益肾活血股密保方治疗早中期股骨头坏死的临床研究及其含药血清对体外破骨细胞影响的实验研究
发布时间：2018-08-06 22:05
【摘要】：目的:1.通过收集临床病例进行随机对照研究,观察益肾活血股密保中药方治疗早中期股骨头坏死(Osteonecrosis of the femoral head,ONFH)的临床疗效。2.通过实验研究,检测股密保含药血清的毒性;利用体外诱导骨髓单核细胞的方式获取足够数量、性状稳定的满足实验要求的破骨细胞;观测股密保含药血清对骨髓单核细胞诱导分化为破骨细胞的影响;观测股密保含药血清对破骨细胞骨吸收功能的影响。方法:1.按照西医纳入标准及排除标准的范围,对2016年1月至2017年2月在苏州市中医医院骨伤科门诊进行治疗并完成随访的0NFH患者,共43例(51髋),采用随机法将病人分为两组,对照组口服阿仑膦酸钠(福善美)70mgqw8周;治疗组口服股密保方,4周为一个疗程,共2个疗程。治疗前后采用Harris评分、疼痛直观模拟量表(VAS表)和影像学检查结果等进行详细的记录,最后统计数据进行分析。2.用体外诱导骨髓单核细胞的方式,在培养及传代完成的骨髓单核细胞中加入含25ng/ml的M-CSF、100ng/ml的RANKL、1%PS、5%FBS的α-MEN溶液进行破骨细胞的诱导;并进行破骨细胞的观察及鉴定;采用CCK-8法检测含药血清毒性;骨髓单核细胞诱导后经多聚甲醛固定后行TRAP染色计算其中阳性细胞数目;对骨片进行甲苯胺蓝染色,然后观察骨片上面骨吸收陷窝形成的个数及面积;最后进行扫描电镜观察。结果:1、治疗后两组患者的Harris评分及VAS评分均较治疗前有明显改善,(p0.05)但两组临床疗效之间无显著统计学差异。2、两组比较治疗前后坏死指数评分差值研究显示,在缓解股骨头坏死进程方面,治疗组优于对照组。3、两组比较治疗前后疗效结果显示,在缓解骨髓水肿及关节积液方面,股密保有一定疗效,与阿仑膦酸钠疗效相似。4.通过骨髓单核细胞体外诱导的方式,可以获取满足实验要求的破骨细胞。5.股密保高、中、低浓度含药血清组与生理盐水对照组相比,在12h,24h,3d及5d四个观察期内毒性差异均无统计学意义(P0.05)。6.通过观察TRAP阳性细胞数,在抑制骨髓单核细胞分化为破骨细胞的作用方面,股密保高、中、低浓度含药血清组与生理盐水对照组相比有显著差异(P0.05),但股密保各浓度组之间疗效无显著差异(P0.05)。7.在限制骨吸收陷窝计数作用方面,通过数据分析,高浓度股密保含药血清组与生理盐水对照组疗效之间存在显著性差异(P0.05);其余各组之间无显著差异。8.在限制骨吸收陷窝面积作用方面,通过数据分析,高浓度股密保含药血清组与生理盐水对照组疗效之间存在显著性差异(P0.05);低浓度及中浓度含药血清组与高浓度含药血清组疗效之间存在显著差异(P0.05);其余各组之间无显著差异。结论:1.对于早中期股骨头坏死患者,股密保方有一定的疗效,可缓解疼痛,改善髋关节功能,减轻骨髓水肿及关节积液,延缓股骨头坏死塌陷进程,疗效与阿仑膦酸钠相似。2.股密保含药血清没有毒性,可以抑制骨髓单核细胞诱导分化为破骨细胞;可以抑制破骨细胞的骨吸收功能。
[Abstract]:Objective: 1. through the collection of clinical cases, a randomized controlled study was carried out to observe the clinical efficacy of Yishen Huoxue shares in the treatment of Osteonecrosis of the femoral head (ONFH) in the treatment of early and mid-term osteonecrosis of the femoral head (head, ONFH) through experimental study to detect the toxicity of the blood serum of the femoral head containing drug, and to obtain sufficient numbers of bone marrow mononuclear cells in vitro. Quantity, stable character of the osteoclasts that meet the requirements of the experiment; the effect of the observation on the induced differentiation of bone marrow mononuclear cells into osteoclasts of the bone marrow mononuclear cells; the effect of the observation of the serum on the bone resorption of osteoclasts. Method: 1. according to the standard and exclusion criteria of Western medicine, from January 2016 to February 2017. A total of 43 patients (51 hips) were treated and followed up in the orthopedics clinic of the State Medical Hospital of Chinese medicine hospital. The patients were divided into two groups by random method. The control group was taken orally alendronate (fuxamy) for 70mgqw8 weeks, and the treatment group was treated with 43 courses for 4 weeks, with a total of 2 courses. The Harris score and the pain visual analogue scale were used before and after treatment (VA The S table) and the results of the imaging examination were recorded in detail. Finally, the statistical data were used to analyze the way that.2. was used to induce bone marrow mononuclear cells in vitro. In the culture and generation of bone marrow mononuclear cells, M-CSF, 100ng/ml RANKL, 1%PS, 5%FBS's alpha -MEN solution was used to induce osteoclasts, and osteoclasts were carried out. Observation and identification; CCK-8 method was used to detect the toxicity of serum containing drugs. The number of positive cells was calculated by TRAP staining after bone marrow mononuclear cells were fixed and fixed with POM. The bone slices were stained with toluidine blue, then the number and area of bone resorption lacunae formed on the bone were observed. Finally, the scanning electron microscope was observed. Results: 1, after treatment. The Harris score and the VAS score of the two groups were significantly better than those before the treatment, (P0.05), but there was no significant difference between the two groups of clinical effects. The difference between the two groups before and after the treatment of the necrosis index showed that the treatment group was better than the control group.3 in alleviating the necrosis of the femoral head, and the two groups were compared before and after the treatment. In alleviating bone marrow edema and joint effusion, it has a certain effect, which is similar to the effect of alendronate in the form of.4. induced by bone marrow mononuclear cells in vitro. It is possible to obtain the.5. strands of osteoclast to meet the requirements of the experiment. The middle, low concentration serum containing group and the saline control group are compared with the saline control group, four observations in 12h, 24h, 3D and 5D. There was no statistical significance (P0.05) in the period of endotoxicity (.6.), by observing the number of TRAP positive cells and the effect of inhibiting the differentiation of bone marrow mononuclear cells into osteoclast, there was a significant difference between the group and the normal saline group (P0.05), but there was no significant difference (P0.05).7 between the group and the concentration group (P0.05).7. There was a significant difference in the effect of limiting the counting of bone resorption lacunae by data analysis. There was a significant difference between the high concentration of the blood serum group and the saline control group (P0.05). There was no significant difference between the other groups and the effect of.8. on the area of bone resorption lacunae. There was significant difference between the curative effect of the saline control group (P0.05), and there was a significant difference between the low concentration and medium concentration serum group and the high concentration serum group (P0.05). There was no significant difference between the other groups. Conclusion: 1. for the early and middle stage of the femoral head necrosis, the femoral head has a certain effect, relieving pain and improving the hip. Joint function, reducing bone marrow edema and joint effusion, postponing the process of necrosis and collapse of the femoral head, the curative effect is not toxic with the.2. share containing alendronate, which can inhibit the differentiation of bone marrow mononuclear cells into osteoclast, and inhibit the bone resorption function of osteoclast.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R274.9
[Abstract]:Objective: 1. through the collection of clinical cases, a randomized controlled study was carried out to observe the clinical efficacy of Yishen Huoxue shares in the treatment of Osteonecrosis of the femoral head (ONFH) in the treatment of early and mid-term osteonecrosis of the femoral head (head, ONFH) through experimental study to detect the toxicity of the blood serum of the femoral head containing drug, and to obtain sufficient numbers of bone marrow mononuclear cells in vitro. Quantity, stable character of the osteoclasts that meet the requirements of the experiment; the effect of the observation on the induced differentiation of bone marrow mononuclear cells into osteoclasts of the bone marrow mononuclear cells; the effect of the observation of the serum on the bone resorption of osteoclasts. Method: 1. according to the standard and exclusion criteria of Western medicine, from January 2016 to February 2017. A total of 43 patients (51 hips) were treated and followed up in the orthopedics clinic of the State Medical Hospital of Chinese medicine hospital. The patients were divided into two groups by random method. The control group was taken orally alendronate (fuxamy) for 70mgqw8 weeks, and the treatment group was treated with 43 courses for 4 weeks, with a total of 2 courses. The Harris score and the pain visual analogue scale were used before and after treatment (VA The S table) and the results of the imaging examination were recorded in detail. Finally, the statistical data were used to analyze the way that.2. was used to induce bone marrow mononuclear cells in vitro. In the culture and generation of bone marrow mononuclear cells, M-CSF, 100ng/ml RANKL, 1%PS, 5%FBS's alpha -MEN solution was used to induce osteoclasts, and osteoclasts were carried out. Observation and identification; CCK-8 method was used to detect the toxicity of serum containing drugs. The number of positive cells was calculated by TRAP staining after bone marrow mononuclear cells were fixed and fixed with POM. The bone slices were stained with toluidine blue, then the number and area of bone resorption lacunae formed on the bone were observed. Finally, the scanning electron microscope was observed. Results: 1, after treatment. The Harris score and the VAS score of the two groups were significantly better than those before the treatment, (P0.05), but there was no significant difference between the two groups of clinical effects. The difference between the two groups before and after the treatment of the necrosis index showed that the treatment group was better than the control group.3 in alleviating the necrosis of the femoral head, and the two groups were compared before and after the treatment. In alleviating bone marrow edema and joint effusion, it has a certain effect, which is similar to the effect of alendronate in the form of.4. induced by bone marrow mononuclear cells in vitro. It is possible to obtain the.5. strands of osteoclast to meet the requirements of the experiment. The middle, low concentration serum containing group and the saline control group are compared with the saline control group, four observations in 12h, 24h, 3D and 5D. There was no statistical significance (P0.05) in the period of endotoxicity (.6.), by observing the number of TRAP positive cells and the effect of inhibiting the differentiation of bone marrow mononuclear cells into osteoclast, there was a significant difference between the group and the normal saline group (P0.05), but there was no significant difference (P0.05).7 between the group and the concentration group (P0.05).7. There was a significant difference in the effect of limiting the counting of bone resorption lacunae by data analysis. There was a significant difference between the high concentration of the blood serum group and the saline control group (P0.05). There was no significant difference between the other groups and the effect of.8. on the area of bone resorption lacunae. There was significant difference between the curative effect of the saline control group (P0.05), and there was a significant difference between the low concentration and medium concentration serum group and the high concentration serum group (P0.05). There was no significant difference between the other groups. Conclusion: 1. for the early and middle stage of the femoral head necrosis, the femoral head has a certain effect, relieving pain and improving the hip. Joint function, reducing bone marrow edema and joint effusion, postponing the process of necrosis and collapse of the femoral head, the curative effect is not toxic with the.2. share containing alendronate, which can inhibit the differentiation of bone marrow mononuclear cells into osteoclast, and inhibit the bone resorption function of osteoclast.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R274.9
【参考文献】
相关期刊论文 前10条
1 张华峰;徐倩;;细胞凋亡在激素性股骨头坏死中作用机制的研究进展[J];中华老年骨科与康复电子杂志;2016年02期
2 苏敬阳;曹斌;董焕娥;侯勇;郝志鹏;;补肾生骨方治疗预防股骨头缺血坏死塌陷疗效观察[J];河北医药;2011年22期
3 李s，
本文编号：2169130
本文链接：https://www.wllwen.com/zhongyixuelunwen/2169130.html
最近更新
教材专著
