宣白承气汤对急性肺损伤机械通气患者呼吸力学的影响

·30·

2010年8月第42卷第8期

JOURNALOFNEWCHINESEMEDICINEAugust2010Vol．42No．8

新中医

宣白承气汤对急性肺损伤机械通气患者呼吸力学的影响

张忠，乔秋杰，向素英，黄若兰，谢纬

深圳市中医院，广东深圳518033

[摘要]目的：研究宣白承气汤对急性肺损伤(ALI)机械通气患者呼吸力学的作用及其机制。方法：将符合要求的45例ALI患者随机分为治疗组23例和对照组22例，均给予常规治疗及机械通气，治疗组加用宣白承气汤，比较治疗前后气道峰压(PIP)、平台压(Pplat)、气道阻力(Raw)、氧合指数(PaO2/FiO2)、静态肺顺应性(Cst)及动态肺顺应性(Cdyn)等呼吸力学参数，胸片评分及血清肿瘤坏死因子α(TNF－α)、白介素－1β(IL－1β)和白介素－10(IL－10)等炎性因子。结果：治疗后治疗组患者PIP、Raw、Cdyn及胸片评分等均有改善，与对照组比较，差异均有显著性意义(P＜0．05)；而Pplat、Cst、PaO2/FiO2等改善更显著，明显优于对照组(P＜0．01)。炎性指标方面，治疗后治疗组TNF－α、IL－1β水平较对照组明显下降(P＜0．05)；而IL－10较对照组明显上升(P＜0．05)。结论：宣白承气汤对急性肺损伤患者呼吸力学有较好的改善作用，其机制可能与宣白承气汤调节促炎因子与抑炎因子之间的平衡有关。

[关键词]急性肺损伤；机械通气；宣白承气汤；呼吸力学；炎性因子[中图分类号]R563

[文献标识码]A

[文章编号]0256－7415(2010)08－0030－02

急性肺损伤(ALI)是以低氧血症为特征的急性起病的呼吸衰竭，急性呼吸窘迫综合征(ARDS)是病情进展的结果。如何在机械通气纠正顽固性缺氧的基础上，进一步改善患者的气道顺应性及呼吸动力，实现尽早脱机，减少其发展为ARDS的机会，仍是监护治疗的重要课题。本研究旨在观察宣白承气汤对应用机械通气的ALI患者呼吸力学的影响，为中医药治疗ALI提供思路。11．1

资料与方法病例来源

选择2006年3月～2009年6月于本院ICU

脉推注乌司他丁针剂每次40万U，每6小时1次；④维持水、电解质和酸碱平衡，给予必要的对症支持治疗。

治疗组在上述治疗的基础上给予宣白承气汤。处方：生石膏、瓜蒌皮各20g，生大黄9g，苦杏仁15g。由本院煎药室制成200mL煎剂，每天1剂，分早晚2次鼻饲。对照组同时给予温开水200mL，分早晚2次鼻饲。2组疗程均为7天。治疗过程中如病情发展为ARDS，或患者死亡，则研究中止，并作为无效统计。1．3

机械通气策略

2组患者均采用经口气管插管，气管导

管内径为男性8．0mm，女性7．5mm。使用MAQUETServo－i型呼吸机辅助通气，患者取平卧位，静脉注射咪唑安定以保持适当的镇静，Ramsay评分为2～3级[2]，采用保护性机械通气策略，通气模式设为定容型，潮气量6～10mL/kg，吸气流速40～60L/分，吸气末暂停时间0．1～0．5秒，通气频率15～20次/分，呼吸末正压6～12cmH2O，吸氧浓度40%～60%，持续通气60分钟后，在患者生命体征及血流动力学稳定的情况下记录呼吸力学参数，每隔5分钟监测1次气道峰压(PIP)和平台压(Pplat)，并计算气道阻力(Raw)、静态肺顺应性(Cst)及动态肺顺应性(Cdyn)，共5次，取平均值作为统计数据。1．4

呼吸力学指标观测

观察治疗前(机械通气后60分

钟)、治疗7天时的氧合指数(PaO2/FiO2)、PIP、Pplat、Raw、Cst及Cdyn等，Cst(mL/cmH2O)=VT/(Pplat－PEEP)；Cdyn(mL/cmH2O)=VT/(PIP－PEEP)[3]。

和呼吸内科住院的患者共45例，全部病例符合1994年美国和欧洲ARDS评审会议制订的ALI诊断标准[1]，并需要有创机械通气治疗，将患者随机分为治疗组23例和对照组22例。治疗组男14例，女9例；年龄在28～69岁；其中脓毒症10例、腹部外伤5例、颅脑外伤4例、急性胰腺炎2例、误吸2例。对照组男15例，女7例；年龄在30～65岁；其中脓毒症12例、腹部外伤5例、颅脑外伤3例、急性胰腺炎1例、误吸1例。2组患者在性别、年龄、原发疾病、急性生理学评分系统(APACHEⅡ)评分等经统计学处理，差异均无显著性意义(P＞0．05)，具有可比性。1．2

治疗方法

2组患者均积极处理原发病，外伤患者及时

行手术治疗。所有患者给予常规治疗，包括：①必要的抗感染治疗，根据药敏选择和调整药物；②祛痰药物，静脉推注沐舒坦针剂每次45mg，每6小时1次；③抑制炎症反应药物，静

[收稿日期]2010－04－27

[作者简介]张忠(1970－)，男，副主任医师，主要从事心血管和急危重症的临床、教学及科研工作。

2010年8月第42卷第8期

JOURNALOFNEWCHINESEMEDICINEAugust2010Vol．42No．8

新中医

·31·

1．5

胸部摄片

分别于治疗前(开始机械通气60分钟内)、

治疗7天时行床边胸部摄片了解肺部浸润情况，并给予评分。胸片评分标准[4]：0分，无肺泡浸润；1分，肺泡浸润局限于1个象限；2分，肺泡浸润局限于2个象限；3分，肺泡浸润局限于3个象限；4分，肺泡浸润局限于4个象限。1．6

炎性因子指标检测

分别于治疗前及治疗7天后清晨空

腹各抽取外周静脉血4mL，低温离心留血清，－80℃保存待测。采用放射免疫法测定肿瘤坏死因子α(TNF－α)、白介素－1β(IL－1β)和白介素－10(IL－10)等炎性因子。1．7统计学方法采用SPSS12．0统计学分析软件进行数据

处理，计量资料以(±s)表示，采用t检验。

2结果

2．1

2组治疗前后PIP、Pplat及Raw值比较

见表1。观察

期间治疗组1例，对照组3例发展为ARDS，均无死亡病例。2组治疗前呼吸力学指标比较均无差异性(P＞0．05)；治疗后治疗组患者PIP、Paw值下降程度较大，与对照组比较，差异均有显著性意义(P＜0．05)，Pplat值下降更显著，明显优于对照组(P＜0．01)。

表12组治疗前后PIP、Pplat及Raw值比较(±s)

组别n

PIP(cmH2O)

Pplat(cmH2O)Raw(cmH2O/L/S)治疗组治疗前2335．42±1．9726．71±2．2618．11±2．81治疗后2221．55±2．08①15．29±1．80②

10．79±0．54①对照组

治疗前2236．49±1．7027．83±2．3518．93±3．48治疗后1923．89±2．13

20．24±1．97

13．86±0．90

与对照组治疗后比较，①P＜0．05，②P＜0．012．2

2组治疗前后PaO2/FiO2、Cst、Cdyn及胸片评分比较

见表2。2组治疗前氧合指数、肺顺应性及胸片评分比较均无差异性(P＞0．05)。治疗后治疗组Cdyn和胸片评分的改善程度优于对照组(P＜0．05)，而PaO2/FiO2、Cst值的改善程度更加明显，与对照组比较，差异均有非常显著性意义(P＜0．01)。表22组治疗前后PaO2/FiO2、Cst、Cdyn及胸片评分比较(±s)

组别nPaO2/FiO2(mmHg)Cst(mL/cmH2O)Cdyn(mL/cmH2O)胸片评分(分)治疗组治疗前23211．56±8．2736．71±12．8231．58±8．772．94±0．87

治疗后22302．10±6．91②52．68±10．13②47．19±10．12①1．25±0．55①

对照组

治疗前22215．99±7．4537．20±12．0932．04±7．853．01±0．61治疗后19

273．24±9．18

44．39±10．87

41．58±11．06

1．87±0．39

与对照组治疗后比较，①P＜0．05，②P＜0．012．3

2组治疗前后TNF－α、IL－1β及IL－10变化比较

见

表3。2组患者治疗前TNF－α、IL－1β及IL－10等炎性因子比较，差异均无显著性意义(P＞0．05)。治疗后治疗组TNF－α、IL－1β水平下降程度优于对照组(P＜0．05)；而IL－10呈上升改变，且治疗组上升程度较对照组显著(P＜0．05)。

表32组治疗前后TNF－α、IL－1β及IL－10变化比较(±s)pg/mL

组别n

TNF－α

IL－1βIL－10治疗组治疗前23520．15±28．70713．20±20．63495．10±34．65治疗后22457．85±29．04①661．50±24．60①547．72±38．14①

对照组

治疗前22514．68±26．51716．09±22．74483．06±30．90治疗后19481．34±23．97

689．32±23．11

520．21±33．26

与对照组治疗后比较，①P＜0．053

讨论

ALI的病因及发病机制存在“肠－肝－肺轴”的假说，因而ALI并非单纯意义上的肺部疾病，而是失控的全身炎症反应在肺部的表现，上述发病机制表明胃肠道与肺之间有着内在的联系，这也符合“肺与大肠相表里”的中医学理论。当机体受致病因素打击，外邪入侵，机体正气受损，免疫力下降，肠道屏障功能亦随之下降，肠道菌群入血，内毒素释放，从而引发脓毒血症，即邪毒亢盛，此时以实热亢盛为主要表现，可见发热、大便秘结、腹胀等；若邪气太盛，正气不足以抗邪外出，邪毒壅滞于肺，灼伤气阴，煎熬血液，则见瘀血，血瘀则水停，瘀血、水邪阻滞则肺失宣降，可见肺间质渗出、水肿，肺泡透明膜形成，局灶性肺不张等，此时病以暴喘、结胸、腑实为主，进一步发展则内闭外脱甚至死亡。宣白承气汤出自《温病条辨》，是阳明温病“下之不通”五方之一，专治肺与大肠的同病证。生石膏与大黄合用，兼清肺胃肠腑之热，荡涤肠胃邪实积聚；苦杏仁与瓜蒌皮合用同走肺肠，止咳化痰，润肠降气。全方用药精当，仿麻杏石甘汤和承气汤之意，对于肺热痰壅兼胃肠邪实之候，不失为一张有参考意义的示范方。观察表明，宣白承气汤可通过相关途径抑制炎症反应，使促炎因子(TNF－α、IL－1β)和抑炎因子(IL－10)达到新的平衡，改善、延缓ALI一系列的病理变化进程，对机械通气患者呼吸力学有明显的改善作用。

[参考文献]

[1]

中华医学会呼吸病学分会．急性肺损伤/急性呼吸窘迫综合征的诊断标准(草案)[J]．中华结核和呼吸杂志，2000，23(4)：203．[2]

RamsayMAE，SavegeTM，SimpsonBRJ，etal．Controlledsedationwithalphadolone[J]．BritishMedicalJournal，1974，2：656－659．[3]

TobinMJ．Respiratorymonitoring[J]．JAMA，1990，246：244－251．

[4]

王育珊．急救医学[M]．北京：高等教育出版社，2006：27．

(编辑：冯天保)

ABSTRACTSOFORIGINALARTICLES

ExplorationofThoughtsforTreatingPancreaticCancerwithChineseMedicine

BAIJianping(白建平)，ZHANGHaibo(张海波)，QUXin(曲鑫)，etal．

Abstract:Pancreaticcanceristhecommonly－seenmalignanttumorofdigestivesystem．Mostofthepancreaticcancerpatientsareinthemiddleandlatestageswhentheyhavethefinaldiagnosis．Inthemiddleandlatestages，thepancreaticcancerpatientshavelowexcisionrate，andareinsensitivetothechemicaltherapy．Insuchacase，com-prehensivetreatmentwithoraluseandexternalapplicationofChinesemedicinecanen-hancethetherapeuticeffectofexcision．OraluseofChinesemedicineshouldbebasedonstrengtheningspleenandQifortherootcause，resolvingdampnessandremovingphlegmforthesymptoms．ExternalapplicationofChinesemedicineshouldpayattentiontothedifferencesofregionsofthehead，bodyandtailofthepancreas．

(Originalarticleonpage1)InvestigationofYinandYangSeries－syndromesandCarotidIntima－mediaThicknessinIschemicStrokePatientswithImpairedGlucoseTolerance

WUHaike(吴海科)，TANFeng(谭峰)，XUXiangqing(徐向青)，etal．

Abstract:Objective:Toinvestigatethedistributionofyinandyangseries－syn-dromes，intima－mediathickness(IMT)，andneurologicimpairmentinischemicstrokepatientswithimpairedglucosetolerance(IGT)．Methods:Basedontheresultsoforalglucose(tolerancetest，117qualifiedpatientsweredividedintonormalglucosetoleranceNGT)group，IGTgroupanddiabetesmellitus(DM)group．Allofthepatientswereclassifiedintoyinseries－syndromeoryangseries－syndromeaccordingtothesymptomsand(signs．Theneurologicscore)evaluatedbytheNationalInstitutesofHealthStrokeScaleNIHSS)，bloodglucose(BGandIMTwereexamined．Results:Thepatientswithyangseries－syndromeaccountedfor54．3%inIGTgroupand57．9%inDMgroup，higherthan31．8%inNGTgroup，thedifferencebeingsignificantbetweenthetwogroups()P＜0．05．NIHSSscoreinIGTgroupandDMgroupwashigherthanthatinNGTgroup(＜P0．05orP＜0．01)．NIHSSscoreinIGTpatientswithyangseries－syndromewasob-viouslyhigherthanthatinIGTpatientswithyinseries－syndrome(P＜0．01)．Thedif-ferenceofNIHSSscorewasinsignificantbetweenDMgroupandIGTgroup(P＞0．05)．Conclusion:InischemicstrokepatientswithIGT，Yangseries－syndromeisdominant，IMTisincreasedandneurologicimpairmentisserious．

(Originalarticleonpage10)PreliminaryAnalysisofComprehensiveTherapeuticRegimenforAcuteIschemicStrokePatientswithYinSeries－syndromes

GUOJianwen(郭建文)，HUANGYan(黄燕)

Abstract:Objective:ToobservethetherapeuticeffectoftraditionalChinesemedicine(TCM)combinedwithwesternmedicine(WM)foracuteischemicstrokepa-tientswithYinseries－syndromes，whichhavenooperationindications．Methods:Eighty－sevenqualifiedpatientswererandomizedinto2groups:thetreatmentgroupwasgivensymptomatictreatmentcombinedwithHuatuoZaizaoPills，DengzhanXixinInjectionanddecoctionofherbalmedicine，andthecontrolgroupwasgivensymptomatictreatmentcombinedwithCiticolineInjectionandplaceboofherbalmedicine．Aftertreatment，theneurologicscoreevaluatedbytheNationalInstitutesofHealthStrokeScale(NIHSS)，Barthelindex(BI)，modifiedRankinScale(mRS)score，TCMscoreofstrokewereob-served．Results:Aftertreatment，thedifferenceoftherateforNIHSSscorerecoveringtothenormalandTCMscorewasinsignificantbetweenthetwogroups(P＞0．05)．There-sultsoffollow－up90daysaftertheonsetshowedthattheactivitiesofdailylifeandmRSscoreinthetreatmentgroupdidnotdifferfromthoseinthecontrolgroup(P＞0．05)．Conclusion:WecannotobtaintheresultthatTCMcombinedwithWMhasabetteref-fectthanroutinewesternmedicineforacuteischemicstrokepatientswithYinseries－syn-dromes．TogivetheobjectiveevaluationofChinesemedicineforacuteischemicstroke，weshouldenlargethesamplesize，strengthenthequalitycontroloftreatmentcourse，de-creasethenumberofdropped－outpatientsandthepatientsfailinginfollow－up，andincreasetheadoptionofpatientswithvarioussyndromes．

(Originalarticleonpage12)AnalysisofChineseMedicalConstitutionsinCoronaryThrombosisPatientsPANChaoxin(潘朝锌)，WANGQinggao(王庆高)，HEXinbing(何新兵)，etal．Abstract:Objective:ToanalyzethecharacteristicsofChinesemedicalconstitutioninpatientswithcoronarythrombosis，thustosupplyevidencefortheearlypreventionofcoronarythrombosis．Methods:Patientswithconfirmedcoronaryheartdiseasewereran-domizedinto2groups:32patientswithcoronarythrombosiswereinthepositivegroup，and68withoutcoronarythrombosiswereinthenegativegroup．Thedistributionofconsti-tutiontypes，scoresofcoronarypathological)changes，andlevelsofthromboxanB2(TXB2)andvonWillebrandfactor(vWFwereobserved．Results:Inthepositivegroup，theconstitutionofbloodstasisandphlegmdampnesswasdominant;inthenega-tivegroup，theconstitution)ofQideficiency，Qistagnationandyindeficiencywasdomi-nant(P＜0．01．Thescoresofcoronarypathologicalchangeswerethehighestinblood－stasisconstitution，higherinphlegm－dampnessconstitution，andhighintheconstitutionofQideficiency，Qistagnationandyindeficiency(P＜0．01)，sodidtheTXB2andvWFlevels(P＜0．05orP＜0．01)．Conclusion:Theconstitutionofcoro-narythrombosispatientsisdominatedbyphlegmdampnessand(bloodstasis．

Originalarticleonpage16)EffectofXuanbaiChengqiDecoctiononBreathingMechanicsinAcuteLungInjuryPatientsReceivingMechanicalVentilation

ZHANGZhong(张忠)，QIAOQiujie(乔秋杰)，XIANGSuying(向素英)，etal．

Abstract:Objective:ToobservethetherapeuticeffectofXuanbaiChengqiDecoc-tion(XCD)onbreathingmechanicsinacutelunginjury(ALI)patientsreceivingme-chanicalventilation，andtoexploreitsmechanism．Methods:Forty－fivequalifiedALIpatients)wererandomizedintothetreatmentgroup(n=23)andthecontrolgroup(n=22．Thetwogroupsreceivedroutinewesternmedicineandmechanicalventilation，andthetreatmentgroupwasgivenXCDadditionally．Thechangesofbreathingmechanics)pa-rameterssuchaspressureofinspiration(peak(PIP)，platformpressure(Pplat，airwayresistance(Raw)(，oxygenationindexPaO2/FiO2)，lungcompliance(Cst)anddynamiccomplianceCdyn)wereobserved．Meanwhile，thechestX－rayscoreandserumlevelsof(inflammatoryfactorssuchastumornecrosisfactorα(TNF－α)，interleukin－1βIL－1β)andinterleukin－10(IL－10)wereexamined．Results:PIP，Raw，CdynandchestX－rayscorewereimprovedinthetreatmentgroupaftertreatment(P＜0．05com-paredwiththoseinthecontrolgroup)．TheimprovementofPplat，CstandPaO2/FiO2inthetreatmentgroupwassuperiortothatinthecontrolgroup(P＜0．01)．SerumTNF－α

andIL－1βlevelsweredecreasedandIL－10levelwasincreasedinthetreatmentgroup(P＜0．05comparedwiththoseinthecontrolgroup)．Conclusion:XCDcanimprovethebreathingmechanicsinacutelunginjurypatientsreceivingmechanicalventilation，anditspossiblemechanismisrelatedwiththeregulationofinflammatoryfactors．

(Originalarticleonpage30)TherapeuticEffectofZushimaTabletsforUndifferentiatedSpinalOsteoarthritis:AnObservationof50Cases

ZHENGBaolin(郑宝林)，YUJunwen(余俊文)，ZHANGXiaojuan(张小娟)，etal．Abstract:Objective:ToobservethetherapeuticeffectofZushimaTablets(ZT)forundifferentiatedspinalosteoarthritis．Methods:Eighty－threequalifiedpatientswererandomizedinto2groups:thetreatmentgroupwasgivenZT，andthecontrolgroupwasgivensulfasalazine．Thetotaltherapeuticeffectwasevaluatedaftertreatment．Theeffectonrestpain，tenderness，swellingandjointfunctionwasobserved，andthesafetywasmonitored．Results:Inthetwogroups，thetotaltherapeuticeffectwassimilar(P＞0．05)．Andtherestpainindex，jointtendernessindex，jointswellingindex，numberofjointswithtendernessorswelling，andjointfunctionscorewereimprovedascomparedwiththosebeforetreatment(P＜0．01)．Theimprovementofrestpainandjointtendernessinthetreatmentgroupwassuperiortothatinthecontrolgroup(P＜0．05)．Thedifferencesofimprovementofjointswellingandjointfunctionwasinsignificantbetweenthetwogroups(P＞0．05)．Conclusion:ZTiseffectiveandsafeonrelievingrestpainandjointtendernessandswelling，andonimprovingjointfunctionforundifferentiatedspinalos-teoarthritispatients．

(Originalarticleonpage48)TherapeuticEffectofAcupunctureCombinedwithMoxa－boxMoxibustionforHuntFacialParalysis

ZHANGMin(张敏)，QIULing(邱玲)，ZHANGJi(张吉)

Abstract:Objective:Toobservethetherapeuticeffectofacupuncturecombinedwithmoxa－boxmoxibustionforHuntfacialparalysis．Methods:Forty－eightqualifiedpatientswereequallyrandomizedintothetreatmentgroupandthecontrolgroup．Thetwogroupsreceivedacupuncture．Additionally，thetreatmentgroupwasgivenmoxa－boxmoxibustionontheauralregionoftheaffectedside．Therapeuticeffectwasevaluatedandthetimeforrelievingpainwascountedaftertreatment．Results:Thedifferencesofcurerateforperipheralfacialparalysisandherpeszosterweresignificantbetweenthetwogroups(P＜0．05)，indicatingthatthetreatmentgrouphadbettertherapeuticeffect．Theonsettimeforpainreliefwasshorterinthetreatmentgroupthanthatinthecontrolgroup(P＜0．01)，sodidtheaveragetimeforthepainrelief(P＜0．05)，indicatingthatthetreatmentgrouphadbetteranalgesiceffect．Conclusion:Acupuncturecombinedwithmoxa－boxmoxibustionexertscertaineffectforthetreatmentofHuntfacialparalysis．

(Originalarticleonpage102)EffectofElectroacupunctureonHippocampalNeurogenesisinEpilepsyRatsLIUJianhua(刘健华)，FUWenbin(符文彬)，XUZhenhua(徐振华)，etal．

Abstract:Objective:Toobservethepossibleeffectofhippocampalneurogenesisonelectroacupuncture(EA)intreatingepilepsyrats．Methods:Epilepsyratsmodelswereinducedwithlithiumchloride－pilocarpine．Thefrequencyofspontaneousrecurrentseizures(SRS)wasobservedafterEAfor1，3and4week(s)．Immunohistochemicalas-saywasusedtodetectthenumberofneoformativeneuronswith5－bromo－2－deoxyuri-dine(Brdu)positiveinhippocampaldentategyrus．Results:EarliestSRSoccurredinthesurvivalratsatepilepticstate3daysaftertheonsetofepilepsy．Fromthesecondweek，SRSwasfoundinthemodelgroupandEAgroup．AfterEAfor3and4weeks，thefrequencyofSRSwasreducedinEAgroup(P＜0．05comparedwiththemodelgroup)．ThenumberofBrdu－positiveneuronswasincreasedinthemodelgrouponeweekand3weeksaftertheonsetofepilepsy(P＜0．01comparedwiththeblankgroup)，anddecreasedtothelevelofblankgroupfromthefourthweek．OnthefirstweekofEA，thenumberofBrdu－positiveneuronswasdecreased，butthedifferencewasinsignificantascomparedwiththemodelgroup(P＞0．05)，andthenthedecreasewasobviousonthethirdweek(P＜0．05)．ThenumberofBrdu－positiveneuronsinEAgrouparrivedtothelevelinthemodelgroupandblankgrouponthefourthweekofEA．Conclusion:EAcaninhibitthehippocampalneurogenesisinthehippocampaldentategyrusofepilepsyrats，indicatingthathippocampalneurogenesisplaysanimportantroleinthetherapeuticeffectofEA．

(Originalarticleonpage117)TherapeuticMechanismofBushenTongluoPrescriptioninRegulatingSubchondralBoneRemodelingandinProtectingArticularCartilage

LIZhao(李钊)，LIANGZujian(梁祖建)，ZHANGBaidang(张百挡)，etal．

Abstract:Objective:ToexplorethetherapeuticmechanismofBushenTongluoPre-scription(TBP)inregulatingsubchondralboneremodelingandinprotectingarticularcar-tilage．Methods:ThirtySPFSDratswererandomizedinto3groups:sham－operationgroup，modelgroupandTBPgroup．TheratmodelsofosteoarthritiswereinducedbymodifiedHulthmethod．Fourweeksaftertheoperation，TBPwasgiventotheratsinTBPgroupbygastricgavage，andtheratsinothertwogroupsweregiventhesamevolumeofnormalsaline．ContentsofproteoglycanandcollagentypeⅡinthearticularcartilageweredetectedwithimmunohistochemicalassay，andthemorphometryofthesubchondralbonewasanalyzedbyapplyingcriteriaestablishedbytheOsteoarthritisResearchSocietyInter-national(OARSI)8，12and16weeksaftertheoperation．Results:OARSIscoreinthesham－operationgroupandTBPgroupdifferedfromthatinthemodelgroup(P＜0．05)8，12and16weeksaftertheoperation．ThelossofproteoglycanandcollagentypeⅡ，subchondralboneformationandsclerotinhardeningwereobviousinthemodelgroupcom-paredwiththoseinthesham－operationgroup．Inthemodelgroup，thebonetrabeculaareapercent，trabeculathichness，trabeculanumber，trabeculaseparation，andosteoclastnumberinpermillimeterdifferedfromthoseinthesham－operationgroupandTBPgroup(P＜0．01)．Thefluorescenceperimeterpercent，mineralizationsedimentationrateandboneformationwerelowerinthemodelgroupthanthoseinthesham－operationgroupandTBPgroup(P＜0．01)．Conclusion:Subchondralboneplaysanimportantroleinthedevelopmentofosteoarthritis，andTBPcanpreventchondroclasis，andcandelayandrelievechondropathyinosteoarthritispatientsbyregulatingthebiomechanicspropertyofsubchondralbone．

(Originalarticleonpage120)