针刀治疗膝骨性关节炎的临床疗效及机制研究  

Clinical efficacy and mechanism of acupotomy in the treatment of knee osteoarthritis

作　　者：张良志 刘洪[1,2] 杨金硕 刘晶 余文英 李阳阳 谢梓毅 施橙维 修忠标[1,2] ZHANG Liangzhi;LIU Hong;YANG Jinshuo;LIU Jing;YU Wenying;LI Yangyang;XIE Ziyi;SHI Chengwei;XIU Zhongbiao(Department of Orthopedics-Traumatology,the Affiliated People's Hospital,Fujian University of Traditional Chinese Medicine,Fuzhou,Fujian 350108,China;Key Laboratory of Orthopedics&Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education,Fujian university of TCM,Fuzhou,Fujian 350122,China;Fujian University of Traditional Chinese Medicine,Fuzhou,Fujian 350122,China)

机构地区：[1]福建中医药大学附属人民医院骨伤科,福州350004 [2]福建中医药大学中医骨伤及运动康复教育部重点实验室,福州350122 [3]福建中医药大学,福州350122

出　　处：《福建医药杂志》2024年第2期18-22,F0003,共6页Fujian Medical Journal

基　　金：2019年度国家中医临床研究基地专项科研课题(JDZX201932)。

摘　　要：目的观察针刀治疗膝关节骨性关节炎临床疗效,并探讨针刀治疗膝骨性关节炎的机制。方法通过招募正常人10例、膝骨性关节炎(KOA)患者40例,分为正常组、针刀组。正常组直接抽取关节积液;针刀组予针刀治疗,7 d为1个疗程,持续3个疗程。针刀组中随机抽取10例在治疗前、3个疗程结束后抽取关节积液。对针刀治疗前后股直肌剪切波成像(SWE)、视觉模拟评分法(VAS)、骨关节炎指数(WOMAC)进行对比,以评价治疗的效果。对关节液行Western blot检测关节液中IL-1β、Caspase-1蛋白表达,差异蛋白筛选和KEGG富集分析。结果与治疗前相比,治疗后SWE值、VAS评分、WOMAC评分明显下降,差异均具有统计学意义(P<0.05);治疗后股直肌硬度较治疗前下降。针刀能够下调KOA患者关节液中IL-1β、Caspase-1蛋白的表达,发挥抗炎、保护软骨的作用。KEGG富集分析显示参与KOA病变的信号通路主要为PPAR信号通路、MAPK信号通路。结论针刀治疗膝骨关节炎有较好临床疗效,同时针刀能够通过下调软骨相关信号通路的蛋白靶点的表达,降低关节内炎症反应。Objective To observe the clinical effect of acupotomy on knee osteoarthritis and explore the mechanism of acupotomy on knee osteoarthritis.Methods Ten healthy people and forty patients with KOA were recruited and divided into normal group and acupotomy group.In the normal group,the joint effusion was extracted directly,and the acupotomy group was treated with acupotomy for 7 days,lasting for 3 courses.In the acupotomy group,10 patients were randomly selected to extract joint effusion before treatment and after 3 courses of treatment.Shear wave elastography(SWE),Visual analogue scale(VAS)and Western Ontario and McMaster Universities(WOMAC)were compared before and after acupotomy to evaluate the therapeutic effect.The expression of IL-1βand Caspase-1 protein in joint fluid were detected by Western blot,differential protein screening and KEGG enrichment analysis.Results SWE value,VAS score and WOMAC score decreased significantly after treatment,and the differences were statistically significant(P<0.05).The hardness of the rectus femoris muscle after treatment was lower than that before treatment.Acupotomy can down-regulate the expression of IL-1βand Caspase-1 protein in joint fluid of KOA patients,and play an anti-inflammatory and protective role in cartilage.KEGG enrichment analysis showed that the signal pathways involved in KOA lesions were mainly PPAR signal pathway and MAPK signal pathway.Conclusion Acupotomy has good clinical efficacy in the treatment of knee osteoarthritis.At the same time,acupotomy can reduce the intraarticular inflammation by down-regulating the expression of protein targets in chondro-related signaling pathways.

关 键 词：高通量蛋白组学 膝骨关节炎 针刀 

分 类 号：R319[医药卫生—基础医学] R733