苓桂术甘汤加减联合膝关节镜关节清理术治疗膝关节骨性关节炎的作用机制

The mechanism of lingguizhugan decoction combined arthroscopic debridement in knee osteoarthritis

目的：研究苓桂术甘汤加减联合膝关节镜关节清理术在治疗膝关节骨性关节炎（knee osteoarthritis，Knee-OA）中的作用机制。方法选取2013年1月至2015年12月本院收治的成人Kellgren分级Ⅰ～Ⅱ期Knee-OA患者60例，随机分为两组，分别采用苓桂术甘汤加减联合膝关节镜关节清理术（试验组），单纯膝关节镜关节清理术（对照组），每组30例。试验组患者于接受关节镜关节清理术前及术后3天应用苓桂术甘汤加减治疗，对照组服用温盐水进行对照。分别在苓桂术甘汤加减治疗前（T1），关节镜手术前（T2）及术后第3天（T3）采集各组患者的膝关节滑液，应用ELISA检测标本中IL-1β、透明质酸和基质金属蛋白酶-3（matrixmetalloproteinase-3，MMP-3）的表达差异。结果与对照组比较，试验组膝关节滑液中的IL-1β、透明质酸和MMP-3在T1时间点的表达水平相近，差异无显著性（P＞0.05），在T2和T3时间点，IL-1β与MMP-3的表达水平明显下降，差异具有显著性（P＜0.05），膝关节滑液中的透明质酸在T2和T3时间点的含量水平明显上调，差异具有显著性（P＜0.05）。结论苓桂术甘汤加减联合膝关节镜关节清理术能明显减轻Knee-OA的炎症水平，并可能通过调节基质蛋白酶-3的含量和增加透明质酸的分泌来治疗Knee-OA。

Objective To investigate the mechanism of lingguizhugan decoction combined arthroscopic debridement in knee osteoarthritis. MethodSixty patients with knee osteoarthritis （Knee-OA） of Kellgren gradeⅠ~Ⅱ were randomly divided into the lingguizhugan decoction treated group and the control group （n=30）. The patients of LGZ group were treated with lingguizhugan decoction for 3 days before and after arthroscopic debridement and the patients of CON group were treated with warm salt water as control. The synovial fluid were collected before the traditional Chinese medicine （TCM） treatment （T1） and arthroscopic debridement （T2） and 3 days after arthroscopic debridement （T3） for determination of the expression of interleukin-1 beta （IL-1β）, hyaluronic acid （HA） and matrix metalloproteinase-3 （MMP-3） by ELISA.ResultCompared with CON group, there was no significant difference of concentration of IL-1β, HA and MMP-3 in group LGZ of T1（P〉0.05）; The concentration of IL-1β and MMP-3 decreased significantly in group LGZ of T2 and T3 （P〈0.05）; The concentration of HA in synovial fluid increased significantly in group LGZ of T2 and T3 （P〈0.05）.Conclusion The lingguizhugan decoction combined arthroscopic debridement can attenuate the secretion of IL-1β in Knee-OA and may regulate the secretion of HA and MMP-3 in the treatment of Knee-OA.