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[1]邢潤麟,王培民,張農(nóng)山,等.中醫(yī)“肝腎同源”理論異病同治膝骨關(guān)節(jié)炎和絕經(jīng)后骨質(zhì)疏松癥的實驗理論基礎(chǔ)研究[J].中醫(yī)正骨,2017,29(01):1-10.
　XING Runlin,WANG Peimi,ZHANG Nongshan,et al.Application of TCM theory of HOMOGENY OF LIVER AND KIDNEY and TREATING DIFFERENT DISEASES WITH SAME METHOD to treatment of knee osteoarthritis and postmenopausal osteoporosis:an experimental research of theoretical foundation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(01):1-10.
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中醫(yī)“肝腎同源”理論異病同治膝骨關(guān)節(jié)炎和絕經(jīng)后骨質(zhì)疏松癥的實驗理論基礎(chǔ)研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年01期
頁碼:
1-10
欄目:
基礎(chǔ)研究
出版日期:
2017-01-20

文章信息/Info

Title:
Application of TCM theory of HOMOGENY OF LIVER AND KIDNEY and TREATING DIFFERENT DISEASES WITH SAME METHOD to treatment of knee osteoarthritis and postmenopausal osteoporosis:an experimental research of theoretical foundation
作者:
邢潤麟; 王培民; 張農(nóng)山; 李曉辰; 趙凌睿; 張立
南京中醫(yī)藥大學附屬醫(yī)院,江蘇 南京 210029
Author(s):
XING Runlin; WANG Peimi; ZHANG Nongshan; LI Xiaochen; ZHAO Lingrui; ZHANG Li
The Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Nanjing 210029,Jiangsu,China
關(guān)鍵詞:
骨關(guān)節(jié)炎; 膝;  骨質(zhì)疏松; 絕經(jīng)后;  肝腎同源;  異病同治;  動物實驗;  大鼠; Sprague-Dawley
Keywords:
osteoarthritis; knee;  osteoporosis; postmenopausal;  homogeny of liver and kidney;  treating different diseases with same method;  animal experimentation;  rats; Sprague-Dawley
摘要:
目的:從骨代謝角度探討依據(jù)中醫(yī)“肝腎同源”理論異病同治膝骨關(guān)節(jié)炎(knee osteoarthritis,KOA)和絕經(jīng)后骨質(zhì)疏松癥(postmenopausal osteoporosis,PMOP)的實驗理論基礎(chǔ)。方法:將60只8月齡SPF級雌性SD大鼠隨機分為空白組、KOA組和PMOP組。空白組大鼠不進行任何處理,KOA組和PMOP組分別采用改良Hulth法和去卵巢法制作KOA和PMOP大鼠模型。分別于造模后7、28、56 d從各組隨機選取6只大鼠測定股骨骨密度,抽取腹主動脈血測定血清中抗酒石酸酸性磷酸酶5b(tartrate resistant acid phosphatase-5b,TRACP-5b)、骨堿性磷酸酶(bone alkaline phosphatase,BALP)、Ⅰ型前膠原氨基端前肽(N-terminal propeptide of typeⅠprecollagen,PⅠNP)、Ⅰ型前膠原羧基端前肽(C-terminal propeptide of typeⅠprecollagen,PⅠCP)、Ⅰ型膠原羧基端交聯(lián)端肽(C-terminal cross-linked telopeptides of typeⅠcollagen,CTX-Ⅰ)、Ⅰ型膠原氨基端交聯(lián)端肽(N-terminal cross-linked telopeptides of typeⅠcollagen,NTX-Ⅰ)、白細胞介素-1β(interleukin-1β,IL-1β)、IL-6、IL-8、IL-10、腫瘤壞死因子-α(tumor necrosis factor-α,TNF-α)、基質(zhì)金屬蛋白酶-9(matrix metalloproteinase-9,MMP-9)及MMP-13含量,切取雙側(cè)后肢膝關(guān)節(jié)軟骨組織制成切片,在光鏡下觀察其形態(tài),并采用Mankin's評分標準進行評分。結(jié)果:造模后7、28、56 d時各組大鼠股骨骨密度和血清中TRACP-5b、BALP、PⅠNP、PⅠCP、CTX-Ⅰ、NTX-Ⅰ、IL-1β、IL-6、IL-8、IL-10、TNF-α、MMP-9、MMP-13含量及膝關(guān)節(jié)軟骨Mankin's評分總體比較,組間差異均有統(tǒng)計學意義。造模后7 d時,KOA組與空白組骨密度比較,差異無統(tǒng)計學意義(P=0.059),PMOP組骨密度低于空白組(P=0.005); 造模后28、56 d時,KOA組和PMOP組骨密度均低于空白組(P=0.000,P=0.002; P=0.003,P=0.000)。造模后各時點KOA組和PMOP組血清TRACP-5b濃度均高于空白組(P=0.015,P=0.013,P=0.000; P=0.000,P=0.000,P=0.000),BALP濃度均高于空白組(P=0.000,P=0.003,P=0.001; P=0.000,P=0.000,P=0.000),PⅠNP濃度均低于空白組(P=0.000,P=0.003,P=0.000; P=0.000,P=0.000,P=0.000),PⅠCP濃度均低于空白組(P=0.005,P=0.000,P=0.001; P=0.000,P=0.005,P=0.000),CTX-Ⅰ濃度均高于空白組(P=0.000,P=0.002,P=0.003; P=0.000,P=0.000,P=0.000),NTX-Ⅰ濃度均高于空白組(P=0.000,P=0.000,P=0.008; P=0.005,P=0.003,P=0.000),IL-1β濃度均高于空白組(P=0.023,P=0.003,P=0.006; P=0.013,P=0.006,P=0.003),IL-8濃度均高于空白組(P=0.000,P=0.000,P=0.000; P=0.008,P=0.000,P=0.000),IL-10濃度均低于空白組(P=0.032,P=0.029,P=0.013; P=0.010,P=0.000,P=0.000),TNF-α濃度均高于空白組(P=0.000,P=0.000,P=0.009; P=0.000,P=0.016,P=0.006); 造模后各時點KOA組血清IL-6濃度均高于空白組(P=0.026,P=0.003,P=0.000),造模后28、56 d時PMOP組血清IL-6濃度均高于空白組(P=0.023,P=0.006),造模后7 d時PMOP組血清IL-6濃度與空白組比較,差異無統(tǒng)計學意義(P=0.068)。造模后各時點KOA組和PMOP組血清MMP-9濃度均高于空白組(P=0.000,P=0.021,P=0.002; P=0.002,P=0.018,P=0.000),MMP-13濃度均高于空白組(P=0.000,P=0.000,P=0.000; P=0.000,P=0.010,P=0.000)。造模后各時點KOA組關(guān)節(jié)軟骨Mankin's評分均高于空白組(P=0.000,P=0.000,P=0.000); 造模后7、28 d時,PMOP組Mankin's評分與空白組比較,差異均無統(tǒng)計學意義(P=0.082,P=0.056),造模后56 d時PMOP組Mankin's評分高于空白組(P=0.043)。結(jié)論:KOA從早期開始即存在與PMOP類似的高轉(zhuǎn)換型骨代謝紊亂,而PMOP中后期也會出現(xiàn)類似KOA的軟骨退變; 高轉(zhuǎn)換型骨代謝紊亂可能在KOA和PMOP的發(fā)病中具有同樣重要的作用,這可作為中醫(yī)學根據(jù)“肝腎同源”理論對KOA和PMOP進行異病同治的實驗理論基礎(chǔ)。
Abstract:
Objective:To explore the experimental theoretical foundation for treating knee osteoarthritis(KOA)and postmenopausal osteoporosis(PMOP)with same method under the guidance of TCM theory of HOMOGENY OF LIVER AND KIDNEY through bone metabolism experimentation.Methods:Sixty 8-month-old SPF-grade female SD rats were randomly divided into blank group,KOA group and PMOP group.The rats in blank group did not receive any treatment,while the KOA rat models were built by using improved Hulth method in KOA group and the PMOP rat models were built by ovariectomy in PMOP group.Six rats were randomly selected from each group at 7,28 and 56 days after the modeling respectively and their femoral bone mineral densities(BMD)were measured.Their blood was drawn from abdominal aorta and the serum contents of tartrate resistant acid phosphatase-5b(TRACP-5b),bone alkaline phosphatase(BALP),N-terminal propeptide of typeⅠprecollagen(PⅠNP),C-terminal propeptide of typeⅠprecollagen(PⅠCP),C-terminal cross-linked telopeptides of typeⅠcollagen(CTX-Ⅰ),N-terminal cross-linked telopeptides of typeⅠcollagen(NTX-Ⅰ),interleukin-1β(IL-1β),IL-6,IL-8,IL-10,tumor necrosis factor-α(TNF-α),matrix metalloproteinase-9(MMP-9)and MMP-13 were measured.The knee articular cartilage tissues of bilateral posterior limbs were sectioned for HE staining and their morphous were observed under light microscope and were evaluated by using Mankin's scoring standard.Results:There was statistical difference in femoral BMD and serum contents of TRACP-5b,BALP,PⅠNP,PⅠCP,CTX-Ⅰ,NTX-Ⅰ,IL-1β,IL-6,IL-8,IL-10,TNF-α,MMP-9,MMP-13 and Mankin's scores of knee articular cartilage between the 3 groups at 7,28 and 56 days after the modeling respectively.There was no statistical difference in femoral BMD between KOA group and blank group(P=0.059)and the femoral BMD were lower in PMOP group compared to blank group(P=0.005)at 7 day after the modeling.The femoral BMD were lower in KOA group and PMOP group compared to blank group at 28 and 56 days after the modeling(P=0.000,P=0.002; P=0.003,P=0.000).At each time point after the modeling,the serum concentration of TRACP-5b were higher in KOA group and PMOP group compared to blank group(P=0.015,P=0.013,P=0.000; P=0.000,P=0.000,P=0.000),the serum concentration of BALP were higher in KOA group and PMOP group compared to blank group(P=0.000,P=0.003,P=0.001; P=0.000,P=0.000,P=0.000),the serum concentration of PⅠNP were lower in KOA group and PMOP group compared to blank group(P=0.000,P=0.003,P=0.000; P=0.000,P=0.000,P=0.000),the serum concentration of PⅠCP were lower in KOA group and PMOP group compared to blank group(P=0.005,P=0.000,P=0.001; P=0.000,P=0.005,P=0.000),the serum concentration of CTX-Ⅰwere higher in KOA group and PMOP group compared to blank group(P=0.000,P=0.002,P=0.003; P=0.000,P=0.000,P=0.000),the serum concentration of NTX-Ⅰwere higher in KOA group and PMOP group compared to blank group(P=0.000,P=0.000,P=0.008; P=0.005,P=0.003,P=0.000),the serum concentration of IL-1β were higher in KOA group and PMOP group compared to blank group(P=0.023,P=0.003,P=0.006; P=0.013,P=0.006,P=0.003),the serum concentration of IL-8 were higher in KOA group and PMOP group compared to blank group(P=0.000,P=0.000,P=0.000; P=0.008,P=0.000,P=0.000),the serum concentration of IL-10 were lower in KOA group and PMOP group compared to blank group(P=0.032,P=0.029,P=0.013; P=0.010,P=0.000,P=0.000),the serum concentration of TNF-α were higher in KOA group and PMOP group compared to blank group(P=0.000,P=0.000,P=0.009; P=0.000,P=0.016,P=0.006).The serum concentration of IL-6 were higher in KOA group compared to blank group at each time point after the modeling(P=0.026,P=0.003,P=0.000).The serum concentration of IL-6 were higher in PMOP group compared to blank group at 28 and 56 days after the modeling(P=0.023,P=0.006).There was no statistical difference in serum concentration of IL-6 between PMOP group and blank group at 7 day after the modeling(P=0.068).At each time point after the modeling,the serum concentration of MMP-9 were higher in KOA group and PMOP group compared to blank group(P=0.000,P=0.021,P=0.002; P=0.002,P=0.018,P=0.000),the serum concentration of MMP-13 were higher in KOA group and PMOP group compared to blank group(P=0.000,P=0.000,P=0.000; P=0.000,P=0.010,P=0.000).The Mankin's scores of knee articular cartilage were higher in KOA group compared to blank group at each time point after the modeling(P=0.000,P=0.000,P=0.000).There was no statistical difference in Mankin's scores of knee articular cartilage between PMOP group and blank group at 7 and 28 days after the modeling(P=0.082,P=0.056).The Mankin's scores of knee articular cartilage were higher in PMOP group compared to blank group at 56 days after the modeling(P=0.043).Conclusion:The high-turnover-type bone metabolic disorder can be found in KOA from the early period and the cartilage degeneration can be found in PMOP in the middle and later period,so PMOP is similar to KOA in these features.The high-turnover-type bone metabolic disorder may play an equally important role in morbidity of KOA and PMOP,so it can be considered as the experimental theoretical foundation for treating KOA and PMOP with same method according to the TCM theory of HOMOGENY OF LIVER AND KIDNEY.

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備注/Memo

備注/Memo:
基金項目:國家自然科學基金項目(81573993); 江蘇省自然科學基金項目(BK20151598); 南京中醫(yī)藥大學附屬醫(yī)院院級課題(Y14022)
通訊作者:王培民 E-mail:[email protected]
更新日期/Last Update: 2017-01-20