| Objective:Under the guidance of meridians theory,the clinical efficacy of Jingjintong Chinese traditional patent formulation in treating post-menopausal female KOA patients was discussed,the effect of meridians on the flexural muscle strength of knee joint was observed,and the modern medical theoretical basis for its treatment was further explored by experimental research.Method:This study is divided into two parts:Ⅰ.Clinical part:By giving Chinese and western medicine oral treatment to KOA patients,the effect of each group was compared and analyzed.Divided into three groups:(1)Chinese medicine group take oral Chinese medicine(Jingjintong prescription),the composition of the medicine is:fructus psoraleae 15g,radices paeoniae alba 30g,drynaria rhizome 15g,peach kernel 10g,red flower 5g,pseudo-ginseng 10g,raw Astragalus 30g,poria cocos 15g,radices cyathulae 15g,roasted Atractylodes macrocephala 15g,roasted ephedra 10g,Indian epimeredi.herb 10g,asarum sieboldi mig 3g(decocted first),roasted licorice 10g.Take 1 dose of the above Chinese medicine daily,fry it to 250ml,to be taken warm,take medicine for 6 consecutive days,rest for 1 day,2 weeks for 1 course,take 3 courses in a row.(2)Western medicine group:oral Serracyb capsules 200mg,1 pill at a time,2 times a day,6 days in a row,rest for a day,2 weeks for a course of treatment,take 3 consecutive courses.(3)Combination group:at the same time,Seraxib capsule 200mg and Jingjintong prescription were given oral administration.The dosage usage was the same as above.Take 6 days,rest one day,2 weeks for 1 course,take 3 courses in a row.Isokinetic muscle strength tester was used to measure the changes of the flexion and extension of the affected knees before and after treatment,and the WOMAC scores of the knee joints before and after treatment were statistically compared.Each group of patients has been treated with a series of meridian therapy to discuss the change law of the meridian.The relationship between flexion and extension muscle strength of the knee joint of postmenopausal women and the function of knee joint was further investigated with the guidance of the meridian therapy,and the effect of the Jingjintong prescription on flexion and extension strength and WOMAC score of the patients with postmenopausal KOA were observed.Ⅱ.Experimental part:the KOA model of castrated rats was made,and the 78 SD rats that met the requirements were divided into 6 groups,each of which was 13.After stratifying them by weight,they were grouped by random numerical tables and randomly divided into sham operation group,model group,treatment of high dose group,treatment of medium dose group,treatment of low dose group,and positive control group.Treatment group was given by Jingjintong prescription,the intervention concentration are:high,medium and low concentration.The different doses of Jingjintong prescription were converted into the same volume of water solution with different concentrations for lavage.The positive control group was given the same volume of celecoxib solution,the sham operation group and the model group were given the same volume of normal saline.The time of drug intervention was 6 weeks.After the intervention,the tibial and gastrocnemius muscles of the knee joint were taken and fixed in the concentration of 10%polyformaldehydethen slice and stain them respectively.The morphological changes of immunohistochemical gastrocnemius muscle,the expression of MHC-Ⅱ B protein in gastrocnemius muscle and the expression of epigenetic factors JMJD2A and JMJD2B in the articular cartilage of the knee were observed.And carries on the statistical analysis of relevant data,through the above research,the basis of the prevention and treatment of KOA by Chinese medicine”Jingjintong prescription" is proved.The analysis of relevant data was established by SPSS 18.0 software and statistical analysis was performed to evaluate the relevant conclusions.Results:Ⅰ.clinical research(Ⅰ)In three groups of patients,the distribution of the meridian lesion was dominated by Taiyang meridian and Yangming meridian,which accounted for 84%and 77%respectively,and the compound tendons were the main lesions,at the same time,it is mainly composed of compound meridian lesions.(Ⅱ)The analysis showed that the lateral flexural muscle strength of KOA patients was negatively correlated with the WOMAC score,and the difference was statistically significant(P<0.05),indicating that the lateral knee flexural and extensional muscle strength of KOA patients had a certain correlation with joint function.(Ⅲ)WOMAC score:1.After treatment,the WOMAC score of the three groups was significantly improved,the difference in the overall score of the three groups before and after treatment was statistically significant(P<0.05).2.There was no statistically significant difference in the stiffness of the joints between the groups(P>0.05).3.In terms of pain,the combination group was better than the western medicine group and the traditional Chinese medicine group,and the difference was-statistically significant(P<0.05),the western medicine group had better effect than the single Jingjintong prescription treatment group,and the difference was statistically significant(P<0.05).4.In terms of the activity degree of the knee joint,the combination group was better than the western medicine group and the traditional Chinese medicine group,and the difference was statistically significant(P<0.05),the Jingjintong prescription group is better than the single western medicine group,and the difference is statistically significant(P<0.05).(Ⅳ)Muscle strength measurement:1.After treatment,the flexion strength of the three groups was obviously improved,the difference of the flexion strength between the three groups before and after the treatment was statistically significant(P<0.05).2.Comparison between groups,in terms of buckling strength changed,the curative effect of combination group is superior to the traditional Chinese medicine and western medicine group,the difference has statistical significance significantly(P<0.05).3.There was no significant difference between the curative effect of traditional Chinese medicine group and that of Western medicine group(P>0.05),The results showed that there was no significant difference between the single Jingjintong prescription group and the simple use of cellaceb in improving flexor muscle strength.4.After treatment,the strength of knee extensor muscle of the three groups improved obviously.Before and after treatment,the difference of flexion strength between the three groups was statistically significant(P<0.05),indicating that all three treatments could improve the strength of the knee extension.5.The combined group has a good effect in improving the knee extensor strength.6.Compared with the western medicine group,the Chinese medicine group was superior to the western medicine group in improving the muscle strength(P<0.05),and the difference was statistically significant.Ⅱ.Experimental part(Ⅰ)1.Comparison of muscle fiber morphology and weight:In the high dose group,medium dose group,sham operation group and positive control group,’ the muscle fiber bundles of the gastrocnemius were intact,arranged closely,obviously many and thick,and there were also more muscle fibers and muscle nuclei with clear stripes.2.Compared with the positive control group,the Jingjintong prescription treatment group can increase the weight of the gastrocnemius muscle and promote the biosynthesis of actin.The difference between the high,middle and low dose groups was statistically significant(P<0.05),indicating that the strong enough concentration of the Jingjintong Chinese herbal medicine can improve the weight of the muscle,but there is a certain concentration of the maximum threshold.(II)Comparison of expression of MHC-IIb protein in rat gastrocnemius muscle:the level of the gastrocnemius MHC-Ⅱ B protein expression level in the high,middle dose group and the positive control group was significantly higher than that in the model control group(P<0.01),there was a statistically significant difference between the groups,it is indicated that high and medium dose Jingjintong and celecoxib can improve the expression of MHC II B protein in gastrocnemius muscle.2.Compared between the three groups of high,medium and low concentrations,the difference between the groups was statistically significant(P<0.05),indicating that the Jingjintong Chinese herbal medicine can improve the expression of the MHC-II B protein of the gastrocnemius,and in a certain range,the higher the concentration,the more significant the effect.3.The difference between the positive control group and the low dose Jingjintong group was statistically significant(P<0.05),indicating that celecoxib was superior to the low dose Jingjintong medicine in improving the expression of MHC-II B protein in the gastrocnemius muscle of rats.(Ⅲ)Comparison of the expression of JMJD2A and JMJD2B in articular cartilage:1.The expression of JMJD2A and JMJD2B in the articular cartilage could be improved by the Jingjintong treatment group and the model control group,and the difference between the three groups of high,middle and low concentrations was statistically significant(P<0.05).It indicated that the Jingjintong Chinese herbal medicine can improve the expression of JMJD2A and JMJD2B of articular cartilage,and in a certain range,the higher the concentration,the more significant the effect.3.Compared with the positive control group,the expression of JMJD2A and JMJD2B in the articular cartilage was improved by the high dose of the Jingjintong medicine group,indicating that the high dose of Jingjintong Chinese herbal medicine in a certain range was better than the Western drug celecoxib in improving the expression of JMJD2A and JMJD2B.4.The difference between the positive control group and the low dose Jingjintong group was statistically significant(P<0.05),indicating that celecoxib was better than the low dose Jingjintong medicine in improving the expression of JMJD2A and JMJD2B in the articular cartilage.Clusion:Through the above research,we have preliminarily concluded the following conclusions:1.In postmenopausal KOA patients,the rule of meridian lesion of the knee joint is mainly composed of the Taiyang meridian and Yangming meridian,and it is mainly compound lesions.2.The symptoms of postmenopausal KOA were associated with changes in knee flexion and extensor muscle strength.3.Oral Jingjintong medicine combined with exercise therapy has a good clinical effect on postmenopausal KOA patients.4.Jingjintong prescription can improve the clinical symptoms by improving the flexion and extension muscle strength of postmenopausal women with KOA.5.Animal experiments have proved that Jingjintong prescription can improve the fiber diameter of the gastrocnemius muscle fibers and improve the function of the atrophic muscle fibers in rats.The effective components of the Jingjintong prescription can increase the synthesis of the gastrocnemius protein,increase the weight of the muscle fiber,and promote the biosynthesis of actin.6.Jingjintong prescription can enhance the expression of MHC-II B protein in gastrocnemius muscle to improve muscle strength,and has certain relationship with the concentration of Jingjintong medicine.7.The Jingjintong Chinese herbal medicine can improve the expression of histone demethylation enzyme(JMJD2A,JMJD2B)in articular cartilage,so as to participate in the regulation of hormone and to protect the cartilage.8.Through the study of different concentrations of Chinese medicine,it is found that Chinese medicine needs to reach a certain concentration to exert its therapeutic effect.This study has made a preliminary exploration on the treatment of KOA with Jingjintong prescription,and some of its mechanisms have been discussed,but there are many shortcomings in this study,especially in the depth and width of the experiment.Because the clinical effect of this prescription in treating KOA is good,so we hope to continue in-depth and systematic research in the next step. |
