【作者】 周丕琪；

【导师】 沈霖；

【作者基本信息】 华中科技大学 ， 中西医结合临床， 2008， 博士

【摘要】 第一部分补肾方治疗膝关节骨性关节炎合并滑膜炎的临床观察目的:观察补肾中药治疗膝关节骨性关节炎(OA)合并滑膜炎的临床疗效和安全性。方法:选择83例膝关节OA合并滑膜炎患者,随机分为治疗组及对照组:治疗组应用补肾中药青娥丸加味片;对照组应用消炎止痛(NSAIDs)西药奥湿克,两组均辅以患肢制动或抽取关节腔积液疗法,疗程1个月,并观察了患者治疗前后关节疼痛、晨僵、关节肿胀、关节压痛、关节功能等变化。结果:治疗组和对照组治疗后症状体征均有明显改善,治疗前后差异明显(P＜0.01)。治疗组改善晨僵及关节肿胀症状明显优于对照组(P＜0.05);且副作用与对照组比较差异显著。结论:补肾中药治疗膝关节OA不仅能改善患者症状体征,而且不良反应少,值得临床推广应用。第二部分补肾方治疗骨质疏松症合并骨关节炎的作用机理研究目的:探讨补肾方对骨质疏松症合并骨关节炎的作用机理。方法:采用补肾中药青娥丸加味片治疗50例骨质疏松症合并骨关节炎患者,疗程为三个月,同时观察患者治疗前后症状体征、骨密度的变化,并检测患者血清IL-6、TNF-α水平。结果:在补肾中药作用下,患者症状及体征缓解,骨密度稍升高,血清IL-6、TNF-α水平下降。结论:补肾中药可能通过增加骨密度、影响细胞因子从而治疗骨质疏松症合并骨关节炎患者。第三部分补肾活血方治疗酒精性股骨头坏死的临床观察目的:研究补肾活血中药对酒精性股骨头坏死患者的治疗作用和血液流变学的影响。方法:选择酒精性股骨头坏死患者32例,采用补肾活血中药内服治疗3月,检测患者治疗前后症状体征及血液流变学的变化。结果:治疗后患者症状体征及功能活动均较治疗前有改善;治疗后全血比粘度、血浆比粘度、红细胞压积、红细胞电泳时间均明显降低,与治疗前比较有显著性差异(P＜0.05)。结论:补肾活血中药可改善股骨头处的供血,促进坏死股骨头的修复。第四部分补肾活血方对兔股骨头缺血性坏死的治疗作用与机理研究目的:研究补肾活血中药治疗股骨头缺血性坏死的作用机理。方法:选择24只大白兔,采用冷冻法制作成股骨头缺血性坏死模型,并随机分为3组:治疗组、对照组、模型组。治疗组和对照组分别给予补肾活血中药和左旋多巴灌胃,模型组灌服生理盐水,一月后处死兔,测量其股骨头的骨密度、生物力学和血清血管内皮生长因子(VEGF)浓度的变化。结果:补肾中药组能明显增加模型兔血清中VEGF浓度、骨密度和生物力学性质,与对照组及模型组比较有显著差异(P＜0.01)。结论:补肾活血中药可增加股骨头缺血性坏死兔骨组织骨密度,提高生物力学强度,该复方中药治疗股骨头缺血性坏死的作用可能与其能提高血清中VEGF的浓度有关。更多还原

【Abstract】 PARTⅠThe Clinical Observation of Combination of Chinese Traditional and Western Medicine to Treat Knee Joint Osteoarthritis complicating by SynovitisAim:To observe the clinical effect and security of combination of Chinese traditional and western medicine on knee joint osteoarthritis(OA) complicating by synovitis.Methods:83 cases of knee joint OA complicating by Synovitis were randomly divided into treated group and control group.The treated group was used Qinger tablet and the control group was used Aoshike.Two groups were hold knees in place or drawn liquid from cavum articulare as auxiliary measure.The course of treatment was one month.The symptoms and physical signs were observed before and after treatment.Result:The symptoms and physical signs were improved after treatment.There was obviously difference before and after treatment(p＜0.01).Some symptoms and physical signs of the treated group such as arthralgia and joint’s stiff in the morning were superior to that of the control group(p＜0.05).The adverse reaction was obviously difference between two groups.Conclusion:The knee joint OA was treated with combination of Chinese traditional and western medicine.Not only the symptoms and physical signs were improved,but also the adverse reaction was small and slight.So Qinger tablet is worth being popularized and applied in clinical. PARTⅡThe Mechanism Research of Kidney Invigoration on Osteoarthritis and OsteoporosisObjective:To probe into the mechanism of kidney invigoration on osteoarthrosis and osteoporosis.Methods:50 cases of osteoarthritis and osteoporosis were treated with,Qinger tablet, Traditional Chinese medicinal drug of kidney invigoration.The course of treatment was three months.At the same time,the symptoms,signs,bone mineral density were observed in treatment before and after.The serum levels of IL-6 and TNF-a were measured.Results:It was showed that osteodynia symptoms were improved,bone mineral density was increased.The serum levels of IL-6 and TNF-a was lower than that of pretreatment.Conclusions:The Traditional Chinese medicinal drug of Kidney invigoration could increase the patients’ bone mineral density and affect IL-6 and TNF-a secretion to treat Osteoarthritis and Osteoporosis.PARTⅢThe Clinical Observation of Bushen Huoxuefang to Treat Necrosis of Femoral Head Caused by AlcoholObjective:To study on the effects of blood rheology and treatment on patients with necrosis of femoral head caused by alcohol using Bushen Huoxuefang(BSHXF).Methods:32 patients were selected in this study,and they were treated continuing 3 months with BSHXF.The changes of blood rheology and symptoms were measured before and after treatment of BSHXF. Results:Blood viscosity,plasma viscosity,electrophoresis time of RBC and hematocrit of patients after treatment were lower than that before treatment,and there were significant statistical differences between both.(P＜0.05).Conclusion:BSHXF might improve the blood circulation in the region of femoral head and promote repair of femoral head necrosisPARTⅣThe Treatment Effect and Mechanism Research of Experimental Rabbits With Avascular Necrosis of Femoral Head Treated by BushenhuoxuefangObjective:To study the mechanism of avascular necrosis of femoral head treated by bushenhuoxuefangMethods:24 rabbits’ left femoral heads were induced by freezing with liquid nitrogen. At the same time,they were randomly divided into three groups:the Traditional Chinese medicine group,the levodopa group and the model group.Traditional Chinese medicine group and levodopa group were treated continuing one month.Bone mineral density and Biomechanical index of femoral head and serum VEGF concentration were measured after rabbits being sacrificed.Results:Femoral head of bone mineral density,serum VEGF concentration and the Biomechanical index in the traditional Chinese medicine group had significant statistical differences contrast with that of levodopa group and model group.(P＜0.01)Conclusion:The traditional Chinese medicine bushenhuoxuefang can increase bone density and biomechanical strength of the experimental rabbits with avascular necrosis of femoral head.The treatment might attributed to it can increase the serum VEGF concentration.更多还原