补肾除湿联合富血小板血浆调控血清TGF-β1及Smad-1水平治疗膝骨关节炎

Effect of Bushen Chushi(补肾除湿)decoction combined with platelet-rich plasma on regulating TGF-β1 and Smad-1 expression in serum of knee osteoarthritis patient

目的:探讨补肾除湿联合富血小板血浆(platelet-rich plasma,PRP)治疗早中期膝骨关节炎(knee osteoarthritis,KOA)的临床疗效及对患者血清中转化生长因子-β1(transforming growth factor-β1,TGF-β1)和Smad-1水平的影响。方法:选取2020年5月至2022年4月收治的45例早中期KOA患者,分为对照组和观察组。对照组30例,男12例,女18例;年龄43~69(57.3±6.5)岁;Kellgren-Lawrence(K-L)分级Ⅰ级8例,Ⅱ级13例,Ⅲ级9例;病程1.5~5.0(3.8±1.7)年;分别于1、3周时向患膝关节腔注射5 ml的PRP 1次,共2次。观察组15例,男7例,女8例;年龄45~70(56.7±6.2)岁;K-L分级Ⅰ级4例,Ⅱ级9例,Ⅲ级2例;病程1.8~5.7(4.0±1.8)年;注射PRP 5 ml,时间、次数与对照组相同,同时口服补肾除湿方水煎剂,每日1剂,共28剂。两组疗程均为4周。分别于治疗前后采用疼痛视觉模拟评分(visual analogue scale,VAS)和Lequesne MG评分评估患膝疼痛及关节功能改善情况。分别于治疗前、治疗结束后1 d采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)检测TGF-β1、Smad-1的含量,并观察两组患者并发症发生情况。结果:45例患者获得随访,时间26~30(28.0±0.6)d。治疗前两组VAS和膝关节Lequesne MG评分比较,差异无统计学意义(P>0.05);治疗结束后1 d,两组VAS和膝关节Lequesne MG评分均低于治疗前(P<0.05);治疗结束后1 d,观察组VAS和膝关节Lequesne MG评分低于对照组(P<0.05)。两组治疗结束后1 d,TGF-β1含量均较治疗前降低(P<0.05);治疗结束后1 d,观察组TGF-β1含量低于对照组(P<0.05)。两组治疗结束后1 d的Smad-1含量与治疗前比较,差异无统计学意义(P>0.05);治疗结束后1 d,观察组Smad-1含量高于对照组(P<0.05)。两组并发症情况比较,差异无统计学意义(P>0.05)。结论:补肾除湿联合关节腔注射PRP治疗早中期KOA疗效确切,优于单纯关节腔内注射PRP,并在一定程度上降低患者血清TGF-β1水平,升高Smad-1水平,抑制炎症反应,促进软骨修复,这可能是补肾除湿联合PRP治疗KOA的作用机制之一。

Objective To investigate the effect of Bushen Chushi decoction combined with platelet-rich plasma(PRP)to treat knee osteoarthritis(KOA)in early and middle stage and its regulation on TGF-β1 and Smad-1 expression in serum.Methods Total of 45 patients with KOA in early and middle stage from May 2020 to April 2022 were treated and divided into control group and observation group.In control group,there were 30 patients including 12 males and 18 females,aged from 43 to 69 years old with an average of(57.3±6.5)years old and disease duration ranged from 1.5 to 5.0 years with an average of(3.8±1.7)years,and there were 8 cases in gradeⅠ,13 cases in gradeⅡ,and 9 cases in gradeⅢaccording to Kellgren-Lawrence Grade,PRP 5 ml was injected into knee joint on the first day of No1,3 week together for 2 times.In the observation group,there were 15 cases including 7 males and 8 females,aged from 45 to 70 years old with an average of(56.7±6.2)years old and disease duration ranged from 1.8 to 5.7 years with an average of(4.0±1.8)years,there were 4 cases in gradeⅠ,9 cases in gradeⅡand 4 cases in gradeⅢaccording to the Kellgren-Lawrence Grade,PRP 5 ml were injected into knee joints thatthe time and frequency were the same as those in the control group,and at the same time Bushen Chushi decoction orally were taken 1 dose per day with a total of 28 doses.All patients were treated for four weeks.Visual analogue scale(VAS)and Lequesne MG score before and after treatment were used to evaluate improvement of knee pain and joint function.The TGF-β1 and Smad-1 levels in serum were measured before and after treatment in two groups.The incidence of complications in two groups was observed.Results All patients were followed up for 26 to 30 days with an average of(28.0±0.6)days.There was no significant difference in VAS and knee Lequesne MG scores between two groups before treatment(P>0.05).The scores of VAS and knee Lequesne MG on the first day after treatment in both groups were lower than those before treatment(P<0.05).The VAS and knee Lequesne MG scores in observation group were lower than those in control group(P<0.05)on the first day after treatment.The TGF-β1 level in serum after treatment were higher significantly than that before treatment in two groups(P<0.05).After treatment,TGF-β1 level in serum in observation group were lower than those in control group with statistically significant differences(P<0.05).The Smad-1 levels in serum after treatment in observation group were higher significantly than that in control group(P<0.05).The levels of Smad-1 were not statistically significant between before and after treatment(P>0.05).There was no significant difference in postopertaive complications between two groups(P>0.05).Conclusion The efficacy of Bushen Chushi decoction combined with PRP in treatment of early and middle KOA is better than that of PRP injection alone.The combined treatment could reduce TGF-β1 level and increase Smad-1 level in serum,which may be a mechanism to inhibit inflammation and alleviate cartilage degeneration to some extent.