芍灵消增贴对膝骨关节炎患者MMP-3及RANKL表达的影响  

Effect of Shaoling Plaster on the Expression Level of MMP-3 and RANKL in the Knee Osteoarthritis Patients

作　　者：李恒[1] 沈霖[1] 李丽琴[2] 郭向飞[1] 帅波[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院,湖北武汉430022 [2]华中科技大学生命科学与技术学院,湖北武汉430074

出　　处：《中华中医药学刊》2009年第5期994-997,共4页Chinese Archives of Traditional Chinese Medicine

基　　金：湖北省卫生厅资助项目(鄂卫发2004-79)

摘　　要：目的:观察芍灵消增贴对各级膝骨关节炎(OA)患者血清MMP-3与外周血单个核细胞(PBMC)的MMP-3mRNA、RANKLmRNA表达的影响,探讨其疗效机理。方法:OA患者共105例,根据Kellgren和Lawrence标准分为4级,治疗2周。治疗前后取空腹血清测定MMP-3含量与PMBC的MMP-3mRNA、RANKLmRNA表达,并采用Lequense指数作为疗效评分标准,观察治疗前后膝关节症状变化。结果:试验组与对照组血清MMP-3、PBMC的MMP-3mRNA、RANKLmRNA基础值均高于健康组;Ⅰ、Ⅱ级OA患者中血清MMP-3的表达量高,且与Lequesne总指数呈明显正相关(r=0.51,r=0.53),治疗前后MMP-3的浓度及Lequesne总指数比较皆有显著性差异(P<0.05);但PBMC中MMP-3mRNA治疗前后的表达量的差异无统计学意义。治疗后Ⅰ级OA患者RANKLmRNA的表达量与基础值比较明显下降(P<0.01),症状Lequesne总指数也明显下降(P<0.01),两者呈明显相关性(r=0.62)。Ⅰ级、Ⅱ级、Ⅳ级OA患者治疗后肿胀、压痛Lequesne指数明显改善,PBMC中RANKLm-RNA表达与肿胀、压痛Lequesne指数呈明显正相关。结论:芍灵消增贴作用机理可能是通过抑制滑膜细胞和软骨细胞中MMP-3mRNA的表达从而下调血清MMP-3的浓度,达到改善OA早期(Ⅰ级、Ⅱ级)临床症状的治疗作用;下调PBMC的RANKLmRNA表达,从而抑制破骨细胞的破骨活动,达到治疗和缓解OA早期、活动期临床症状的目的。Objective：To observe the effect of Shaoling plaster for detumescence on serum levels of matrix metalloproteinase - 3 （ MMP - 3 ） and levels of MMP - 3 mRNA and receptor activator of nuclear factor kappa B ligand（RANKL） mRNA in peripheral blood mononuclear cell（PBMC） in knee osteoarthritis （OA）patients at various grades. Methods：We did a randomised, double - blind placebo trial, and serum and PBMC were obtained from all people. In both prior - treat- ment and post -treatment,we measured serum levels of MMP- 3 and levels of MMP -3mRNA and RANKLmRNA in PB- MC. Symptoms were also scored by Lequesne＇s index including knee pain at rest, at movement, and at pressure, knee swelling, morning stiffness and walking ability. Results：Compared with findings in the prior -treatment, values for the concentrations of serum MMP - 3 and Lequense scores in the post - treatment, were significantly lower in the grade 1 and 2 patients. It is the same to levels of PBMC RANKLmRNA and Lequesne scores in grade 1, and scores of knee pain at pressure and knee swelling in grade 1,2, and 4. In Shaoling plaster for detumescence group,linear logistic regression analysis showed a signifeant postive correlation between concentrations of serum MMP - 3 and Lequesne scores in the grade 1 and 2 patients. It was also showed that a signifcant postive correlation between levels of PBMC RANKLmRNA and Lequesne scores in grade 1 patients, and between levels of PBMC RANKLmRNA and scores of knee pain at pressure and knee swelling in grade 1,2, and 4. Conclusion ：These findings made us think that during Shaoling plaster for detumeseenee therapy on knee ostearthiris, one of action mechanism was decreased concentrations of serum MMP - 3 by down regulation of MMP -3mRNA expression in synoviocytes and chondrocytes of articular cartilage, sequently amended knee joints failure and improved functions of knee joints in grade land grade 2 ; another is down regulation expression levels of PBMC RANKI.an- RNA to inhibite osteoclasts＇action,to f

关 键 词：骨关节炎 基质金属蛋白酶-3 细胞核因子κB受体活化因子配基 

分 类 号：R684.3[医药卫生—骨科学]