标题：兔膝骨性关节炎治疗中透明质酸钠与曲安奈德对滑膜和软骨的影响

      作者：李伟 1，姜春岩 1，王战伟 2，任士友 2，肖德明 2    (1.北京大学第四临床医学院北京积水潭医院运动损伤科，北京 100035；2.北京大学深圳医院运动医学与康复科，广东 深圳 518036)

      卷次： 2016年27卷21期

      【摘要】 目的 评估透明质酸钠与曲安奈德对兔膝骨性关节炎中关节滑膜及软骨的影响。方法 24只新西兰兔制造骨关节炎模型后按数表法随机分为对照组、透明质酸钠(SH)组、曲安奈德(TA)组，每组各8只，分别进行关节腔注射生理盐水0.4 mL、SH 0.4 mL、TA 0.4 mL，每周一次，每组6次。6周后观察每组兔膝关节滑膜组织病理切片、血管滑膜SP法染色、软骨AB-PAS染色及MMP-1免疫组化。结果 滑膜病理切片显示，SH组滑膜增生最少，TA组滑膜增生较少，对照组滑膜增生明显；滑膜SP法染色显示SH组、TA组VEGF阳性细胞百分数较对照组减少[(42.50±5.29)%、(50.80±5.24)% vs (53.38±4.75)%，P<0.05]，SH组、TA组平均光密度值较对照组减少[(0.32±0.02)、(0.43±0.04) vs (0.48±0.05)，P<0.05]，TA组较SH组和对照组内软骨细胞减少，软骨基质成分减少，SH组、TA组较对照组软骨表层破坏减少。SH组、TA组软骨MMP-1细胞百分数评分优于对照组[(61.25±4.06)%、(76.27±4.68)% vs(87.13±3.64)%，P<0.05]；SH组、TA组软骨Mankins评分优于对照组[(6.88±1.25)分、(7.27±0.68)分 vs (8.13±0.83)分，P<0.05]。结论 透明质酸钠和曲安奈德均能抑制滑膜炎增生，减少兔膝关节腔内的炎性细胞因子，减少了软骨基质的破坏，且透明质酸钠要优于曲安奈德。
      【关键词】 骨性关节炎；关节软骨；曲安奈德；透明质酸钠；关节腔内注射
      【中图分类号】 R-332 【文献标识码】 A 【文章编号】 1003—6350（2016）21—3444—04

Effect of intraarticular injection of sodium hyaluronate and triamcinolone acetonide on cartilage and synovium ofosteoarthritis rabbits.
LI Wei 1, JIANG Chun-Yan 1, WANG Zhan-Wei 2, RNE Shi-You 2, XIAO De-Ming 2. 1. Department ofSports Medicine, the Fourth Clinical Medical College of Peking University, Beijing Jishuitan Hospital, Beijing 100035, CHINA;2. Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen 518036, CHINA
【Abstract】 Objective To evaluate the effects of intraarticular injection of sodium hyaluronate (SH), triamcino-lone acetonide (TA) on cartilage and synovium of osteoarthritis (OA) rabbit models. Methods After the models of OAestablished, a total of 24 male rabbits were divided into the control group, sodium hyaluronate (SH) group and triamcino-lone acetonide (TA) group, with 8 rabbits in each group. The control group, SH group and TA group respectively receivedintraarticular injection of 0.9% saline 0.4 mL, SH 0.4 mL, TA 0.4 mL one time each week for 6 weeks. After 6 weeks, thesynovial tissue biopsy, vascular synovial SP staining, cartilage alcian blue and periodic acid-Schiff (AB-PAS) staining andmatrix metalloproteinase-1 (MMP-1) immunohistochemistry were observed. Results Compared with the control group,the histological observation of synovium showed that SH group had least synovial hyperplasia, and TA group had less sy-novial hyperplasia. The histological observation of cartilage SP staining showed the percentage of positive cells ofVEGF and average optical density in the SH group and TA group were (42.50±5.29)%, (0.32±0.02), (50.80±5.24)%,(0.43±0.04), respectively, which were significantly lower than those in the control group (53.38±4.75)%, (0.48±0.05), re-spectively (P<0.05). The SH group and TA group had less apoptosis of chondrocytes and more integrated structure of ma-trix compared with the control group. The MMP-1 percentage cartilage cells and cartilage Mankins score of the SHgroup and TA group were (61.25±4.06)%, (6.88±1.25)%, (76.27±4.68)%, (7.27±0.68), respectively, which were signifi-cantly better than those in the control group (87.13±3.64)%, (8.13±0.83), respectively (P<0.05). Conclusion Intraartic-ular injection of SH and TA can relieve inflammation of OA, alleviate the pathologic process of OA, reduce the destruc-tion of cartilage matrix, and SH better than TA.
      【Key words】 Osteoarthritis (OA); Articular cartilage; Triamcinolone acetonide (TA); Sodium hyaluronate (SH);Intraarticular injection·论 著·doi:10.3969/j.issn.1003-6350.2016.21.002