,随机分为干针组(n=29)和ESWT组(n=29).分别于治疗前(T0)、1个疗程治疗结束后4周(T1)、1个疗程治疗结束后12周(T2),...     

脑囊虫病患者脑脊液中丙二醛、超氧化物歧化酶检测及意义

目的 探讨脑囊虫病患者各期脑脊液中MDA、SOD的变化规律及它们在脑囊虫病中的作用机制。方法 检测2000-07～2003-03北京朝阳医院神经科49例明确诊断并依据MRI分期,单发脑实质内囊虫的脑囊虫病患者,以及20名对照者脑脊液中MDA、SOD水平并予SPSS统计学分析。结果 SOD在脑囊虫病病理过程中除Ⅳ期接近正常外,其余各期含量持续显著不足,MDA在脑囊虫病病理过程中水平是整体增高趋势,且于Ⅱ期显著高于其它各期。MDA与SOD有负相关关系。结论 在单发脑实质内囊虫病中氧自由基可能与杀伤脑囊尾蚴有密切的关系。