The Mechanism Of Three Diffident Therapeutic Methods On Steroid-induced Osteonecrosis Of Femoral Head:Tonifying Kidney, Activating Blood And Eliminating Phlegm

Objective:To discuss the mechanism of three diffident therapeutic methods,Tonifying kidney,Activating blood and Eliminating phlegm on steroid-induced osteonecrosis of femoral head,then provide experimental basis for Tonifying kidney,Activating blood and Eliminating phlegm on steroid-induced osteonecrosis of femoral head.Method:When rabbit steroid-induced osteonecrosis of femoral head model was successful established by improved Matsui method,108rabbits were randomly divided into Normal control group,Model control group,Tongluoshenggu group,Activating blood group,Tonifying kidney group,Eliminating phlegm group,each group of18,rabbits of Tongluoshenggu group,Activating blood group,Tonifying kidney group,Eliminating phlegm group were given by gavage with Tongluoshenggu capsule,Yougui Yin, Taohongsiwu decoction,Lingguizhugan decoction respectively,The rest of the group were given by gavage with the same dose normal saline.Then detect hemorheology,blood lipid, serum TXB2,6-keto-PGF1α,OPG and RANKL,and check femoral head with DR,CT, MRIscan,also pathological section and detect OPG,BMP-2,VEGF mRNA expression by RT-qPCR in rabbit femoral head necrosis tissue after2,4,8weeks respectively.Results:①Rabbit steroid-induced osteonecrosis of femoral head model could successful established by improved Matsui method,while its pathologic change was similar to human SONFH.②After2weeks intervention,Compared with Normal control group,the hemorheology,Triglycerides, total cholesterol, serum TXB2,RANKL,the rate of empty lacunae of Model control group,Tongluoshenggu group,Tonifying kidney group, Activating blood group,Eliminating phlegm group were increased/while high-density lipoprotein, serum6-keto-PGF1α,OPG were decreased,the difference was statistically significant(P<0.05),there was also changes in imaging indicators.Compared with Model control group, the hemorheology, serum TXB2,6-keto-PGF1α,OPG,RANKL,the rate of empty lacunae of Tongluoshenggu group was improved(P<0.05),but there was no improvement in blood lipid(P>0.05).The serum OPG,RANKL,the rate of empty lacunae of Tonifying kidney group was improved(P<0.05),bue there was no improvement in hemorheology, blood lipid, serum TXB2,6-keto-PGF1α,(P>0.05).The hemorheology, serum TXB2,6-keto-PGF1α,the rate of empty lacunae of Activating blood group was improved(P<0.05),bue there was no improvement in blood lipid, serum OPG,RANKL,(P>0.05).The hemorheology,blood lipid,serum TXB2,6-keto-PGF1α of Eliminating phlegm group was improved(P<0.05),bue there was no improvement in serum OPG,RANKL and the rate of empty lacunae (P>0.05). ③After4weeks intervention,Compared with Normal control group,the hemorheology,Triglycerides, total cholesterol, serum TXB2, RANKL,the rate of empty lacunae of Model control group were increased,while high-density lipoprotein, serum6-keto-PGF1α,OPG were decreased,the difference was statistically significant(P<0.05),there was also changes in imaging indicators.The serum OPGRANKLof Tongluoshenggu group and Tonifying kidney group,and blood lipid of Eliminating phlegm group were reached normal levels(P>0.05).Compared with Model control group, the hemorheology, blood lipid, serum TXB2,6-keto-PGF1α,the rate of empty lacunae of Tongluoshenggu group and Tonifying kidney group was improved(P<0.05).The hemorheology, serum TXB2,6-keto-PGF1α, OPGRANKL, the rate of empty lacunae of Activating blood group and Eliminating phlegm group was improved(P<0.05),and there was also improvement in blood lipid of Activating blood group (P<0.05).④After8weeks intervention,Compared with Normal control group,the hemorheology,Triglycerides, total cholesterol, serum TXB2,RANKL,the rate of empty lacunae of Model control group were increased,while high-density lipoprotein, serum6-keto-PGF1α,OPG, OPG、BMP-2、VEGF mRNA expression in rabbit femoral head necrosis tissue were decreased,the difference was statistically significant(P<0.05),there was also changes in imaging indicators.The serum OPG,RANKL,OPG、BMP-2mRNA expression of Tongluoshenggu group and Tonifying kidney group, hemorheology, serum TXB2,6-keto-PGF1α,VEGF mRNA expression of Tongluoshenggu group and Activating blood group,and blood lipid of Eliminating phlegm group were reached normal levels(P>0.05).Compared with Model control group,the blood lipid, the rate of empty lacunae of Tongluoshenggu group was improved(P<0.05),The hemorheology, blood lipid, serum TXB2,6-keto-PGF1α,the rate of empty lacunae, VEGF mRNA expression of Tonifying kidney group was improved(P<0.05),the blood lipid,the rate of empty lacunae,OPG、BMP-2mRNA expression of Activating blood group was improved(P<0.05),the hemorheology,serum TXB2,6-keto-PGF1α,OPG,RANKL,the rate of empty lacunae, OPG、BMP-2、VEGF mRNA expression of Eliminating phlegm group was improved(P<0.05).Conclusion:①Rabbit steroid-induced osteonecrosis of femoral head model could successful established by improved Matsui method,while its pathologic change was similar to human SONFH,and its hemorheology,Triglycerides, total cholesterol, serum TXB2, RANKL were increased,while high-density lipoprotein, serum6-keto-PGF1α OPG,OPG、BMP-2、VEGF mRNA expression in femoral head necrosis tissue were decreased.②Yougui Yin has better curative effect on SONFH, its mechanism may be through increasing serum OPG,decreasing RANKL,promote OPG and BMP-2mRNA expression in femoral head, increase osteoblast activity,reduce osteoclast activity,then to promote bone formation to repair and treat SONFH necrotic area.The improvement in hemorheology,blood lipid and serum TXB2,6-keto-PGF1α,VEGF mRNA may be correlate with promote bone metabolism,reduce differentiation towards into fat,improve lipid metabolism.This may be the mechanism of Tonifying kidney method of traditional Chinese medicine on SONFH.③Taohongsiwu decoction has better curative effect on SONFH, its mechanism may be through improving hemorheology,increasing serum6-keto-PGF1α decreasing TXB2, Promote VEGF mRNA expression in femoral head,increasing the femoral blood supply,then to promote bone formation to repair and treat SONFH necrotic area.The improvement in OPG, RANKL,BMP-2,blood lipid may be correlate with promote systemic and local femoral head microcirculation,bone metabolism.This may be the mechanism of Activating blood method of traditional Chinese medicine on SONFH.④Lingguizhugan decoction has curative effect on SONFH, its mechanism may be through improve the lipid metabolism and hemorheology,increasing serum6-keto-PGF1α decreasing TXB2,reduce the blood viscosity and the blood vessels in the femoral head fat embolus formation, increasing the femoral blood supply,then to promote bone formation to repair and treat SONFH necrotic area.The improvement in serum OPG, RANKL,and OPG、BMP-2、VEGF mRNA expression may be correlate with improve the lipid metabolism, reduce the blood viscosity and increasing the femoral blood supply.This may be the mechanism of Eliminating phlegm method of traditional Chinese medicine on SONFH.⑤Tongluoshenggu capsule has better curative effect on SONFH, its mechanism may be through improve the hemorheology,increasing serum OPG,6-keto-PGF1α,decreasingRANKL,TXB2,promote OPG,BMP-2,VEGF mRNA expression in femoral head,promote vascular endothelial cell proliferation and bone formation,inhibit bone resorption,then to promote to repair and treat SONFH necrotic area.The improvement in blood lipid may be correlate with promote systemic and local femoral head microcirculation and bone formation and repair.⑥The mechanism of three diffident therapeutic methods,Tonifying kidney,Activating blood and Eliminating phlegm on steroid-induced osteonecrosis of femoral head may be different.However,After8weeks intervention,Tonifying kidney and Activating blood had the same action on the rate of empty lacunae, Eliminating phlegm worst, illustrated that when coming to TCM methods on SONFH, Tonifying kidney and Activating blood should be used,and consideration could give to Eliminating phlegm.