The Effect Of Tongluozhitong Chinese Medicine Assisted With Sonophoresis On KOA

Objective:1To discuss the mechanisms of Tongluozhitong Chinese medicine assisted with sonophoresis treating KOA,we observed the influence on the morphology of synovium and articular cartilage tissue,cytokines in serum and synovial fluids of KOA models of rabbits by Tongluozhitong Chinese medicine assisted with sonophoresis.2To evaluate the effect of Tongluozhitong Chinese medicine assisted with sonophoresis on KOA and to discuss the mechanisms,we observed the changes of serum inflammatory factors, VAS score, WOMAC score and SF-36score before and after treatment.Methods:1Experiment1:We randomly divided15rabbits into normal group, low dose group (1.6%papain solution) and high dose group(4%papain solution),5each.The KOA model is established by injecting papain into the knee. The three groups were observed and evaluated through their animal ethology, the morphology of synovium and articular cartilage tissue, and cytokines in serum and synovial fluids.2Experiment2:We randomly divided32rabbits into4groups:normal group of5, model group and treatment group(Tongluozhitong decoction assisted with sonophoresis) and control group(Saline solution assisted with sonophoresis) of9each group. To observe the influence of Tongluozhitong Chinese medicine assisted with sonophoresis on cytokines,we tested the changes of cytokines in serum and synovial fluids by the method of radioimmunoassay.3Clinic trial:60cases who Conformed to the standard of KOA and the syndrome of liver and kidney insufficiency and relative stasis were randomly divided into3groups:Tongluozhitong decoction assisted with sonophoresis group, Tongluozhitong decoction with external application group and Saline solution assisted with sonophoresis group,20each. We tested the changes of IL-1β、TNF-α in serum by ELISA,and evaluated the effects of each group by comparing VAS score, WOMAC score and SF-36score before and after the treatment.Results:1Results of Experiment1:Compared with normal group, rabbits’weights of high and low dose group decreased significantly (P<0.05). Compared with normal group,local reactions,gait,joint mobility and joint swelling of high and low dose group made significant differences (P<0.05).The Mankin’s histologic scores of cartilage and synovial membrane of high dose group were higher than that of low dose group (P<0.05).The level of cytokines in serum and synovial fluids of high dose group were higher than that of low dose group (P<0.05)2Results of Experiment2:Compared with normal group, rabbits’weights of model group, treatment group and control group made significant differences (P<0.05),and the weights of treatment group increased mostly. Compared with normal group, the gait,joint mobility and joint swelling of model group, treatment group and control group made significant differences (P<0.05),but the local reactions of the three groups made no obvious differences. Compared with model group,the level of local inflammatory cell invasion into synovial membrane of treatment group was lower than that of model group, and the Mankin’s histologic scores of synovial membrane of treatment group were higher (P<0.05). Compared with normal group,the level of IL-1β、TNF-α、COMP、NO in serum and synovial fluids of model group increased significantly (P<0.05). Compared with model group,the level of IL-1β、TNF-α、COMP、NO in synovial fluids of treaement group decreased significantly (P <0.05)3Results of clinic trial:Two weeks after the end of trial,the level of TNF-α、IL-β in serum of KOA patients treated by Tongluozhitong Chinese medicine assisted with sonophoresis decreased significantly than that before trial (P<0.05).The VAS score, WOMAC score and SF-36score made significant differences two weeks after the end of trial(P<0.05), especially the Tongluozhitong decoction assisted with sonophoresis group.The VAS score and WOMAC score of Tongluozhitong decoction assisted with sonophoresis group four weeks after the end of trial were higher than that two weeks after the end of trial(P>0.05)Conclusion:1The KOA model which is established by injecting1.6%papain into the knee of rabbits coform to clinicopathological significance of mild KOA.2Mechanism of action on skin permeation of Tongluozhitong Chinese medicine assisted with sonophoresis to KOA of rabbits may be reliseving the inflammatory response of synovial cells and suppressing the generation of cytekines,thus,it could relieve the inflammatory response of knee.3Mechanism of method in which Tongluozhitong Chinese medicine assisted with sonophoresis decrease significantly the level of TNF-α、IL-β in serum of KOA patients;and ameliorate the VAS score, WOMAC score and SF-36score of the patients, especially psychological health and emotion change.