基于A3r受体探讨针刀疗法治疗膝骨关节炎的作用机制

Action Mechanism of Acupotomy Therapy in Treating KOA Based on A3r Receptor

目的:在A3r受体的基础上探讨针刀疗法治疗膝骨关节炎的分子生物学机制。方法:选取2018年3月—2019年12月本院(黑龙江中医药大学附属第一医院)收治的膝骨关节炎96例患者为研究对象,随机分成对照组及观察组各48例。对照组均进行口服药物(硫酸氨基葡萄糖胶囊)治疗,观察组在其基础上增加针刀松解术治疗。治疗结束后分别比较两组治疗前后的临床疗效、骨关节炎指数(WOMAC)评分、骨关节炎的严重程度指数(Lequesne MG)评分、P38MAPK、MEK3/6含量、NF-KB信号通路指标变化[p50、p65及NF-KB抑制蛋白α(IKBα)]及炎症因子[白介素1β(IL-1β)、人基质金属蛋白酶3(MMP-3)、超敏C反应蛋白(hs-CRP)及肿瘤坏死因子(TNF-α)]表达水平。结果:治疗后,观察组总有效率91.67%(44/48),显著高于对照组的77.08%(37/48),差异有统计学意义(P<0.05);治疗后,观察组与对照组WOMAC评分、Lequesne MG评分均明显低于治疗前,差异有统计学意义(P<0.05),且观察组明显低于对照组,差异有统计学意义(P<0.05);治疗后观察组与对照组AIMS2-SF评分均明显高于治疗前,差异有统计学意义(P<0.05),且观察组明显高于对照组(P<0.05);治疗后,观察组与对照组P38MAPK、MEK3/6、p50、p65及IKBα含量均明显低于治疗前(P<0.05),且观察组明显低于对照组,差异有统计学意义(P<0.05);治疗后观察组与对照组炎症因子(IL-1β、MMP-3、hs-CRP与TNF-α)水平均明显低于治疗前,差异有统计学意义(P<0.05),且观察组明显低于对照组,差异有统计学意义(P<0.05)。结论:针刀疗法可明显改善KOA患者临床症状(疼痛、肿胀和晨僵等)以及膝关节活动功能,降低相关炎性因子的表达,其起作用的原因可能与抑制P38MAPK、MEK3/6和NF-KB信号通路有关。

Objective: To investigate the molecular biological mechanism of acupotomy in treatment of knee osteoarthritis(KOA) based on A3r receptor. Methods: A total of 96 patients with KOA were randomly divided into the control group and the observation group, with 48 patients in each group. The control group was treated with Glucosamine Sulfate Capsule;on which basis, the observation group was also treated with acupotomy debonding therapy. WOMAC score and Lequesne MG score, P38MAPK, MEK3/6 content, NF-KB signaling pathway indicators of p50, p65, IKBα, as well as inflammatory factors of IL-1β, MMP-3, hs-CRP and TNF-α were compared before and after the treatment in the two groups. Clinical efficacy was also compared between the two groups. Results: The effective rate of the observation group was 91.67%(44/48), which was significantly higher than 77.08%(37/48) of the control group(P<0.05). WOMAC score and Lequesne MG score were significantly lower after the treatment than those before the treatment in the two groups(P<0.05), of which the observation group was significantly lower than the control group(P<0.05). AIMS2-SF score was significantly higher after the treatment than that before the treatment in the two groups(P<0.05), of which the observation group was significantly higher than the control group(P<0.05). The contents of P38MAPK, MEK3/6, p50, p65 and IKBα were lower after the treatment than those before the treatment in the two groups(P<0.05), of which the observation group was significantly lower than the control group(P<0.05). The levels of inflammatory factors of IL-1β, MMP-3, hs-CRP and TNF-α were lower after the treatment in the two groups(P<0.05), of which the observation group was significantly lower than the control group(P<0.05). Conclusion: Acupotomy therapy can significantly improve the clinical symptoms of pain, swelling, morning stiffness and knee function of the patients with KOA, and it can reduce the expressions of related inflammatory factors, which may be related to the inhibition of P38MAPK, MEK3/6 and NF-KB signaling pathways.