李阳 张丽曼 张立颖 狄生云 王菲 姜雪原

摘要 目的：探讨骨痹汤对膝骨关节炎大鼠软骨基质金属蛋白酶-13（MMP-13）及转化生长因子-β1（TGF-β1）的影响。方法：选择健康SD大鼠40只，建立膝骨关节炎模型，随机分为对照组和观察组，每组20只。对照组造模术后不予治疗，观察组自造模成功后，给予骨痹汤熏蒸治疗，疗程4个周。治疗后，比较每组大鼠痛阈、膝关节周径及膝关节活动度情况。采用免疫组织化学法检测各组大鼠关节软骨中MMP-13及TGF-β1表达变化情况。结果：治疗后，观察组痛阈、膝关节周径及膝关节活动范围比对照组明显改善（P<0.05）;治疗后，观察组MMP-13表达水平明显下降，且明显低于对照组（P<0.05）;治疗后，观察组TGF-β1表达水平明显升高，且明显高于对照组（P<0.05）。结论：骨痹汤可改善膝骨关节炎的疼痛，减少软骨中MMP-13的表达，延缓骨性关节炎的发展，并明显上调TGF-β1的表达，促进软骨修复。

关键词 骨痹汤;熏蒸治疗;骨关节炎;膝关节;基质金属蛋白酶-13;转化生长因子-β1;疾病模型;动物

Abstract Objective：To investigate the effect of Gubi Decoction on matrix metalloproteinase-13 and transforming growth factor β1 in knee osteoarthritis rats.Methods：A total of 40 healthy SD rats were selected to establish knee osteoarthritis model，and randomly divided into a control group and a treatment group，with 20 rats in each group.The control group was not treated after the model making operation，and the treatment group was given fumigating and steaming treatment of Gubi Decoction for 4 weeks.After treatment，the pain threshold，the diameter of the knee joint and the activity of the knee joint were compared.The expression of matrix metalloproteinase-13（MMP-13）and transforming growth factor β1（TGF-β1）in articular cartilage of rats in each group was detected by immunohistochemistry.Results：After treatment，the pain threshold，the diameter of knee joint and the range of motion of knee joint in the treatment group were significantly improved，compared with the control group（P<0.05）; the expression level of MMP-13 in the treatment group was significantly lower than that in the control group（P<0.05）; the expression level of TGF-β1 in the treatment group was significantly higher than that in the control group（P<0.05）.Conclusion：Gubi Decoction can improve the pain of knee osteoarthritis，reduce the expression of MMP-13 in cartilage，delay the development of osteoarthritis，and obviously up regulate the expression of TGF-β1 to promote cartilage repair.

Keywords Gubi Decoction; Fumigation treatment; Osteoarthritis; Knee joint; Matrix metalloproteinase-13; Transforming growth factor beta 1; Disease model; Animal model

中圖分类号：R289.5;R684文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.10.006

骨关节炎（Osteoarthritis，OA）是临床常见的关节疾病，中老年人是高发人群，其中以膝骨关节炎（Knee Osteoarthritis，KOA）是最为常见[1]。随着我国人口老龄化的不断加剧，KOA的发病率不断增高，其具有极高的致残率，给患者的生命质量带来严重影响[2]。KOA的病理基础是关节软骨呈现退行性的病变，临床症状主要表现为膝关节活动受限、疼痛、行走困难，膝关节畸形等[3-4]。早中期KOA可采取非手术治疗，晚期则需要进行手术治疗[5]。早中期若能有效药物治疗，可促进膝关节组织软骨的修复，有效延迟病变进程。西医通常采用口服塞来昔布、布洛芬等非甾体抗炎药物及关节腔注射玻璃酸钠的方式来缓解膝关节疼痛，润滑关节，达到治疗的目的，但长期用药会增加各种不良反应[6]。中医对KOA的治疗方式较多，包括中药内服外用、针灸、推拿、小针刀及中药熏蒸等，均具有一定的疗效[7]。……