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肖宇旃, 叶栋, 乔峰, 谢芳.补肾活血汤治疗肾虚血瘀型膝骨关节炎疗效及机制探讨[J].湖南中医药大学学报,2026,46(7):1405-1413[点击复制] |
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| 补肾活血汤治疗肾虚血瘀型膝骨关节炎疗效及机制探讨 |
| 肖宇旃,叶栋,乔峰,谢芳 |
| (湖南省中西医结合医院(湖南省中医药研究院附属医院), 湖南 长沙 410006;常德市第一中医医院, 湖南 常德 415000) |
| 摘要: |
| 目的 探究补肾活血汤治疗肾虚血瘀型膝骨关节炎（KOA）的临床疗效，并结合相关外周血指标初步探讨其与CC趋化因子配体2（CCL2）/CC趋化因子受体2（CCR2）轴、经典激活型（M1）/交替激活型（M2）样表型及相关炎症因子变化的关系。方法 纳入2024年12月至2025年12月就诊于湖南省中西医结合医院的肾虚血瘀型KOA患者72例，随机分为治疗组和对照组，每组36例。治疗组予口服补肾活血汤，对照组予口服塞来昔布胶囊。两组连续治疗4周，停药后随访2周。比较两组患者治疗前后西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分、中医证候各项积分、外周血白细胞介素（interleukin，IL）-4、IL-1β、CCL2、CCR2、M1/M2样表型水平、治疗总有效率和不良反应情况。结果 与治疗前比较，两组患者治疗2、4周后WOMAC评分、中医证候积分、CCL2/CCR2、M1和IL-1β水平均降低（P＜0.05）；M2、IL-4水平升高（P＜0.05）。与对照组相比，治疗组在治疗2、4周及停药后随访2周腰膝酸软证候积分、补肾维度积分、CCL2水平均降低（P＜0.016 7）；在治疗4周及停药后随访2周中医证候总积分降低（P＜0.016 7）；治疗组在停药后随访2周WOMAC评分、关节疼痛证候积分、活血止痛维度积分、CCR2和M1水平均降低，IL-4水平升高（P＜0.016 7）。两组组间总有效率比较，无统计学差异（P＞0.05），两组患者均未发生严重不良反应事件。结论 补肾活血汤可有效改善肾虚血瘀型KOA患者的临床症状与关节功能，且停药后短期内的临床疗效维持效果较好，其可能通过调节外周血CCL2/CCR2轴、M1/M2样单核细胞相关指标及炎症因子水平来干预肾虚血瘀型KOA患者疾病进程。 |
| 关键词: 膝骨关节炎|肾虚血瘀型|补肾活血汤|CCL2/CCR2轴|M1/M2样表型|炎症因子 |
| DOI：10.3969/j.issn.1674-070X.2026.07.011 |
| 投稿时间：2026-04-23 |
| 基金项目:湖南省中医药管理局项目（B2024033）；湖南省自然科学基金项目（2025JJ60630）；长沙市自然科学基金项目（kq2403134）；常德市第一中医医院国家中医优势专科建设项目（湘中医药〔2025〕1号）。 |
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| Clinical efficacy and mechanism of Bushen Huoxue Decoction in the treatment of knee osteoarthritis with kidney deficiency and blood stasis pattern |
| XIAO Yuzhan, YE Dong, QIAO Feng, XIE Fang |
| (Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine (The Affiliated Hospital of Hunan Academy of Chinese Medicine), Changsha, Hunan 410006, China;Changde First Hospital of Traditional Chinese Medicine, Changde, Hunan 415000, China) |
| Abstract: |
| Objective To investigate the clinical efficacy of Bushen Huoxue Decoction (BSHXD) in the treatment of knee osteoarthritis (KOA) with kidney deficiency and blood stasis pattern, and to preliminarily explore its association with changes in the chemokine ligand 2 (CCL2)/chemokine receptor 2 (CCR2) axis, M1/M2-like monocyte phenotypes, and related inflammatory cytokines based on peripheral blood indicators. Methods A total of 72 patients with KOA characterized by kidney deficiency and blood stasis pattern who were treated at Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine between December 2024 and December 2025 were enrolled and randomly assigned to treatment group or control group, with 36 patients in each group. The treatment group received oral BSHXD, whereas the control group received oral celecoxib capsules. Both groups underwent continuous treatment for 4 weeks, followed by a 2-week post-treatment follow-up. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, individual Chinese medicine (TCM) pattern scores, peripheral blood levels of interleukin (IL)-4, IL-1β, CCL2 and CCR2, and M1/M2-like phenotype-related indicators were compared before and after treatment. The overall response rate and incidence of adverse reactions were also evaluated. Results Compared with pre-treatment levels, both groups showed significant reductions in WOMAC scores, TCM pattern scores, CCL2 and CCR2 levels, M1-like phenotype-related indicators, and IL-1β levels after 2 and 4 weeks of treatment (P<0.05), whereas M2-like phenotype-related indicators and IL-4 levels were significantly increased (P<0.05). Compared with the control group, the treatment group exhibited significantly lower scores for soreness and weakness of the waist and knees, kidney-tonifying dimension scores, and CCL2 levels after 2 and 4 weeks of treatment and at the 2-week post-treatment follow-up (P<0.016 7). The total TCM pattern score was significantly lower in the treatment group after 4 weeks of treatment and at the 2-week post-treatment follow-up (P<0.016 7). At the 2-week post-treatment follow-up, the treatment group also showed significantly lower WOMAC scores, joint pain pattern scores, blood-activating and pain-relieving dimension scores, CCR2 levels, and M1-like phenotype-related indicators, together with significantly higher IL-4 levels, than the control group (P<0.016 7). No statistically significant difference in the overall response rate was observed between the two groups (P>0.05). No serious adverse events occurred in either group. Conclusion BSHXD effectively improves clinical symptoms and joint function in patients with KOA characterized by kidney deficiency and blood stasis pattern and demonstrates a favorable short-term maintenance of therapeutic effects after treatment discontinuation. Its effects may be associated with modulation of the peripheral blood CCL2/CCR2 axis, M1/M2-like monocyte phenotype-related indicators, and inflammatory cytokine levels, thereby potentially interfering with the progression of KOA in patients with kidney deficiency and blood stasis pattern. |
| Key words: knee osteoarthritis|kidney deficiency and blood stasis pattern|Bushen Huoxue Decoction|CCL2/CCR2|M1/M2-like phenotypes|inflammatory cytokines |
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