从炎性细胞因子与Dickkopf-1变化研究补肾活血方对绝经后膝骨关节炎的干预作用

Intervention Effect of Bushen Huoxue Decoction on Postmenopausal Knee Osteoarthritis from Changes in Inflammatory Cytokines and Dickkopf-1

目的:研究自拟中药补肾活血方对绝经后膝骨关节炎(Knee Osteoarthritis,KOA)患者血清白细胞介素1(Interleukin1,IL-1)、肿瘤坏死因子α(Tumor Necrosis Factorα,TNF-α)、雌二醇(Estradiol,E_2)、Dickkopf-1(Dkk-1)水平的影响。方法:将60例符合标准的KOA患者随机分为治疗组与对照组,每组均30人。治疗组予自拟补肾活血方,1剂/d,分早晚2次服;对照组予双醋瑞因50 mg/d;疗程均为4周,测定患者治疗前后血清IL-1、TNF-α、E_2、Dkk-1含量。结果:治疗组控显率与总有效率分别为60%、96.67%;对照组控显率与总有效率分别为53.33%、93.33%。实验室指标检测显示,2组治疗后血清IL-1、TNF-α水平均较治疗前降低(P<0.01);2组治疗后的组间比较显示,IL-1含量差异无统计学意义(P>0.05),TNF-α含量差异有统计学意义(P<0.05)。血清E_2水平检测结果显示,治疗组治疗后较治疗前增加(P<0.01),对照组治疗后较治疗前有所增加,但差异无统计学(P>0.05),治疗组与对照组治疗后的组间比较差异有统计学意义(P<0.01)。血清Dkk-1水平方面,2组治疗前后比较及2组治疗后组间比较差异均无统计学意义(P>0.05)。结论:绝经后KOA的主要病机为肾虚血瘀,补肾活血中药可改善绝经后KOA的症状;补肾活血方可能通过调节雌激素水平以及炎性细胞因子起到干预绝经后KOA的作用;补肾活血方对于Wnt信号通路中Dkk-1无明显作用,可能Wnt信号通路不参与补肾活血方的干预途径。

Objective：To study the curative effect of Bushen Huoxue Decoction, nourishing kidney and removing blood stasis, on serum interleukin 1, tumor necrosis factor α, Estradiol and Dickkopf-1 level in patients with postmenopausal knee osteoarthritis.Methods：A total number of 60 patients with knee osteoarthritis meeting the diagnosis criteria were randomly divided into treatment group and control group with 30 patients in each group.Patients in the treatment group were given with Bushen Huoxue Decoction a dose and twice daily, while patients in the control group were taken Diacerein Capsule for 50 mg/d.The observation period was 4 weeks.The contents of IL-1, TNF-α, E2, Dkk-1 of all patients were detected before and after treatment.Results：In treatment group, the controlled effective rate was 60% and the total effective rate was 96.67%.While in the control group, the controlled effective rate was 53.33% and the total effective rate was 93.33%.Comparison in serum IL-1 and TNF-α of both the two groups before and after treatment within their groups showed that there was remarkably significant difference （P〈0.01）.Comparison of the two groups after treatment between the group showed no significant difference for IL-1 （P〉0.05） and significant difference for TNF-αcontent （P〈0.05）.Serum E2 of the treatment group before and after treatment showed obviously significant difference （P〈0.01）, while that of the control group before and after treatment indicated no significant difference （P〉0.05）.Comparison after treatment between the group showed there was remarkably significant difference （P〈0.01）.Serum Dkk-1, there were no significant differences within the two groups before and after treatment, and the same result between groups after treatment.Conclusion：The main pathogenesis of postmenopausal KOA may be due to kidney deficiency and blood stasis and Bushen Huoxue Decoction may well improve symptoms of postmenopausal knee osteoarthritis and intervene postmenopausal KOA by regulating the levels of estrogen and inflammatory cytokines.Bushen Huoxue Decoction has no obvious effect for Dkk-1 of Wnt signal pathway, and Wnt signal pathway may not participate in Bushen Huoxue Decoction intervention way.