扶陽溫灸膏對陽虛體質膝骨關節炎患者關節液PACAP和血清IL-1β、MMP-3的影響

【摘要】 目的：研究扶陽溫灸膏對陽虛體質膝骨關節炎（knee osteoarthritis，KOA）患者關節液垂體腺苷酸環化酶激活多肽（pituitary adenylyl cyclase activating polypeptide，PACAP）和血清白細胞介素-1β（interleukin-1β，IL-1β）、基質金屬蛋白酶3（matrix metalloproteinase-3，MMP-3）表達的影響。方法：選擇2021年1—12月于廣東省第二中醫院接受治療的120例陽虛體質KOA患者，并采用隨機數字表法的分組方法，把患者分為對照組和觀察組，各60例。對照組給予玻璃酸鈉注射液治療，觀察組行扶陽溫灸膏治療。比較兩組臨床總有效率、PACAP、IL-1β、MMP-3、視覺模擬評分法（VAS）評分、Lysholm膝關節評分、簡明健康狀況調查量表（SF-36）評分。結果：觀察組臨床治療總有效率較對照組更高（Plt;0.05）。治療4、8周后，兩組PACAP水平均較治療前升高，且治療8周后兩組PACAP水平均較治療4周后更高，觀察組高于對照組（Plt;0.05）；兩組IL-1β、MMP-3水平、VAS評分均較治療前下降，且治療8周后兩組IL-1β、MMP-3水平、VAS評分均較治療4周后更低，觀察組均低于對照組，差異均有統計學意義（Plt;0.05）。治療4、8周后，兩組Lysholm膝關節評分均較治療前升高，且治療8周后兩組Lysholm膝關節評分均高于治療4周后，且觀察組均較對照組更高，差異均有統計學意義（Plt;0.05）。治療4、8周后，兩組SF-36評分均較治療前增加，且治療8周后兩組患者SF-36評分均較治療4周后更高，觀察組高于對照組，差異均有統計學意義（Plt;0.05）。結論：扶陽溫灸膏治療陽虛體質KOA效果顯著，可調控患者關節液PACAP和血清IL-1β、MMP-3水平表達并改善膝關節疼痛癥狀與功能，可有效提高生活質量水平。

【關鍵詞】 膝骨關節炎 垂體腺苷酸環化酶激活多肽 扶陽溫灸膏 白細胞介素-1β 基質金屬酶蛋白酶3

Effect of Fuyang Warm Moxibustion Cream on PACAP in Joint Fluid and IL-1β， MMP-3 in Serum of Patients with Knee Osteoarthritis Due to Yang Deficiency Constitution/SUN Zhengping， LAI Shaoyong， HUANG Wei， LIN Huguang， LIANG Cande. //Medical Innovation of China， 2023， 20（31）： 0-081

[Abstract] Objective： To study the effect of Fuyang Warm Moxibustion Cream on the expression of pituitary adenylate cyclase activating polypeptide （PACAP） and serum interleukin-1β （IL-1β） and matrix metalloproteinase-3 （MMP-3） in the joint fluid of patients with knee osteoarthritis （KOA） due to Yang deficiency constitution. Method： From January to December 2021， 120 patients with KOA with yang deficiency constitution who were admitted to Guangdong Second Traditional Chinese Medicine Hospital for treatment were selected， and the patients were divided into control group and observation group by random number table method， with 60 cases each group. The control group was treated with Sodium Hyaluronate Injection， while the observation group was treated with Fuyang Warm Moxibustion Cream. The clinical total effective rates， PACAP， IL-1β， MMP-3，

visual analogue score （VAS） scores， Lysholm knee joint scores， and 36-item short-form health survey （SF-36） scores were compared in both groups. Result： The total effective rate of clinical treatment in the observation group was higher than that in the control group （Plt;0.05）. After 4 and 8 weeks of treatment， the PACAP levels in both groups were higher than those before treatment， and after 8 weeks of treatment， the PACAP levels in both groups were higher than those after 4 weeks of treatment， and that in the observation group was higher than that in the control group （Plt;0.05）; the levels of IL-1β， MMP-3 and VAS score of patients in both groups were lower than those before treatment， and after 8 weeks of treatment， the levels of IL-1β， MMP-3 and VAS scores in both groups were lower than those after 4 weeks of treatment， and those in the observation group were lower than those in the control group， the differences were statistically significant （Plt;0.05）. After 4 and 8 weeks of treatment， the Lysholm knee joint scores in both groups were higher than those before treatment， and after 8 weeks of treatment， the Lysholm knee joint scores in both groups were higher than those after 4 weeks of treatment， and that in the observation group was higher than that in the control group， the differences were statistically significant （Plt;0.05）. After 4 and 8 weeks of treatment， the SF-36 scores in both groups were increased compared with those before treatment， and the SF-36 score of patients in both groups after 8 weeks of treatment were higher than that after 4 weeks of treatment， the that in the observation group was higher than that in the control group， the differences were statistically significant （Plt;0.05）. Conclusion： Fuyang Warm Moxibustion Cream has a significant effect on the treatment of KOA with Yang deficiency constitution. It can regulate the expression of PACAP in joint fluid and IL-1β and MMP-3 in serum， improve the symptoms and functions of knee joint pain， and effectively improve the quality of life.

[Key words] Knee osteoarthritis Pituitary adenylate cyclase activating polypeptide Fuyang Warm Moxibustion Cream Interleukin-1β Matrix metalloproteinase 3

First-author's address： Guangdong Second Traditional Chinese Medicine Hospital， Guangzhou 510095， China

doi：10.3969/j.issn.1674-4985.2023.31.018

膝骨關節炎（knee osteoarthritis，KOA）是一種慢性的炎性骨科疾病，多發于老年群體。……