| ObjectiveUnder the guidance of the theory of Traditional Chinese Medicine, via experimental and clinical study, this paper is to observe the clinical curative effect of the treatment on postmenopausal knee osteoarthritis(KOA) by supplementing the kidney and quickening the blood method and discuss its possible mechanism of action.MethodsExperimental study:162 female SD rats were randomly divided into 6 groups, group A(27 rats, received oral TCM),group B(27 rats, received voltaren),group C(27 rats, model group),group D(27 rats, normal blank group), group E(27 rats, ovariectomy group),group F(27 rats, cruciate ligament transection).Every group was then randomly divided into 3 small groups, as A1,A2,A3,B1,B2,B3,C1,C2,C3,D1,D2,D3,E1,E2,E3,F1,F2,F3. everygroup had 9 rats. Group A,group B and group C were done to postmenopausal osteoarthritic mode by bilateral ovariectomy and cutting down the right knee cruciate ligament(CL) under anesthetise. In group D, bilateral ovaries were pulled out and after partial resection of the fat, CL retained after incision of right knee skin. Group E only carried out bilateral ovariectomy. Group F only carried out right cruciate ligament transection. 6 weeks later, according to former experimental result, the postmenopausal osteoarthritic mode gained success, then we began to treat by intragastric administration. Group A treated with supplementing the kidney and quickening the blood method, group B treated with voltaren, group C, group D, group E and group F treated with sodium chloride. 8 weeks,10 weeks and 14 weeks after operation, we respectively got their serum to measure the content of typeⅡcollagen. At the same time (14 weeks after postoperation),we took the right tibial articular cartilage for electron microscope study on ultrastructure of group A3, group B3, group C3 and group D3.Clinical study:According to "the revision classified standard of American rheumatism association's osteoarthritis In 1986" and "theⅡissue of clinical test plan for knee osteoarthritis" ,the clinical cases were collected and divided into group of TCM (by supplementing the kidney and quickening the blood medicine) and group celecoxib randomly. These cases were all postmenopausal women. These cases belong to liver-kidney deficiency and obstruction of collaterals by blood stasis. These cases precluded which X ray grade belonged toⅤgrade. Every group had 30 cases respective, which would be treated 5 weeks respectively. When the treatments were accomplished, we evaluated their clinical curative effect, the changes of main symptoms and signs and the Chinese physician symptom.Resultsxperiental study:(1)the content of serum typeⅡcollagen which measured by using ELISA method showed group C's content was higher than group D at 8 weeks and 10 weeks postoperation, with the significant difference(P＜0.05).At 8 weeks postoperation, the content of group A was similar to group D, without significant difference(P＞0.05).At 10 weeks postoperation, the content of group A was higher than group D, with significant difference (P＜0.05).But compared with group C at 8 and 10 weeks postoperation, they had significant difference(P＜0.05). At 8 and 10 weeks postoperation, the content of group B was higher than group D with significant difference(P＜0.05);the content of group g was higher than group D, with significant difference(P＜0.05),but was lower than group C and group F, with significant difference(P＜0.05);tbe content of group F was higher than group C, with significant difference(P＜0.05),but was lower than group C, with significant difference(P＜0.05). At 14 weeks postoperation, the content of group C was lower than group D, with significant difference(P＜0.05);the content of group A was lower than group D, with significant difference(P＜0.05),but was higher than group C, with significant difference(P＜0.05); the content of group B was lower than group D, with significant difference(P＜0.05); the content of group E was lower than group C, with significant difference(P＜0.05), but was higer than group C, with significant difference(P＜0.05); the content of group F was lower than group D and group E, with significant difference, but was higher than group C, with significant difference(P＜0.05). (2) Ultrastructure showed: The degenerative changes of articular cartilage in the Chinese herbs group such as vacuolar degeneration of cytoplasm, decreased quantity and degraded function, pycnosis of nuclear and necrosis even disintegration of cell, are lesser than the group without treatment and voltaren retard tablets group.Clinical study: 1. WOMAC OA index: the WOMAC index of each group after treatment was better than themselves before treatment, with significant difference (P＜0.05). The total WOMAC index of the two groups were similar after treatment, without significant difference(P＞0.05), but having some difference among pain, joint stiffness and physiologic function. 2. Comparison of Chinese medicine symptom: there was significant difference between the Chinese medicine group and the celebrx group after treatment(P＜0.05). 3. Comparison of clinical curative effect: there was no significant difference between the two groups after treatment(P＞0.05).Conclusions1. The content of serum typeⅡcollagen is related with the condition of OA closely. In the early and middle stage of OA, the content of serum typeⅡcollagen is higher than the content of normal group. In the later stage of OA, the content of serum typeⅡcollagen is lower than the content of normal group. Gonadectomy can increase the content of serum typeⅡcollagen in the early and middle stage of OA and it can decrease the content of serum typeⅡcollagen in the later stage of OA. 2. It can regulate the content of serum typeⅡcollagen of post-menopause OA by using supplementing the kidney and quickening the blood method. It can regulate the content of serum typeⅡcollagen to get close to normal level. 3. It can obviously ameliorate the ultramicrostructure damage of post-menopause osteoarthritic rats by using supplementing the kidney and quickening the blood method. 4. The clinical curative effect between Chinese herb group and celebrex group is similar. But Chinese herb is lower side effect than celebrex. And Chinese herb has advantage in the aspect of ameliorating stiffness and the condition of all over the body.
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