Ye Jiang-Nan, Su Cheng-Guo, Jiang Yu-Qing, Zhou Yan, Sun Wen-Xi, Zheng Xiao-Xia, Miao Jin-Tao, Li Xiang-Yue, Zhu Jun
School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Front Neurosci. 2023 Jan 11;16:1098311. doi: 10.3389/fnins.2022.1098311. eCollection 2022.
Most previous studies on acupuncture in the treatment of knee osteoarthritis (KOA) have focused on improving functional efficacy and safety, while related mechanisms have not been systematically reviewed. Acupuncture modulates cytokines to attenuate cartilage extracellular matrix degradation and apoptosis, key to the pathogenesis of KOA, but the mechanisms are complex.
The purpose of this study is to assess the efficacy of acupuncture quantitatively and summarily in animal studies of KOA.
Nine databases including PubMed, Embase, Web of Science (including Medline), Cochrane library, Scopus, CNKI, Wan Fang, and VIP were searched to retrieve animal studies on acupuncture interventions in KOA published since the inception of the journal. Relevant literature was screened, and information extracted. Meta-analysis was performed using Revman 5.4 and Stata 17.0 software.
The 35 included studies involved 247 animals, half of which were in acupuncture groups and half in model groups. The mean quality level was 6.7, indicating moderate quality. Meta-analysis showed that acupuncture had the following significant effects on cytokine levels in p38MAPK and mitochondrial pathways: (1) p38MAPK pathway: It significantly inhibits p38MAPK, interleukin-1beta (IL-1β), tumor necrosis factor alpha (TNF-α), phosphorylated (p)-p38MAPK, matrix metalloproteinase-13 (MMP-13), MMP-1, a disintegrin and metalloproteinase with thrombospondin motifs-5 (ADAMST-5) expression, and significantly increased the expression of collagen II and aggrecan. (2) mitochondrial pathway: It significantly inhibited the expression of Bcl-2-associated X protein (Bax), cysteine protease-3 (caspase-3), caspase-9, and Cytochrome-c (Cyt-c). And significantly increased the expression of B cell lymphocytoma-2 (Bcl-2). In addition, acupuncture significantly reduced chondrocyte apoptosis, Mankin's score (a measure of cartilage damage), and improved cartilage morphometric characteristics.
Acupuncture may inhibit cytokine expression in the p38MAPK pathway to attenuate cartilage extracellular matrix degradation, regulate cytokines in the mitochondrial pathway to inhibit chondrocyte apoptosis, and improve cartilage tissue-related phenotypes to delay cartilage degeneration. These findings provide possible explanations for the therapeutic mechanisms and clinical benefits of acupuncture for KOA.
https://inplasy.com, identifier INPLASY20 2290125.
以往大多数关于针灸治疗膝骨关节炎（KOA）的研究都集中在提高功能疗效和安全性上，而相关机制尚未得到系统综述。针灸通过调节细胞因子来减轻软骨细胞外基质降解和细胞凋亡，这是KOA发病机制的关键，但机制较为复杂。
本研究旨在定量和全面评估针灸在KOA动物研究中的疗效。
检索包括PubMed、Embase、Web of Science（包括Medline）、Cochrane图书馆、Scopus、中国知网、万方和维普在内的9个数据库，以检索自该期刊创刊以来发表的关于针灸干预KOA的动物研究。对相关文献进行筛选，并提取信息。使用Revman 5.4和Stata 17.0软件进行荟萃分析。
纳入的35项研究涉及247只动物，其中一半在针灸组，一半在模型组。平均质量水平为6.7，表明质量中等。荟萃分析表明，针灸对p38丝裂原活化蛋白激酶（p38MAPK）和线粒体途径中的细胞因子水平有以下显著影响：（1）p38MAPK途径：它显著抑制p38MAPK、白细胞介素-1β（IL-1β）、肿瘤坏死因子-α（TNF-α）、磷酸化（p）-p38MAPK、基质金属蛋白酶-13（MMP-13）、MMP-1、含血小板反应蛋白基序的解聚素和金属蛋白酶-5（ADAMST-5）的表达，并显著增加Ⅱ型胶原蛋白和聚集蛋白聚糖的表达。（2）线粒体途径：它显著抑制Bcl-2相关X蛋白（Bax）、半胱天冬酶-3（caspase-3）、caspase-9和细胞色素c（Cyt-c）的表达。并显著增加B细胞淋巴瘤-2（Bcl-2）的表达。此外，针灸显著减少软骨细胞凋亡、曼金评分（一种衡量软骨损伤的指标），并改善软骨形态学特征。
针灸可能通过抑制p38MAPK途径中的细胞因子表达来减轻软骨细胞外基质降解，调节线粒体途径中的细胞因子以抑制软骨细胞凋亡，并改善软骨组织相关表型以延缓软骨退变。这些发现为针灸治疗KOA的治疗机制和临床益处提供了可能的解释。
