张永辉 欧梁 邝高艳 卢敏

摘要：目的 探討加味独活寄生合剂促进膝骨关节炎（KOA）软骨细胞增殖的临床疗效及其作用机制。方法 采用随机数字表法将60例患者随机分为治疗组和对照组各30例。治疗组予加味独活寄生合剂，每次62.5 mL，每日2次，口服；硫酸氨基葡萄糖胶囊，每次1粒，每日3次，口服。对照组予双醋瑞因胶囊，每次1粒，每日2次，口服；硫酸氨基葡萄糖胶囊，用法用量同治疗组。嘱患者行股四头肌舒缩功能锻炼，注意保暖。连续治疗6周。观察2组治疗前后视觉模拟评分法（VAS）评分、西安大略和麦克马斯特大学骨关节炎指数（WOMAC），检测患膝关节液白细胞介素-1（IL-1）、一氧化氮（NO）、Wnt5a、β-连环蛋白（β-catenin）、Sox9、胶原蛋白Ⅱ（CollagenⅡ）含量，监测不良反应。结果 与本组治疗前比较，2组治疗后IL-1、NO、Wnt5a、β-catenin含量明显降低（P<0.05），Sox9、CollagenⅡ含量明显升高（P<0.05），VAS评分、WOMAC明显降低（P<0.05），以上指标2组治疗后比较差异无统计学意义（P>0.05）。2组均未见明显不良反应。结论 加味独活寄生合剂可降低关节液中炎症因子水平，抑制Wnt信号通路，通过调节通路中Sox9、CollagenⅡ表达促进KOA软骨细胞的增殖分化，有效缓解疼痛并改善关节功能。

关键词：加味独活寄生合剂；膝骨关节炎；软骨修复

DOI：10.3969/j.issn.1005-5304.2018.01.007

中图分类号：R274.94 文献标识码：A 文章编号：1005-5304（2018）01-0028-05

Clinic Efficacy and Action Mechanism of Promoting Repairment of Knee Osteoarthritiss Cartilage Corpuscle via Modified Duhuo Jisheng Mixture

ZHANG Yong-hui1， OU Liang1， KUANG Gao-yan1， LU Min2

1. Hunan University of Chinese Medicine， Changsha 410007， China；

2. The First Affiliated Hospital of Hunan University of Chinese Medicine， Changsha 410007， China

Abstract： Objective To discuss the clinic efficacy and its mechanism of action in promoting the cell proliferation of knee osteoarthritiss cartilage corpuscle via modified Duhuo Jisheng Mixture. Methods Totally 60 cases were divided into treatment group and control group by random number table method， with 30 cases in each group. Treatment group was given modified Duhuo Jisheng Mixture， 62.5 mL each time， twice a day， orally， and sulfoglycan sulfate capsules， 1 capsule a day， three times a day， orally； while control group was given diacerein capsules， 1 pill a day， twice a day， orally， and sulfoglycan sulfate capsules， the same as treatment group. Patients were required to do quadriceps muscle systolic and functional exercise， and keep warm. The treatment lasted for 6 weeks. VAS score and WOMAC of the two group were observed before and after treatment. IL-1， NO， Wnt5a， β-catenin， Sox9， Collagen Ⅱ in knee joint fluid were detected. Adverse reactions were monitored. Results Compared with pre-treatment， the contents of IL-1， NO， Wnt5a and β-catenin in two groups were reduces （P<0.05）； while the contents of Sox9 and Collagen Ⅱ were raised （P<0.05）. The VAS scores and WOMAC were reduced in two groups after treatment （P<0.05）. There was no statistical significance between the two group in the above indexes （P>0.05）. There were no obvious adverse reactions in both groups. Conclusion Modified Duhuo Jisheng Mixture can reduce

基金项目：国家自然科学基金（81574004）；湖南省中医药管理局课题（201408）

通讯作者：卢敏，E-mail：lumin6563@163.com

inflammatory factors of the joint fluid and inhibit the Wnt signal pathway through regulating the expression of Sox9 and Collagen Ⅱ in the pathway， which can promote the cell proliferation of knee osteoarthritis's cartilage corpuscle and benefit the repairment of cartilage corpuscle in order to relieve pains and improve functions of knee joint.

Keywords： modified Duhuo Jisheng Mixture； knee osteoarthritis； repairment of cartilage corpuscle

膝骨关节炎（knee osteoarthritis，KOA）是中老年常见疾患，随着病情逐渐加重，严重影响患者的生活质量。近年来，中医药治疗KOA取得了良好疗效[1-3]，但发病机制尚不明确，缺乏特异性疗法。目前基础研究主要针对中医药对KOA中软骨的细胞因子某一基因层面的干预作用，多局限于补肾活血类或补肾类药物对KOA的干预作用，尚未系统阐明补肾活血、祛痹止痛中药治疗KOA的作用靶点基因和调控通路。……