^(99)Tc-MDP联合骨康灵治疗骨质疏松的实验研究

The experimental value of ^(99)Tc-MDP combined with GUKANGLING for the treatment of osteoporosis

目的 "99Tc-MDP"结合"骨康灵"联合治疗骨质疏松模型的分析。方法制作兔骨质疏松动物模型并进行实验分析。购置实验兔49只,分为7组:A组(正常对照组)、B组(骨质疏松对照组)、C组("99 Tc-MDP"治疗组)、D组("阿仑膦酸钠"治疗组)、E组("骨康灵"治疗组)、F组("99 Tc-MDP"联合"骨康灵"治疗组)、G组("阿仑膦酸钠"联合"骨康灵"治疗组)。采用肌肉注射"地塞米松磷酸钠注射液"(DX)制作兔骨质疏松模型,2次/每周,连续6周,以后骨质疏松模型继续维持"DX"肌肉注射,但剂量改为一次/周,直至试验结束。分别在骨质疏松的基础上进行治疗,疗程为16周。疗效评判指标:病理细胞学、骨形态计量分析、骨密度检测、生物力学试验、X线摄片、CT摄片、核素骨骼显像ROI的比值、血清BALP、BGP检测。各治疗组试验数据统计结果与B组相比较,依次评判疗效为显效、有效和无效。统计方法:SPSS13.0软件分析数据,所得数据采用x珋±s表示,采用方差分析和组间比较t检验。结果治疗16周后的下一周对各组受试动物进行相关指标检测,结果显示:A组与B组的骨形态计量(121.595±33.445和65.280±21.907)、骨密度(股骨头、L4分别为0.309±0.015、0.298±0.017和0.238±0.011、0.233±0.015)、骨生物力学(股骨头、L4分别为404.433±43.655、698.380±77.520和269.437±40.595、349.350±57.288)、核素骨骼显像(4.126±0.643和6.734±0.458)、BALP(9.000±2.828和42.833±12.714)、BGP(0.105±0.0147和0.176±0.0263),检测结果差异明显(P值均<0.01),病理细胞学显示B组实验兔骨小梁排列稀疏,存在较明显的骨小梁断裂现象,而A组骨小梁排列规则、正常。但X线摄片和CT摄片比较差异不显著。证明本次实验制作兔骨质疏松动物模型成立。各治疗组与B组比较也存在不同程度的差异,方差分析示:形态计量统计值F=12.371;骨密度(股骨头的F=8.832,第四腰椎F=7.174);生物力学(股骨头F=10.548,第四腰椎F=22.737);核素骨骼显像F=24.830,BALP与BGP统计值分别为F=37.356和F=12.061,均存在统计学意义(P值<0.01)。以数据的疗效评判以F组改善最明显,其次为C、G、D组,虽然E组在骨密度、生物力学实验结果改善不明显,但在骨形态计量、核素骨骼扫描以及血清BALP、BGP略有改善。结论本试验结果显示,以"99 Tc-MDP"联合"骨康灵"治疗疗效更明显。可能与合适的中西医配伍、"99Tc-MDP"在人体内具有保护过氧化歧酶(SOD)的活力,抑制了诱导单核破骨细胞前体分化,降低了骨钙流失和"骨康灵"的益气活血、补肝肾壮筋骨,促进了骨的修复有关。使中医和西医的各自特点互补,达到增进疗效意义,提供临床治疗参考。

Objective To investigate the value of 99Tc-MDP combined with GUKANGLING for the treatment of osteoporosis model.Methods Rabbit osteoporosis model was established and analyzed.Forty-nine rabbits were bought and divided into 7 groups,including Group A（normal control）,Group B（osteoporosis control）,Group C（99Tc-MDP treatment group）,Group D（lendronate sodium treatment group）,Group E（GUKANGLING treatment group）,Group F（99Tc-MDP combined with GUKANGLING treatment）,and Group G（alendronate sodium combined with GUKANGLING treatment）.Rabbit osteoporosis model was made by intramuscular injection of dexamethasone sodium phosphate,twice a week for 6 weeks continuously.Dexamethasone was then injected once a week until the experiment ended.The treatment was conducted for 16 weeks.Pathocytology,BMD,biomechanics,bone morphology,X-ray,CT,radionuclide bone scintigraphy,and serum BALP and BGP were used to compare the treatment results.SPSS 13.0 was used to analyze the data.A variance analysis and t-test were chosen as the statistics method.Results Relative indexes were examined on the next week after the 16-week treatment.Results showed that bone morphology（121.595±33.445 and 65.280±21.907）,BMD（femoral head,L4 0.309±0.015,0.298±0.017 and 0.238±0.011,0.233±0.015）,bone biomechanics（femoral head,L4 404.433±43.655,698.380±77.520 and 269.437±40.595,349.350±57.288）,radionuclide bone scintighraphy（4.126±0.643 and 6.734±0.458）,and serum BALP（9.000±2.828 and 42.833±12.714）,BGP（0.105±0.015 and 0.176±0.026） were significantly different between Group A and Group B（P0.01）.The pathocytology of Group B showed diffused trabecula lining and more apparent trabecular broken.But in Group A,the trabecular was formulated in a normal state.This result proved the success in the osteoporosis animal model establishing.The treatment groups showed difference compared to Group B.The variance analysis showed bone morphology F=12.371,BMD F=8.832 in the femoral head and F=7.174 in L4,bone biomechanics F=10.548 in the femoral head and F=22.737 in L4,radionuclide bone scintighraphy F=24.830,BALP F=37.356,and BGP F=12.031,with statistical differences（P0.01）.Group F improved most apparently,and then Group C,G,and D,according to efficacy data.Group E did not showed apparent improvement in BMD and biomechanics,but a little improvement showed in bone morphology,radionuclide bone scintigraphy,and serum BALP and BGP.Conclusion The combining treatment of 99Tc-MDP and GUKANGLING show a better result.Combing with Chinese traditional medicine,99Tc-MDP may have activity of protecting SOD,suppressing the differentiation of mononuclear osteoclast precursor,decreasing the calcium lose.It may relate to the effect of benefiting qi for activating blood circulation and reinforcing liver and kidney to strengthen bones of KUKANGLING.A combining treatment of Chinese medicine and western medicine may enhance the clinical effect.