[1]沈兴潮,宋才渊,吕帅洁,等.膝关节腔注射外周血干细胞和富血小板血浆联合口服补肾活血汤治疗膝骨关节炎[J].中医正骨,2019,31(06):45-48.
点击复制

膝关节腔注射外周血干细胞和富血小板血浆联合口服补肾活血汤治疗膝骨关节炎()
分享到:

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期数:
2019年06期
页码:
45-48
栏目:
临床报道
出版日期:
2019-06-20

文章信息/Info

作者:
沈兴潮1宋才渊2吕帅洁3厉驹3童培建3夏炳江1
(1.绍兴市中医院,浙江 绍兴 312000; 2.杭州市富阳中医骨伤医院,浙江 杭州 311400; 3.浙江中医药大学附属第一医院,浙江 杭州 310006)
关键词:
骨关节炎 富血小板血浆 外周血干细胞移植 补肾活血汤
摘要:
目的:观察膝关节腔注射外周血干细胞和富血小板血浆(platelet rich plasma,PRP)联合口服补肾活血汤治疗膝骨关节炎(knee osteoarthritis,KOA)的临床疗效和安全性。方法:2014年 6月至2016年6月收治19例KOA患者。男3例,女16例; 年龄 45~67岁,中位数56岁; 均为单膝病变,左膝9例、右膝10例; 按照Kellgren-Lawrence影像学分级标准,Ⅰ级2例、Ⅱ级9例、Ⅲ级3例、Ⅳ级5例; 中医辨证均为肝肾两虚证; 病程6~36个月,中位数17个月。抽取自体静脉血制备PRP,采集自体外周血干细胞悬浮液,提纯后备用。第1周膝关节腔内注射10 mL外周血干细胞提纯液和5 mL PRP,第2周和第3周分别仅注射5 mL PRP,共注射3次。同时口服补肾活血汤,每天1 剂,连续服用1个月。分别于治疗前及治疗开始后1个月、3个月、6个月测定患者的西安大略和麦克马斯特大学(Western Ontario and McMaster Universities,WOMAC)骨关节炎指数,并于治疗前及治疗开始后6个月行膝关节MRI检查,应用CaLs软骨评分系统进行软骨评分。观察治疗及随访过程中不良反应和并发症的发生情况。结果:1例在外周血干细胞采集过程中出现抽搐,要求停止治疗; 1例治疗期间因外伤致腰椎骨折,停止治疗。其余17例患者均完成治疗及随访观察,随访时间6~12个月,中位数9个月。随访过程中无不良反应和并发症发生。17例患者治疗前及治疗开始后1个月、3个月、6个月的WOMAC骨关节炎指数分别为(35.18±12.67)分、(19.76±9.29)分、(17.65±11.26)分、(19.71±14.90)分; 治疗开始后6个月的CaLs软骨评分高于治疗前[(1.13±0.88)分,(1.43±0.75)分,t=2.553,P=0.023]。结论:膝关节腔注射外周血干细胞和PRP联合口服补肾活血汤治疗KOA,可有效改善患者的临床症状,修复受损软骨,而且具有较高的安全性。

参考文献/References:

[1] 国家中医药管理局医政司.22个专业95个病种中医诊疗方案(合订本)[M].北京:中国中医药出版社,2012:131-132. [2] PATEL S,DHILLON M S,AGGARWAL S,et al.Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis:a prospective,double-blind,randomized trial[J].Am J Sports Med,2013,41(2):356-364. [3] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:275-276. [4] ALIZAI H,VIRAYAVANICH W,JOSEPH G B,et al.Cartilage lesion score:comparison of a quantitative assessment score with established semiquantitative MR scoring systems[J].Radiology,2014,271(2):479-487. [5] VAHEDI P,JAROLMASJED S,SHAFAEI H,et al.In vivo articular cartilage regeneration through infrapatellar adipose tissue derived stem cell in nanofiber polycaprolactone scaffold[J].Tissue Cell,2019,57:49-56. [6] SOFIA V,NASRUL E,MANJAS M,et al.The influence of wharton jelly mesenchymal stem cell toward matrix metalloproteinase-13 and RELA synoviocyte gene expression on osteoarthritis[J].Open Access Maced J Med Sci,2019,7(5):701-706. [7] CHAHAL J,GMEZ-ARISTIZBAL A,SHESTOPALOFF K,et al.Bone marrow mesenchymal stromal cells in patients with osteoarthritis results in overall improvement in pain and symptoms and reduces synovial inflammation[J/OL].Stem Cells Transl Med,2019[2019-01-16].https://stemcellsjournals.onlinelibrary.wiley.com/doi/full/10.1002/sctm.18-0183. [8] KHALIFEH SOLTANI S,FOROGH B,AHMADBEIGI N,et al.Safety and efficacy of allogenic placental mesenchymal stem cells for treating knee osteoarthritis:a pilot study[J].Cytotherapy,2019,21(1):54-63. [9] 彭艳.富血小板血浆激活PI3K/AKT/NF<kappa>B信号通路促进骨髓间充质干细胞再生及修复功能的相关研究[D].广州:南方医科大学,2013. [10] 唐晓波,王健,董佩龙.自体富血小板血浆诱导兔脂肪干细胞成软骨分化的实验研究[J].中国矫形外科杂志,2014,22(11):1025-1033. [11] 钟达,廖前德,卢吉平,等.不同体积分数富血小板血浆对犬骨髓间充质干细胞增殖的影响[J].中国组织工程研究与临床康复,2009,13(49):9727-9730. [12] 刘伟,陈剑,宋佳,等.利用自体富血小板血浆构建凝胶生物细胞支架的实验研究[J].中国实验诊断学,2013,17(11):1937-1940. [13] VINOD E,VINOD FRANCIS D,MANICKAM AMIRTHAM S,et al.Allogeneic platelet rich plasma serves as a scaffold for articular cartilage derived chondroprogenitors[J].Tissue Cell,2019,56:107-113. [14] CHEN Y C,HSU Y M,TAN K P,et al.Intraarticular injection for rabbit knee osteoarthritis:effectiveness among hyaluronic acid,platelet-rich plasma,and mesenchymal stem cells[J].Journal of the Taiwan Institute of Chemical Engineers,2018,91:138-145. [15] KOH Y G,KWON O R,KIM Y S,et al.Comparative outcomes of open-wedge high tibial osteotomy with platelet-rich plasma alone or in combination with mesenchymal stem cell treatment:a prospective study[J].Arthroscopy,2014,30(11):1453-1460. [16] 张颖,张蕾蕾,孙瑞波,等.补肾活血法对人骨髓间充质干细胞成骨能力的影响及miR-93-5p对其的抑制作用[J].中华中医药杂志,2018,33(2):667-671. [17] 吴刚,童培建.补肾活血汤含药血清干预体外培养大鼠骨髓间充质干细胞成软骨分化及补肾活血汤联合骨髓间充质干细胞治疗大鼠膝骨关节炎的实验研究[J].中医正骨,2018,30(1):6-11.

相似文献/References:

[1]樊庆阳,任凯晶.定制3D打印切模辅助全膝关节置换术治疗 膝骨关节炎合并股骨干骨折畸形愈合[J].中医正骨,2015,27(11):37.
[2]刘晓雅,孙永强,刘国杰.主动快速康复锻炼对全膝关节置换术后关节活动度的影响[J].中医正骨,2015,27(09):73.
[3]郑春松,叶蕻芝,李西海,等.透骨消痛胶囊中补肾柔肝药和活血祛风药治疗 骨关节炎作用方式的计算机模拟比较[J].中医正骨,2015,27(07):6.
 ZHENG Chunsong,YE Hongzhi,LI Xihai,et al.Comparison of the mode of action of Bushen Rougan(补肾柔肝)drugs versus Huoxue Qufeng(活血祛风)drugs contained in Tougu Xiaotong Jiaonang(透骨消痛胶囊)for the treatment of osteoarthritis:A computer simulation study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(06):6.
[4]宋兵华,孙俊英,倪增良,等.全膝关节置换术前CT测量股骨后髁角的临床意义[J].中医正骨,2015,27(07):38.
[5]郑春松,叶蕻芝,李西海,等.独活寄生汤含药血清对白细胞介素1β诱导的 退变关节软骨细胞中基质金属蛋白酶 和环氧化酶2表达的影响[J].中医正骨,2015,27(12):1.
 ZHENG Chunsong,YE Hongzhi,LI Xihai,et al.Impact of Duhuo Jisheng Tang(独活寄生汤)medicated serum on expression of matrix metalloproteinase and cyclooxygenase 2 in degenerative articular chondrocytes induced by interleukin-1 beta[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(06):1.
[6]王金良,孙京涛,李玲,等.骨水泥联合螺钉修复全膝关节置换术中 胫骨平台内侧骨缺损[J].中医正骨,2015,27(12):55.
[7]冯荣,王平,李炳奇,等.铍针刺络拔罐结合中药口服治疗膝骨关节炎合并 原发性血小板增多症1例[J].中医正骨,2015,27(12):73.
[8]蔡云仙.围手术期耳穴按压联合平衡针疗法 在全膝关节置换术后镇痛中的应用[J].中医正骨,2015,27(06):41.
[9]张荣,王健.人工全膝关节置换术的围手术期心理护理[J].中医正骨,2015,27(05):77.
[10]喻长纯,杨明路,王战朝.不同手术方式治疗胫骨平台骨折畸形愈合的体会[J].中医正骨,2015,27(03):37.
[11]孟维娜,明立功,王新德,等.关节镜下清理联合腓骨近1/3段截骨治疗膝骨关节炎[J].中医正骨,2015,27(11):40.
[12]明立功,孟维娜,王新德,等.腓骨近端截骨治疗内侧间室膝骨关节炎的近期疗效观察[J].中医正骨,2015,27(10):25.
[13]张杰,王人彦,张玉柱.膝骨关节炎的治疗进展[J].中医正骨,2015,27(10):68.
[14]梁朝,蔡静怡,闫立,等.针刀疗法改善膝骨关节炎早期疼痛症状的疗效评价[J].中医正骨,2015,27(09):9.
 LIANG Zhao,CAI Jingyi,YAN Li,et al.Evaluation of the curative effect of needle-knife therapy for relieving knee pain in patients with early knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(06):9.
[15]王建武,党建军,李强,等.四联疗法治疗膝骨关节炎[J].中医正骨,2015,27(08):44.
[16]刘红娟,郭会利,郭树农.云克联合中药治疗膝骨关节炎的护理[J].中医正骨,2015,27(08):75.
[17]陈卫衡.探索建立系统的膝骨关节炎中医临床科研范式 和理论体系[J].中医正骨,2015,27(07):1.
[18]帅波,沈霖,杨艳萍,等.加味青娥丸治疗膝骨关节炎的作用机制研究[J].中医正骨,2015,27(07):15.
 SHUAI Bo,SHEN Lin,YANG Yanping,et al.Study on the mechanism of action of Jiawei Qing'e Wan(加味青娥丸)for the treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(06):15.
[19]梅其杰,袁长深,段戡,等.壮药骨痹方烫熨联合运动疗法治疗膝骨关节炎的临床研究[J].中医正骨,2015,27(07):27.
 MEI Qijie,YUAN Changshen,DUAN Kan,et al.Clinical study of the curative effect of hot compressing and rubbing with packet of Gubi Fang(骨痹方)combined with exercise therapy in the treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(06):27.
[20]王丹辉,张燕,刘丽娟,等.重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白 关节腔注射联合中药薰洗治疗膝骨关节炎的临床研究[J].中医正骨,2015,27(07):31.
 WANG Danhui,ZHANG Yan,LIU Lijuan,et al.Clinical study on intra-articular injection of TypeⅡrecombinant human tumor necrosis factor receptor-Fc fusion protein combined with Chinese herbal steaming and washing therapy for treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(06):31.

备注/Memo

备注/Memo:
基金项目:浙江省中医药科技计划项目(2019ZQ016) 通讯作者:童培建 E-mail:tongpeijian@163.com(收稿日期:2019-02-16 本文编辑:李晓乐)
更新日期/Last Update: 1900-01-01