Objective To evaluate the effects and the molecular mechanism of Liuwei dihuang pills in preventing steroid-induced osteonecrosis of the femoral head (ONFH) so as to provide an expremental basis for preventing ONFH cl inically. Methods Thirty-six adult Kunming mice (weighing 40-50 g, 46 g on average) were randomly divided into three groups (n=12): group A (control group), group B (model group) and group C (prevention group). In groups B and C, ONFHmice models were produced by intraperitoneal injection of horse serum at first (10 mL/kg) and a second injection of horse serum intraperitoneally (5 mL/kg) and prednisolone intramuscularly [45 mL/(kg•day), for 5 days] 2 weeks later. At the same time, the mice in group C were given Liuwei dihuang pills intragastrically [2 g/(kg•day)] and were given normal sal ine [10 mL/(kg•day)] in group B. In group A, mice were given normal sal ine intramuscularly and intragastrically as controls. The animals were sacrificed 2, 4, and 8 weeks after first treatment with prednisone, and femoral heads and l ivers were harvested to do histopathology analysis and apoptosis assay. Results Other mice survived throughout the experiment period except two death at 7 and 11 days after second injection of horse serum intraperitoneally in group B and one death at 24 hours after second injection of horse serum intraperitoneally in group C. The appearance and shape of the femoral head and the surface of cartilages were all normal. The histological observation showed: normal structures of l iver and femoral head were seen in group A at each time point; swell ing l iver cells with small fat vacuole, unclear structure of hepatic cords and narrower sinus hepaticus were seen, the bone trabeculae of femoral head was thin, sparse and collapsed in some regions and the changes became more obvious with time in group B; group C had similar results to group A. The percentage of empty osteocyte lacunae was significantly higher in group B than in groups A and C (P lt; 0.01). The osteoprotegrin expression significantly decreased and the osteoprotegrin l igand expressionsignificantly increased in group B when compared with groups A and C (P lt; 0.01). Apoptosis analysis showed that the apoptosis index in group B was significantly higher than that in groups A and C (P lt; 0.01). Conclusion Liuwei dihuang pills can prevent steroid-induced ONFH by improving l ipid metabol ism, releiving bone lesion, and protecting against cell death.
【摘要】 目的 探讨六味地黄丸对糖尿病合并高血压病所致慢性肾脏疾病（chronic kidney disease，CKD）患者肾损害及胰岛素抵抗的影响。 方法 收集2008年7月1日-2010年7月1日在成都市第五人民医院住院部及门诊就诊的120例糖尿病合并高血压病患者相关资料，随机分为对照组和治疗组各60例，对照组给予西医治疗，治疗组在西医治疗的基础上加用六味地黄丸，12周为1个疗程。观察治疗前后尿白蛋白∕尿肌酐（ACR），内生肌酐清除率（Ccr）及胰岛素抵抗指数（HOMA-IR）、C反应蛋白（CRP）、血脂等指标的变化。 结果 治疗后治疗组与对照组比较，ACR（P=0.012）、血清CRP（P=0.000）和低密度脂蛋白（P=0.014）差异有统计学意义。HOMA-IR治疗前后结果差异有统计学意义（Plt;0.05），但与对照组比较差异无统计学意义（Pgt;0.05）。 结论 六味地黄丸可改善肾损害实验室指标，改善胰岛素抵抗，减轻体内炎性反应，改善脂代谢异常。【Abstract】 Objective To investigate the efficacy of Liuwei Dihuang pill on patients with chronic kidney disease (CKD) induced by diabetes mellitus and hypertensive diseases in terms of renal injury and insulin resistance. Methods We collected the clinical data of 120 patients with diabetes mellitus and hypertensive diseases in the Fifth People’s Hospital of Chengdu from July 1, 2008 to July 1, 2010, and randomly divided them into two groups. In the control group, patients only received therapy of western medicine, while for patients in the treatment group, Liuwei Dihuang pills were added on the basis of western medicine treatment with a treatment course of 12 weeks. Before and after the treatment, urinary albumin / urinary creatinine (ACR), creatinine clearance rate (Ccr) and insulin resistance index (HOMA-IR), C-reactive protein (CRP), and lipids were evaluated and compared. Results After treatment, ACR (P=0.012), serum CRP (P=0.000) and low-density lipoproteins (LDL) (P=0.014) for the treatment group were significantly different from those for the control group. HOMA-IR for the treatment group before and after the treatment was significantly different (Plt;0.05), while there was no statistical difference between the two groups in HOMA-IR (Pgt;0.05). Conclusion Kidney-nourishing therapy with Liuwei Dihuang pill can improve the laboratory indicators of renal injury or insulin resistance, reduce the inflammatory response in vivo, and ameliorate disorders of lipid metabolism.