体外冲击波对兔膝骨性关节炎炎性介质及影像学的影响

Effect of extracorporeal shock wave on the expression of cytokines and imaging of rabbits with knee osteoarthritis

目的在兔膝骨关节炎模型上采用体外冲击波（ESW）干预，观察ESW对关节液炎性介质表达以及影像学表现的影响。方法将48只新西兰大白兔按照体重编号后用抽签法分为空白组（n＝12）和关节炎组（n＝36），关节炎组行常规术前准备，根据改良Hulth法造模，造模成功后再用抽签法随机分为3组：模型组（n＝12）、实验1组（n＝12）、实验2组（n＝12）。空白组及模型组不予ESW干预。实验1组于术后1 d进行ESW冲击波治疗1次，实验2组于术后1 d进行ESW冲击波治疗并之后每周治疗1次。于实验第6、9、12周每批每组随机提取4组兔，进行膝关节数字化X射线摄影（DR），后抽取关节液检测一氧化氮（NO）、一氧化氮合酶（NOS）及白细胞介素（IL）-1的表达。结果影像学改变提示经ESW干预的实验组膝关节病变程度减轻。酶联免疫吸附试验（ELISA）检测结果示实验2组NO于第6、12周[（22.467±2.270）和（25.101±1.409） pg/ml]表达明显低于模型组[（27.364±0.434）、（33.225±1.154） pg/ml，P＝0.017、0.007]、NOS于第12周[（22.014±1.523） pg/ml]表达明显低于模型组[（31.939±2.519） pg/ml，P＝0.008]，以及IL-1于第9、12周[（183.106±28.548）及（213.960±15.256） pg/ml]表达明显低于模型组[（242.630±27.169）（275.120±21.782） pg/ml，P＝0.001、0.007]，差异均有统计学意义。结论ESW可通过减少兔膝关节炎关节内NO、NOS以及IL-1生成，缓解关节内氧化应激损伤及炎性损伤，延缓关节炎病变的进一步进展。

Objective To discuss the influence of extracorporeal shock wave （ESW） on the expression of cytokines and imaging in different therapeutic windows when the ESW therapy was used on rabbit osteoarthritis （OA） model.Methods Forty-eight rabbits were randomly divided into blank group （n=12） and OA group （n=36） by drawing after they were numbered according to their weights. The regular preoperative preparations were used on rabbits in the OA group. After the preparations, the rabbit OA model was established by improved Hulth. After the surgery, the rabbits were divided into three groups by drawing： model group （n=12）, therapy group 1 （n=12）, and therapy group 2 （n=12）. The rabbits in blank group and model group were fed normally and not given ESW. The rabbits in therapy group 1 were subjected to ESW therapy for only once on the day after the surgery. The rabbits in the therapy group 2 received ESW therapy on the day after the surgery, thereafter, once a week. On the 6th, 9th, and 12th week, digital radiography （DR） and the detection of expression of nitric oxide （NO）, nitric oxide synthase （NOS） and interleukin （IL）-1 were performed on rabbits chosen randomly from each group.Results The enzyme linked immunosorbent assay （ELISA） showed that the concentrations of NO in the 6th, 12th week [（22.467±2.270） and （25.101±1.409） pg/ml] in the rabbits of therapy group 2 are lower than those of model group [（27.364±0.434）, （33.225±1.154） pg/ml, P=0.017, 0.007], NOS in the 12th week [（22.014±1.523） pg/ml] in the rabbits of therapy group 2 are lower than those of model group [（31.939±2.519） pg/ml, P=0.008]. IL-1 in the 9th and 12th week [（183.106±28.548）, （213.960±15.256） pg/ml] in the rabbits of therapy group 2 are lower than those of model group obviously [（242.630±27.169）, （275.120±21.782） pg/ml, P=0.001, 0.007]. The difference between the two groups is significant. The imaging changes revealed that the severity of knee joint disease in the rabbits of therapy group was reduced.Conclusion ESW can release the oxidative stress injury and inflammatory injury, and slow the progression of the knee osteoarthritis by reducing the expression of NO, NOS and IL-1.