复方生脉成骨胶囊对激素性股骨头坏死患者VEGF、HIF-1α水平及股骨头微血流灌注超声造影指标的影响  

Effect of compound Shengmaichenggu Capsule on VEGF and HIF-1α level and femoral head micro blood flow perfusion on contrast-enhanced ultrasound indexes in patients with steroid induced femoral head necrosis

作　　者：田媛媛[1] 张佳琦 蓝若丹 贾节[1] 林壮腾 赵萍[1] TIAN Yuan-yuan;ZHANG Jia-qi;LAN Ruo-dan(Department of Medical Technology,the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,Guangzhou Guangdong 510404,China.)

机构地区：[1]广州中医药大学第一附属医院医技科,广东广州510404

出　　处：《临床和实验医学杂志》2022年第12期1294-1299,共6页Journal of Clinical and Experimental Medicine

基　　金：广东省中医药局科研项目(编号:20191104)。

摘　　要：目的观察复方生脉成骨胶囊治疗激素性股骨头坏死对患者血管内皮生长因子(VEGF)、缺氧诱导因子1α(HIF-1α)、Toll样受体-4(TLR4)水平及股骨头微血流灌注超声造影指标的影响。方法前瞻性选取广州中医药大学第一附属医院自2018年9月至2021年6月收治的80例(80髋)激素性股骨头坏死患者作为研究对象,按照随机数字表法分为两组,单组40例。对照组采用双氯芬酸钠肠溶片联合安慰剂治疗,观察组采用复方生脉成骨胶囊联合双氯芬酸钠肠溶片治疗,治疗期间限制负重、行动时需拄拐。比较两组治疗前后血清VEGF、HIF-1α、TLR4水平、超声造影指标[达峰时间(TTP)、衰减斜率(DS)、平均渡越时间(MTT)、曲线下面积(AUC)]、Harris评分、视觉模拟评分法(VAS)评分、股骨头局部骨密度的差异,统计两组疗效。结果两组在治疗后HIF-1α水平较治疗前均上升,而VEGF、TLR4水平较治疗前均下降,且观察组的HIF-1α为(87.13±10.13)ng/mL,高于对照组[(68.36±8.11)ng/mL],VEGF、TLR4分别为(157.23±23.61)pg/mL、(2.54±0.21)ng/mL,低于对照组[VEGF(196.36±27.13)pg/mL、(3.21±0.26)ng/mL],差异均有统计学意义(P<0.05)。两组在治疗后超声造影中TTP、DS较治疗前上升,而MTT、AUC较治疗前下降,且观察组的TTP、DS分别为(13.52±3.16)s、(-0.15±0.05),高于对照组[(11.47±2.91)s、(-0.19±0.06)],MTT、AUC分别为(51.45±6.85)s、(2198.36±78.64),低于对照组[(57.11±8.65)s、(2312.02±85.62)],差异均有统计学意义(P<0.05)。两组在治疗后Harris评分和股骨头局部骨密度较治疗前上升,而VAS评分较治疗前下降,且观察组的Harris评分为(83.14±6.41)分,高于对照组[(70.12±5.85)分],VAS评分为(2.87±0.34)分,低于对照组[(4.34±0.41)分],比较差异均有统计学意义(P<0.05)。股骨头局部骨密度与对照组比较,差异无统计学意义[(0.88±0.20)g/cm 3 vs.(0.85±0.18)g/cm 3,P>0.05]。观察组的总有效率为92.50%,高于对照组的75.00%Objective To observe the effect of compound Shengmaichenggu Capsule on vascular endothelial growth factor(VEGF)and hypoxia inducible factor 1α(HIF-1α),Toll like receptor-4(TLR4)level and femoral head micro blood flow perfusion on contrast-enhanced ultrasound indexes in patients with steroid induced femoral head necrosis.Methods Eighty patients(80 hips)with steroid induced femoral head necrosis treated in the First Affiliated Hospital of Guangzhou University of traditional Chinese medicine from September 2018 to June 2021 were prospectively selected as the research objects.They were randomly divided into two groups with 40 cases in a single group according to the random number table method.The control group was treated with diclofenac sodium enteric coated tablets combined with placebo,and the observation group was treated with compound Shengmaichenggu capsule combined with diclofenac sodium enteric coated tablets.During the treatment,weight-bearing was limited and crutches were required during movement.Serum VEGF and HIF-1 were compared between the two groups before and after treatmentα,the differences of TLR4 level,contrast-enhanced ultrasound index[the peak time(TTP)and descending slope(DS),mean transit time(MTT)and area under the curve(AUC)],Harris score,visual analog(VAS)score and local bone mineral density of femoral head between the two groups were statistically analyzed.Results After treatment,the levels of HIF-1αin the two groups increased compared with those before treatment,while the levels of VEGF and TLR4 decreased compared with those before treatment,while the levels of HIF-1αin the observation group was(87.13±0.13)ng/mL,which was higher than that in the control group[(68.36±8.11)ng/mL],VEGF and TLR4 were(157.23±23.61)pg/mL,(2.54±0.21)ng/mL,which were significantly lower than those in the control group[(196.36±27.13)pg/mL and(3.21±0.26)ng/mL)],the differences were statistically significant(P<0.05).In contrast-enhanced ultrasound after treatment,TTP and DS in the two groups increased,while

关 键 词：激素性股骨头坏死 复方生脉成骨胶囊 双氯芬酸钠肠溶片 微血流灌注 疼痛 

分 类 号：R274.9[医药卫生—中西医结合]