《广州医药》
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《广州医药》编辑部

广州医药杂志服务号
医学教育

医工融合教育的创新路径与实践:以广州医科大学跨学科协同培养复合型人才为例

Innovative pathways and practices of medical-engineering integrated education:A case study on interdisciplinary collaboration cultivation of compound talents at Guangzhou Medical University

:651-656
 
       在“健康中国2030”战略框架下,医工融合已成为推动医疗技术创新与复合型医学人才培养的关键路径。“三维协同”教育体系:课程维度打造“基础模块—交叉课程—项目实训”渐进式矩阵;实践维度建立校企共建实验室与临床转化基地的产教融合平台;师资维度创新“临床医师+工程师+科研导师”三师型导师协同机制。基于广州医科大学等高校的实证分析,该模式显著提升了学生跨学科创新能力与工程实践转化能力。研究进一步提出“政产学研用”五螺旋发展模型,倡导通过建立医工融合特区、构建智能医疗科研共享平台、完善学科交叉质量评价体系等策略,为“新医科”建设提供理论范式与实践路径。本研究为医学教育改革提供了系统化、可复制的解决方案,对推进健康中国战略实施具有重要理论与实践意义。

      Under the framework of the “Healthy China 2030” strategy,the integration of medicine and engineering has become a key path to promoting medical technological innovation and the cultivation of interdisciplinary medical talents.This study has constructed a “three-dimensional synergy” education system:in the curriculum dimension,a progressive matrix of “basic modules - cross-disciplinary courses - project training” is created;in the practical dimension,a platform for industry-education integration is established through the joint construction of university-enterprise laboratories and clinical transformation bases;in the faculty dimension,an innovative “Clinician + Engineer + Research mentor” tripartite mentorship collaboration mechanism is developed.Based on empirical analysis from universities such as Guangzhou Medical University,this model has significantly enhanced students’ cross-disciplinary innovation capabilities and engineering practice transformation abilities.The study further proposes a “government-industry-academia-research-application” five-spiral development model,advocating strategies such as establishing special zones for medicine-engineering integration,building intelligent medical research sharing platforms,and improving the quality evaluation system for interdisciplinary studies,to provide theoretical paradigms and practical paths for the construction of “new medicine”.This research offers a systematic and replicable solution for medical education reform and holds significant theoretical and practical significance for the implementation of the Healthy China strategy.

论著

远志皂苷元通过 Nrf2/HO-1 通路抑制脑出血体外细胞模型 BV2 小胶质细胞炎症的机制研究

Tenuigenin suppresses inflammation via the Nrf2/HO-1 pathway in BV2 microglia within an in vitro model of intracerebral hemorrhage

:729-737
 
       目的 探索Nrf2/HO-1通路是否参与远志皂苷元(远志)在脑出血体外细胞模型中对BV2小胶质细胞炎症反应的调控作用。方法 采用红细胞与BV2小鼠小胶质细胞共培养构建体外脑出血模型。分别给予远志单独处理、远志联合Nrf2抑制剂ML385处理,检测炎症因子水平。收集细胞上清制备条件培养基,用于培养SH-SY5Y人神经母细胞瘤细胞,并检测其铁死亡水平。结果 模型组BV2细胞炎症因子(IL-1β,IL-6,TNF-α)水平较对照组显著升高(P<0.001);高浓度远志(20 μM)可降低炎症因子水平,并上调Nrf2/HO-1通路蛋白表达,而ML385能逆转该作用。模型组条件培养基可诱导SH-SY5Y细胞铁死亡,而经远志处理的BV2细胞条件培养基则减轻该现象;ML385预处理可削弱远志对SH-SY5Y细胞的保护作用,远志组铁离子、丙二醛、转铁蛋白受体1水平低于远志联合ML385组(P<0.05),铁转运蛋白、谷胱甘肽和谷胱甘肽过氧化物酶水平高于远志联合ML385组(P<0.05)。结论 远志皂苷元通过激活Nrf2/HO-1通路抑制BV2小胶质细胞炎症反应,并在脑出血体外模型中发挥神经保护作用。

     Objective To investigate whether the Nrf2/HO1 signaling pathway is involved in the regulatory effect of tenuigenin(TEN)on the inflammatory response of BV2 microglial cells in an in vitro intracerebral hemorrhage(ICH)model.Methods An in vitro ICH model was established by coculturing BV2 murine microglial cells with red blood cells.Cells were treated with TEN alone or in combination with the Nrf2 inhibitor ML385,and the levels of inflammatory factors were measured.The conditioned medium collected from the cell supernatant was used to culture SHSY5Y human neuroblastoma cells,and ferroptosis levels were assessed.Results The levels of inflammatory factors(IL-1β,IL-6,TNF-α)in BV2 cells of the model group were significantly higher than those in the control group(P<0.001).High concentration of TEN(20 μM)could reduce the levels of inflammatory factors and up-regulate the expression of Nrf2/HO-1 pathway proteins,while ML385 could reverse this effect.The conditioned medium of the model group could induce ferroptosis in SH-SY5Y cells,while the conditioned medium of BV2 cells treated with TEN could alleviate this phenomenon.Pretreatment with ML385 could weaken the protective effect of TEN on SH-SY5Y cells.The levels of iron ions,malondialdehyde and transferrin receptor protein 1 in the TEN group were lower than those in the TEN combined with ML385 group(P<0.05),while the levels of ferroportin glutathione and glutathione peroxidase 4 were higher than those in the TEN combined with ML385 group(P<0.05).Conclusions TEN inhibits the inflammatory response of BV2 microglial cells by activating the Nrf2/HO1 pathway and exerts a neuroprotective effect in the in vitro ICH model.
论著

早产儿母亲育儿胜任感的多路径作用机制:基于结构方程模型的验证

Multi-pathway mechanism of parenting competence in premature infant mothers:Validation based on structural equation modeling

:380-388
 
       目的   基于结构方程模型(SEM)验证早产儿母亲育儿胜任感的多路径作用机制。方法  采用便利抽样法选取2024年6月—2025年6月在莆田学院附属医院分娩的早产儿母亲250例作为研究对象。采用一般资料调查表、中文版育儿胜任感量表(C-PSOC)、婴儿母亲育儿支持问卷(PSM)、角色适应问卷、简式亲职压力量表收集数据。通过单因素分析及多元线性回归分析母亲育儿胜任感的影响因素,使用AMOS软件构建结构方程模型,分析早产儿分娩后母亲育儿胜任感的作用路径。结果  250例早产儿母亲的C-PSOC得分为(61.93±6.02)分,多元线性回归分析结果显示,早产儿母亲育儿胜任感的影响因素包括产次、育儿支持、角色适应、亲职压力(均P<0.05)。结构方程模型拟合良好(χ 2 /df=1.026,GFI=0.987,AGFI=0.978,NFI=0.987,CFI=1.000,RMSEA=0.010),其中角色适应正向预测育儿胜任感(β=0.344),育儿支持(β=-0.477)与亲职压力(β=-0.283)负向预测(均P<0.05),并且角色适应通过育儿支持、亲职压力间接提升育儿胜任感(效应值0.467);产次经角色适应间接降低压力源影响(效应值0.529)。结论  早产儿母亲育儿胜任感受多路径机制调控,临床需针对角色适应、育儿支持及亲职压力设计级联干预策略。
       Objective  To verify the multi-pathway mechanism of parenting competence of premature infant mothers based on structural equation modeling(SEM).Methods  A convenience sampling method was used to select 250 mothers of preterm infants who delivered in Affiliated Hospital of Putian University between June 2024 and June 2025 as the study subjects.Data was collected using a general information survey,the Chinese version of the Parenting Sence of Competence Scale(C-PSOC),the Parenting Support Questionnaire for Infant Mothers(PSM),the Role Adaptation Questionnaire,and the Simplified Parenting Stress Scale.By conducting  single factor analysis and multiple linear  regression analysis on the influencing factors of maternal parenting competence,a structural equation model was constructed using AMOS software to analyze the pathway of maternal parenting competence after premature birth.Results  The C-PSOC score of 250 mothers of premature infants was(61.93±6.02).Multiple linear  regression analysis showed that the influencing factors of parenting competence among mothers of premature infants included parity,parenting support,role adaptation,and parental pressure(all P<0.05).The structural equation model fits well(2/df=1.026,GFI=0.987,AGFI=0.978,NFI=0.987,CFI=1.000,RMSEA=0.010),which  role adaptation  positively  predicted parenting competence(β=0.344),parenting support(β=-0.477)and parenting stress(β=-0.283)negatively predicted(all P<0.05),and role adaptation indirectly enhanced parenting competence through parenting support and parenting stress(effect value 0.467).The adaptation of roles during childbirth indirectly reduced the impact of stressors(effect value 0.529).Conclusions  The multi-pathway mechanism of parental competence perception regulation in premature infant mothers requires the design of cascading intervention strategies targeting role adaptation,parenting support,and parental stress in clinical practice.
论著

炎症性肠病与 IgA 肾病共病特征基因及信号通路激活模式的整合分析

Integrated analysis of shared signature genes and signaling pathway activation patterns between inflammatory bowel disease and IgA nephropathy

:46-55
 
      目的   免疫球蛋白A肾病(IgAN)与炎症性肠病(IBD)的相互作用机制尚未阐明。本研究旨在解析IBD与IgAN共病的关键特征基因及核心信号通路,以揭示肠-肾轴的分子调控网络。方法   于GEO数据库获取IBD(GSE75214)和IgAN(GSE93798)基因表达谱,筛选差异表达基因(DEGs)。通过蛋白互作网络(PPI)和拓扑算法(MCC、MNC、Degree、EPC等)识别核心特征基因,并结合公共数据库(CTD、DISEASES和GeneCards)和单细胞转录组测序(GSE171314)进行验证。通过Nephroseq数据库验证基因表达与临床表型的相关性。结果   共筛选出17个IBD-IgAN共病DEGs,PPI网络分析等确定以FOS、EGR1、CXCL2JUNB为核心特征基因。功能富集分析显示白细胞介素-17(IL-17)信号通路显著激活。单细胞测序验证FOS、EGR1、CXCL2JUNB基因在IgAN特异性高表达,并通过Nephroseq数据库验证其与尿蛋白和估算的肾小球滤过率下降(eGFR)显著相关。结论  本研究揭示IBD与IgAN共享IL-17通路异常激活及FOS、EGR1、CXCL2JUNB的基因网络,为开发基于肠-肾轴调控的靶向治疗策略提供理论依据。
       Objective  The complex interplay between immunoglobulin A nephropathy(IgAN)and inflammatory bowel disease(IBD)remains poorly understood.This  study  aimed to identify  key  cross-talk  genes  and  pivotal  signaling pathways shared between IBD and IgAN,thereby elucidating the molecular regulatory network underlying the gut-kidney axis.Methods  Transcriptomic datasets for IBD(GSE75214)and IgAN(GSE93798)were retrieved from the GEO database.Differentially expressed genes(DEGs)were screened,and shared DEGs were intersected.Protein-protein interaction(PPI)networks were constructed using STRING and Cytoscape,with topological algorithms applied to identify hub genes.Gene expression profiles were validated through(CTD,DISEASES and GeneCards)and single-cell RNA sequencing(GSE171314)and the Nephroseq database,focusing on clinical correlations with proteinuria and estimated glomerular filtration rate(eGFR).Results  Seventeen shared DEGs were identified between IBD and IgAN.PPI network analysis revealed FOS,EGR1,CXCL2 and JUNB as core hub genes.Functional enrichment analysis demonstrated significant activation of the interleukin-17(IL-17)signaling pathway.Single-cell sequencing confirmed the specific upregulation of these genes in renal tubular epithelial cells of IgAN patients,which was further validated to correlate with proteinuria and eGFR decline.Conclusions  IBD and  IgAN share aberrant activation of the IL-17 pathway and a co-regulatory gene network involving FOS,EGR1,CXCL2 and JUNB,providing a theoretical foundation for developing therapeutic strategies centered on the gut-kidney axis.
论著

急性缺血性脑卒中介入治疗优化护理路径的构建及应用

Development and application of an optimized nursing pathway for endovascular therapy in acute ischemic stroke

:1563-1568
 
       目的   探讨优化护理路径在急性缺血性脑卒中介入手术中的应用及效果。方法   采用随机对照研究,纳入2024年1月—2025年1月收治的112例急性缺血性脑卒中取栓患者,观察组(56例)实施优化介入护理路径,对照组(56例)采用常规护理。结果   观察组患者的满意度评分、医护满意度评分均优于对照组(P<0.05);观察组的术前等待时间、患者自进入介入室至股动脉穿刺时间、手术时间、住院费用、并发症发生率、差错事故发生率也优于对照组(P<0.05)。结论   通过标准化术前准备、术中多学科协作及术后康复衔接,优化护理路径可显著提升急性缺血性脑卒中治疗时效性(缩短急性脑卒中患者从进入医院到开始静脉溶栓给药的时间至黄金时间窗内),改善患者神经功能预后。
       Objective  To explore the application and efficacy of an optimized nursing pathway in endovascular therapy for acute ischemic stroke(AIS).Methods  A randomized controlled trial was conducted,enrolling 112 AIS patients undergoing mechanical thrombectomy from January 2024 to January 2025.Patients were randomly assigned to either the observation groupn=56),which received the optimized interventional nursing pathway,or the control group(n=56),which  received  routine nursing care.Results  Patient satisfaction score,medical staff satisfaction score,and postoperative favorable  recovery  rate in observation group were better than those of control group(P<0.05).Additionally,the observation group  showed  significant improvements in preoperative waiting time,time from entering the operation room to femoral artery puncture,surgical duration,hospitalization costs,complication incidence rate,and medical error incidence rate(P<0.05).Conclusions  By standardizing preoperative preparations,implementing intraoperative multidisciplinary collaboration,and enhancing postoperative  rehabilitation coordination,the optimized nursing pathway significantly improved the timeliness of thrombectomy treatment(shortening door-to-needle time to reach the golden time window)and enhanced neurological functional prognosis in AIS patients,demonstrating substantial clinical applicability.
综述

Wnt/β-catenin信号通路在心肌纤维化中的作用研究进展

Research progress on the role of Wnt / β-catenin signaling pathway in myocardial fibrosis

:85-90
 
Wnt/β-catenin信号通路是一种在胚胎发育,细胞增殖分化、迁移,干细胞更新等中起关键作用的蛋白质家族。Wnt/β-catenin信号通路的失调常常会导致各种严重的疾病,例如肿瘤、心脏疾病、肺部疾病、肝脏疾病、骨骼疾病、神经疾病等。大量研究表明,Wnt/β-catenin信号通路在心肌纤维化发病机制中起重要作用,本文结合最新研究成果,从心肌纤维化相关疾病的角度对Wnt/β-catenin通路进行综述,为预防心肌纤维化提供新的思路,进一步达到防治心血管疾病的目的。
The Wnt/β-catenin signaling pathway is a family of proteins that play a key role in embryonic development,cell proliferation and differentiation,migration,stem cell renewal,etc.Dysfunctions of Wnt/β-catenin signaling pathway often lead to various serious diseases,such as tumor,heart,lung,liver,bone and neurological diseases,etc.Numerous studies have shown that the Wnt/β-catenin signaling pathway plays an important role in the pathogenesis of cardiac fibrosis.This article,in combination with the latest research findings,presents a review of the Wnt/β-catenin pathway from the perspective of myocardial fibrosis-related diseases,in order to provide new ideas for preventing myocardial fibrosis and achieving the goal of combating cardiovascular disease.
论著

多学科整合护理路径联合手术室优质护理对下肢骨折的应用效果及对术后下肢静脉血栓影响

Application effect of multidisciplinary integrated nursing pathway combined with high-quality nursing in operating room for patients with lower limb fracture and its effect on postoperative lower limb venous thrombosis

:186-191
 
目的 探讨多学科整合护理路径联合手术室优质护理对下肢骨折的应用效果及对术后下肢静脉血栓发生率的影响。方法 选择2021年1月—2022年10月我院收治的70例下肢骨折患者,随机分为联合组与常规组,每组各35例。常规组患者实施常规护理,联合组患者实施多学科整合护理路径联合手术室优质护理,对比两组患者护理效果。结果 联合组患者首次下床活动时间、术后视觉模拟量表(VAS)评分低于常规组(P<0.05),二者住院时间以及引流管拔除时间比较差异无统计学意义(P>0.05);经过护理干预后,两组的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均延长,血浆纤维蛋白原(FIB)降低,联合组优于常规组(P<0.05),且联合组下肢静脉血栓发生率低于常规组(0% vs 17.14%,P<0.05);联合组患者护理满意度更高(P<0.05);术后1个月两组患者日常生活活动能力(ADL)评分、Fugl-Meyer评分均升高,联合组高于常规组(P<0.05)。结论 多学科整合护理路径联合手术室优质护理可改善下肢骨折患者围术期指标和血液高凝状态,降低患者下肢静脉血栓发生率,提升护理满意度及患者远期日常生活能力、肢体运动功能。
Objective To explore the application effect of multidisciplinary integrated nursing path combined with high-quality nursing in operating room on patients with lower limb fracture and the effect on postoperative lower limb venous thrombosis.Methods From January 2021 to October 2022,70 patients with lower limb fracture admitted to our hospital were randomly divided into combination group and conventional group,with 35 cases in each group.Patients in the conventional group received routine nursing,and patients in the combined group received multidisciplinary integrated nursing path combined with high-quality nursing in the operating room.The nursing effect of the two groups was compared.Results The first time of getting out of bed in the combined group was earlier and postoperative VAS score was lower than those in the conventional group(P<0.05),and the length of hospital stay and drainage tube removal time were not significantly different between the two groups(P>0.05).After nursing intervention,the prothrombin time(PT)and activated partial thromboplastin time(APTT)of the two groups were prolonged,and the plasma fibrinogen(FIB)decreased,and the change range of the combined group was greater(P<0.05).The incidence of venous thrombosis in the combined group was significantly lower than that in the conventional group(0.00% vs 17.14%,P<0.05).The nursing satisfaction of patients in combination group was higher(P<0.05).The activities of daily living score and Fugl-Meyer score of both groups increased one month after surgery,and the combined group was higher than the conventional group(P<0.05).Conclusions Multidisciplinary integrated nursing path combined with high-quality nursing in operating room can improve perioperative indicators and blood hypercoagulability of patients with lower limb fractures,reduce the incidence of lower limb venous thrombosis,improve nursing satisfaction,long-term daily living ability and limb motor function of patients.
综述

基于Hedgehog信号通路的中医药干预慢性萎缩性胃炎的研究进展

Research about Chinese medicine intervention in chronic atrophic gastritis based on the Hedgehog signaling pathway

:1255-1263
 
慢性萎缩性胃炎是常见的胃癌前病变,不仅治疗过程漫长,治疗难度大,而且患者依从性欠佳。不仅会对患者的生理、心理健康和生活质量造成严重不良的影响,还会给患者家属造成负担,成为临床上不可忽视的难题。但是本病发病机制目前尚未完全明确,临床治疗还未达成共识。文章综述了近10年基于Hedgehog信号通路的中医药干预慢性萎缩性胃炎的研究概况。中医药调控Hedgehog信号通路辨证论治是治疗慢性萎缩性胃炎的一种独具特色的疗法,近年来有关基于Hedgehog信号通路的中医药干预治疗慢性萎缩性胃炎的报道越来越多。文章主要通过遵循疾病本虚标实的病性,以脾胃虚弱为本,瘀血、气滞、湿热、痰浊等为标,探讨选方治疗对慢性萎缩性胃炎的影响,认为中医药联合Hedgehog信号通路实行现代化发展能够有效干预治疗慢性萎缩性胃炎,以期为进一步临床研究与应用提供参考。
Chronic atrophic gastritis,a common precancerous lesion of gastric cancer,requires a long-term treatment and is difficult to cure.Therefore,it usually leads to decreased patient compliance.It will not only have a serious adverse impact on the patient’s physical and mental health and quality of life,but also cause a burden to the patient’s family,which has become a difficult problem that can not be ignored clinically.However,the pathogenesis has not yet been totally clarified,not to mention a consensus on the clinical treatment.This paper reviews the research revolving around Chinese medicine intervention in chronic atrophic gastritis based on the Hedgehog signaling pathway in the last decade.It’s creative therapy of chronic atrophic gastritis that utilizing Traditional Chinese Medicine to regulate and control Hedgehog signaling pathway,which has been increasingly reported in recent years.This paper is based on “deficiency in origin” and “excess in superficiality” principle.Concretely,spleen-stomach vacuity is characterized by deficiency in origin,and excess in superficiality manifests blood stasis,qi stagnation,dampness-heat and phlegm turbidity as excess in superficiality.By this way,the paper explores the effect of prescription selection on chronic atrophic gastritis.It is believed that the modern therapy that combines traditional Chinese medicine with Hedgehog signaling pathway can tackle chronic atrophic gastritis,thus providing a reference for further clinical trials and practices.
论著

白藜芦醇抑制TLR4/NF-κB通路对毛细支气管炎小鼠的保护作用

Protective effect of resveratrol on bronchiolitis mice by inhibiting TLR4/NF-κB pathway

:18-23
 
目的 研究白藜芦醇通过抑制T样受体4/核因子-κB(TLR4/NF-κB)通路对呼吸道合胞病毒(RSV)毛细支气管炎小鼠的保护作用。方法 选取30只小鼠随机分为对照组、RSV组、给药组,建立RSV毛细支气管炎小鼠模型,检测小鼠肺组织中TLR4、NF-κB的变化;利用肺组织HE染色、ELISA法检测白藜芦醇给药前后气道炎症病变、IL-6、TNF-α因子水平,Western Blot法及实时定量PCR法检测TLR4、 NF-κB蛋白及基因表达等相关变化。结果 与对照组相比,RSV组小鼠组肺组织中TLR4、NF-κB水平升高,肺组织切片HE染色显示气道炎症细胞浸润加剧,ELISA检测炎性因子IL-6、TNF-α升高;而给药组处理后,肺组织TLR4、NF-κB的表达下调,病理改变减轻,炎性因子IL-6、TNF-α下降。结论 白藜芦醇可通过抑制TLR4/NF-κB通路抑制炎性因子的释放,从而减轻毛细支气管炎小鼠的气道炎症反应。
Objective To study the protective effect of resveratrol on lung tissue of respiratory syncytial virus(RSV) bronchiolitis mice by regulating TLR4/NF-κB pathway. Methods Thirty mice were randomly divided into control group, RSV group and resveratrol group. The mice models of RSV bronchiolitis were established, and the changes of TLR4 and NF-κB levels in lung tissues of mice were detected. HE staining and ELISA were used to detect airway inflammation, IL-6 and TNF-α levels before and after resveratrol administration. TLR4 and NF-κB protein and gene expressions were detected by Western Blot and real-time quantitative PCR. Results Compared with the control group, the levels of TLR4 and NF-κB in the lung tissues of mice with bronchiolitis were significantly increased. Airway inflammatory cell infiltration was aggravated in HE staining of lung tissue sections, and inflammatory factors IL-6 and TNF-α were significantly increased showing by ELISA. The expressions of TLR4 and NF-κB in resveratrol group were down-regulated after treatment. Conclusions Resveratrol can inhibit the release of inflammatory factors by inhibiting the TLR4/NF-κB pathway, play a protective role in mice with bronchiolitis.
论著

伴OP的KOA患者TKA术前整体针联合运动处方临床应用的前瞻性研究及其对Wnt/β-catenin通路的影响

Evidence-based evaluation of the clinical application of preoperative combined holistic acupuncture with exercise prescription in KOA patients with OP and its effect on the Wnt/β-catenin pathway

:19-25
 
目的 探索整体针联合运动处方应用于伴骨质疏松症(OP)的膝骨关节炎(KOA)患者全膝关节置换术(TKA)术前预康复的可行性、有效性及其对Wnt/β-catenin通路的影响。方法 2021年5月—2022年4月在广州市第一人民医院南沙医院骨科住院治疗的伴OP的KOA患者随机入组,分3组:A组予常规术前宣教和准备;B组在A组基础上,术前应用标准化运动处方3周;C组在A组基础上,术前联合应用整体针和运动处方3周。比较术前3周、术前1天、术后8周视觉模拟疼痛评分(VAS)、关节活动度(ROM)、膝关节功能评分(HSS)的组间差异,并比较术中关节液β连环蛋白(β-catenin)、基质金属蛋白酶-13(MMP-13)、重组人Dickkopf相关蛋白-1(DKK-1)含量的组间差异。结果 共纳入50例受试者,A组15例,B组18例,C组17例。术前1天组间方差分析显示:B、C组VAS均低于A组(P<0.05),C组VAS低于B组(P<0.05);B、C组ROM均高于A组(P<0.05),B、C组ROM比较差异无统计学意义(P>0.05);B、C组HSS均高于A组(P<0.05),C组HSS高于B组(P<0.05)。术后8周组间方差分析显示:B、C组VAS均低于A组(P<0.05),C组VAS低于B组(P<0.05);B、C组ROM均高于A组(P<0.05),B、C组ROM比较差异无统计学意义(P>0.05);B、C组HSS均高于A组(P<0.05),C组HSS高于B组(P<0.05)。术中关节液标志物含量组间方差分析显示:B、C组β-catenin、MMP-13含量均低于A组(P<0.05),C组β-catenin、MMP-13含量均低于B组(均P<0.05);B、C组DKK-1含量均高于A组(均P<0.05),C组DKK-1含量高于B组(P<0.05)。结论 整体针联合运动处方在OP患者TKA术前应用切实可行,可有效缓解疼痛、改善功能。整体针可增强运动处方的正向预康复作用,其作用机制可能与Wnt/β-catenin通路调节有关。
Objective To explore the feasibility,effectiveness and impact on the Wnt/β-catenin pathway of combined holistic acupuncture and exercise prescription for preoperative rehabilitation in knee osteoarthritis(KOA)patients with osteoporosis(OP)undergoing total knee arthroplasty(TKA).Methods KOA patients with OP were divided into three groups randomly:Group A received conventional preoperative education and preparation,Group B received standardized exercise prescription for three weeks additionally,Group C received combined holistic acupuncture and exercise prescription for three weeks additionally.Between-group differences in visual analogue scale(VAS)pain scores,range of motion(ROM)and knee joint function scores(HSS)were compared at 3 weeks preoperatively,1 day preoperatively and 8 weeks postoperatively.Differences in intraoperative joint fluid levels of β-catenin,MMP-13 and DKK-1 were also compared.Results A total of 50 participants were included,with 15 in Group A,18 in Group B and 17 in Group C.Baseline conditions were comparable among the three groups.One-day preoperative analysis showed that VAS scores were lower in both Groups B and C compared to Group A(P<0.05),and VAS score was lower in Group C compared to Group B(P<0.05).ROM was higher in Groups B and C compared to Group A(P<0.05),with no statistically significant between-group difference between Groups B and C.HSS scores were higher in Groups B and C compared to Group A(P<0.05),and HSS score was higher in Group C compared to Group B(P<0.05).Eight-week postoperative analysis revealed that VAS scores were lower in both Groups B and C compared to Group A(P<0.05),and VAS score was lower in Group C compared to Group B(P<0.05).ROM were higher in Groups B and C compared to Group A(P<0.05),with no statistically significant between-group difference between Group B and C.HSS scores were higher in Groups B and C compared to Group A(P<0.05),and HSS score was higher in Group C compared to Group B(P<0.05).Intraoperative joint fluid biomarker analysis showed that β-catenin and MMP-13 levels were lower in Groups B and C compared to Group A(P<0.05),and β-catenin and MMP-13 levels were lower in Group C compared to Group B(P<0.05).DKK-1 levels were higher in Groups B and C compared to Group A(P<0.05),and DKK-1 level was higher in Group C compared to Group B(P<0.05).Conclusions Combined holistic acupuncture and exercise prescription is feasible and effective for preoperative rehabilitation in TKA for KOA patients with OP.Holistic acupuncture enhances the positive pre-rehabilitation effect of exercise prescription,and its mechanism may be related to the regulation of the Wnt/β-catenin pathway.
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