Effect and mechanism of acupuncture in the treatment of knee osteoarthritis

doi:10.3969/j.issn.2095-4344.2013.28.025

Abstract

Abstract:

BACKGROUND: Studies have shown that acupuncture combined with Chinese medicine has a certain effect in the treatment of knee osteoarthritis.
OBJECTIVE: To investigate the mechanism and effect of acupuncture combined with Chinese medicine for the treatment of knee osteoarthritis.
METHODS: The animal models of knee osteoarthritis were established to detect the expression levels of related factors, including matrix metalloproteinase 3, transforming growth factor β, interleukin-1β and tumor necrosis factor-α. The knee osteoarthritis patients treated with acupuncture combined with Chinese medicine were followed-up, and the patients received acupuncture in the main points and the adjunct points, as well as the Chinese medicine administration and the external application and fumigation. Then, the active function recovery of the knee joint was observed to identify the effect of acupuncture combined with Chinese medicine.
RESUTLS AND CONCLUSION: Acupuncture can delay the destruction of knee joint articular cartilage and improve the knee function through decreasing the contents of matrix metalloproteinase 3, transforming growth factor β, interleukin-1β and tumor necrosis factor-α, thus playing the treatment effect on knee osteoarthritis. The knee osteoarthritis patients treated with acupuncture combined with Chinese medicine can obtain better effect, and the treatment efficiency is more than 90%. Compared with the single application of sodium hyaluronate or acupuncture treatment, acupuncture combined with Chinese medicine has higher treatment efficiency and better treatment effect.

Key words: tissue construction, tissue construction academic discussion, acupuncture, Chinese medicine, knee osteoarthritis, joint cavity, synovium, sodium hyaluronate, matrix metalloproteinase 3, transforming growth factor β, interleukin-1, tumor necrosis factor, other grants-supported paper

CLC Number:

R318

Zhou Jing-hui, Wu Yao-chi, Xie Yan-yan, Zhang Jun-feng, Huang Cheng-fei, Sun Yi-jun. Effect and mechanism of acupuncture in the treatment of knee osteoarthritis[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(28): 5255-5260.

Figures/Tables 5

2.1 针灸治疗膝骨关节炎的炎性递质变化在膝骨关节炎发生的过程中，多种炎性递质参与并发挥重要作用，针灸干预可以使这些炎性递质发生变化，从而发挥治疗膝骨关节炎的作用。李石胜等[8]对针灸干预膝骨关节炎后滑膜组织中基质金属蛋白酶3含量的变化进行了研究，实验选取远交系大鼠40只，随机分为正常组、模型组、长针透刺组和药物治疗组，每组大鼠10只，正常组大鼠不予模型化，另30只大鼠通过膝关节腔内注射1.6%木瓜蛋白酶溶液并驱赶大鼠活动建立膝骨关节炎大鼠模型，2周后，长针透刺组大鼠给予隔日长针透刺犊鼻穴和膝眼穴，药物治疗组大鼠给予1次/周关节腔内注射透明质酸钠，模型组不予干预，治疗时间均为4周。实验结果显示正常组大鼠滑膜组织中基质金属蛋白酶3的含量为(10.26±0.39) μg/g，模型组大鼠滑膜组织中基质金属蛋白酶3的含量为(20.18± 0.46) μg/g，长针透刺组大鼠滑膜组织中基质金属蛋白酶3的含量为(14.24±0.45) μg/g，药物治疗组大鼠滑膜组织中基质金属蛋白酶3的含量为(13.51± 0.38) μg/g。对上述结果进行统计学分析，模型组大鼠滑膜组织中基质金属蛋白酶3的含量明显高于正常组，且差异有显著性意义(P < 0.05)，长针透刺组和药物治疗组大鼠滑膜组织中基质金属蛋白酶3的含量明显低于模型组，且差异有显著性意义(P < 0.05)，而长针透刺组大鼠滑膜组织中基质金属蛋白酶3的含量略高于药物治疗组，二者的差异无显著性意义 (P > 0.05)。周景辉等[9]对电针干预膝骨关节炎后转化生长因子β的含量变化进行了研究，研究对象为雄性远交系大鼠80只，随机分为正常组、模型组、电针干预组和药物治疗组，每组大鼠20只，正常组大鼠不予模型化，而其余组大鼠同样均予以建立膝骨关节炎大鼠模型，造模1个月后，电针干预组大鼠给予1次/d电针刺激犊鼻穴和膝眼穴，药物治疗组大鼠给予1次/周关节腔内注射透明质酸钠，模型组不予干预，治疗2周后，应用实时荧光定量PCR方法检测转化生长因子β1及其受体Ⅰ、Ⅱ的含量。实验结果显示，除正常组外，其余3组大鼠膝关节滑膜中转化生长因子β1的含量均较治疗前明显减少，并且电针干预组和药物治疗组中转化生长因子β1受体Ⅰ、Ⅱ的含量也较治疗前明显减少，此外，与模型组相比较，正常组、电针干预组和药物治疗组转化生长因子β1的含量明显降低，且差异有显著性意义 (P < 0.05)；而电针干预组和药物治疗组中转化生长因子β1受体Ⅰ、Ⅱ的含量与模型组相比较明显降低 (P < 0.05)，正常组中转化生长因子β1受体Ⅰ、Ⅱ的含量与模型组相比较差异无显著性意义(P > 0.05)。周建中等[10]对针灸和中药干预膝骨关节炎后血清白细胞介素1β和肿瘤坏死因子α的含量变化进行了研究，实验对象为新西兰大白兔，并随机分为正常组5只、模型组10只、针刺干预组10只、药物治疗组10只以及针药联合干预组10只。正常组不予任何处理，其余组大白兔均建立膝骨关节炎模型，造模后，针刺干预组大白兔给予1次/d针刺双侧足三里穴，药物治疗组大白兔给予1次/周膝关节腔内注射丹皮酚，针药联合干预组大白兔给予1次/周膝关节腔内注射丹皮酚同时联合1次/d针刺双侧足三里穴，上述3组大白兔给予针灸干预共29次，注射药物干预共5次，模型组不予干预。实验结果显示，药物治疗组、针刺干预组以及针药联合干预组中白细胞介素1β和肿瘤坏死因子α的水平均低于模型组，而高于正常组，并且差异具有显著性意义，而5组结果之间的差异均具有显著性意义，具体结果见表1。"

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