独活续断汤口服和离子导入治疗肝肾亏虚型膝骨关节炎患者疗效及对膝关节液SDF-1/CXCR4信号通路的影响

Effect of Duhuo Xuduan Tang for Oral Administration and Iontophoresis on SDF-1/CXCR4 Signaling Pathway and Relevant Factors of Cartilage Degradation in Knee Joint Fluid of Patients with Knee Osteoarthritis with Liver and Kidney Deficiency

目的:观察独活续断汤口服和离子导入治疗肝肾亏虚型膝骨关节炎(KOA)的临床疗效及对基质细胞衍生因子-1(SDF-1)/C-X-C趋化因子受体4型(CXCR4)信号通路的影响。方法:将150例天津中医药大学第一附属医院确诊的肝肾亏虚型KOA患者随机分为对照组、中药口服组和中药离子导入组,每组各50例,对照组给予硫酸氨基葡萄糖胶囊,口服0.5 g/次,2次/d口服,中药口服组给予独活续断汤150 m L/次,2次/d口服,中药离子导入组给予独活续断汤,于髋骨穴、膝关穴、膝眼穴及犊鼻穴进行离子导入,30 min/次,1次/d,三组患者均治疗4周;观察入组患者治疗前后膝关节肿胀程度及疼痛程度变化,并统计临床疗效;酶联免疫夹心吸附测定检测入组患者治疗前后膝关节液中SDF-1,CXCR4,基质金属蛋白酶-3(MMP-3)及MMP-13含量。结果:中药口服组疗效优于中药离子导入组和对照组,且复发率最低(P<0.05);与本组治疗前比较,中药口服组治疗后压痛值升高(P<0.05),中药口服组患者视觉模拟评分(VAS),膝关节肿胀评分、西安大略麦马斯特大学骨关节炎指数评分(WOMAC)及膝关节液SDF-1,CXCR4,MMP-3及MMP^-13蛋白含量均降低(P<0.05),且优于中药离子导入组和对照组(P<0.05)。结论:独活续断汤口服及离子导入治疗肝肾亏虚型KOA均有明显疗效,但口服疗效最佳,其机制可能与抑制SDF^-1/CXCR4炎症信号通路及软骨细胞降解有关。

Objective:To observe the clinical efficacy of Duhuo Xuduan Tang for oral administration and iontophoresis in the treatment of knee osteoarthritis(KOA)with liver and kidney deficiency and its effect on stromal cell-derived factor-1(SDF-1)/C-X-C chemokine receptor type 4(CXCR4)signaling pathway.Method:Totally 150 KOA patients with deficiency of liver and kidney diagnosed in the Teaching Hospital of Tianjin University of Traditional Chinese Medicine(TCM)were randomly divided into control group,oral TCM group and iontophoresis group,with 50 cases in each group.The control group was given glucosamine sulfate capsule,0.5 g/time,twice a day,while the oral TCM group was given Duhuo Xuduan Tang,150 mL/time,twice a day.In the iontophoresis group,Duhuo Xuduan Tang was administered at Kuangu acupoint,Xiguan acupoint,Xiyan acupoint and Dubi acupoint for iontophoresis for 30 minutes,once a day.All of the three groups were treated for 4 weeks.The swelling degree and the pain degree of knee joint before and after treatment were observed,and the clinical efficacy was recorded.The protein contents of SDF^-1,CXCR4,matrix metalloproteinase-3(MMP-3)and matrix metalloproteinase^-13(MMP^-13)in knee joint fluid before and after treatment were detected by enzyme-linked immunosorbent assay(ELISA).Result:The efficacy of oral TCM group was better than that of iontophoresis group and control group,and the recurrence rate was the lowest(P<0.05).Compared with before treatment,the tenderness increased,whereas visual analogue scale(VAS)score,knee swelling score,The Western Ontario and McMaste Universities(WOMAC)score and SDF^-1,CXCR4,MMP-3 and MMP^-13 protein content in knee joint fluid decreased in oral TCM group after treatment,which were better than those in iontophoresis group and control group(P<0.05).Conclusion:Duhuo Xuduan Tang for oral administration and iontophoresis has an obvious effect on KOA with liver and kidney deficiency,with the best effect through oral administration.Its mechanism may be related to the inhibition of SDF-1/CXCR4 inflammatory signaling pathway and cartilage decomposition.