Article(id=1322218801651896483, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322218723616862544, articleNumber=null, orderNo=null, doi=10.16016/j.2097-0927.202501064, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1737561600000, receivedDateStr=2025-01-23, revisedDate=1741449600000, revisedDateStr=2025-03-09, acceptedDate=null, acceptedDateStr=null, onlineDate=1793171127951, onlineDateStr=2026-10-28, pubDate=1749916800000, pubDateStr=2025-06-15, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793171127951, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793171127951, creator=13701087609, updateTime=1793171127951, updator=13701087609, issue=Issue{id=1322218723616862544, tenantId=1146029695717560320, journalId=1319373162502258839, year='2025', volume='47', issue='11', pageStart='1145', pageEnd='1242', issueExtLink='null', onlineDate='null', pubDate='1749916800000', pubDateStr='2025-06-15', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793171109346, creator='13701087609', updateTime=1793325423536, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322865964295766226, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322218723616862544, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322865964295766227, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322218723616862544, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1208, endPage=1216, ext={EN=ArticleExt(id=1322218801890971812, articleId=1322218801651896483, tenantId=1146029695717560320, journalId=1319373162502258839, language=EN, title=Therapeutic effect and underlying mechanism of low-intensity focused ultrasound on knee arthrofibrosis in rats, columnId=1320434418116837551, journalTitle=Journal of Army Medical University, columnName=Basic Medicine, runingTitle=null, highlight=null, articleAbstract=
Objective

To assess the therapeutic efficacy of low-intensity focused ultrasound (LIFU) on knee arthrofibrosis in rats and explore its underlying mechanisms.

Methods

Fifteen male SD rats (8 weeks old, weighing 250~300 g) were randomly divided into a blank control group, a model group, and an ultrasound treatment group, with 5 animals in each group. Rat model of knee joint stiffness was established in the model and ultrasound treatment group. The rats in the ultrasound group received LIFU intervention (frequency: 1 MHz, power: 1.5 W, 20 min per session, 5 times/week) for 4 weeks. The knee ranges of motion (ROM, flexion and extension) were measured in all 3 groups at 0, 14 and 28 d after intervention. Histological analysis was conducted for the morphological changes in the posterior capsular area of the knee. After the synovial fibroblasts were primary isolated from rat knee joints, the cells were divided into blank control, LIFU, TGF-β (10 ng/mL), and TGF-β+LIFU groups. Changes in fibrosis-related indicators and the TGF-β/Smad signaling pathway were assessed in each group.

Results

In the animal experiments, LIFU intervention for 14 d resulted in significantly improved flexion-extension ROM in knee joints when compared with the rats in the model group (P<0.05), and the improvement was more obvious at 28 d after intervention (P<0.05). After 28 d of LIFU intervention, the fibrosis of the posterior capsule of the knee joint was notably improved in the ultrasound group than the model group, and the expression levels of fibrosis-related indicators (α-SMA,TGF-β) were decreased (P<0.05). In the cellular experiments, the TGF-β group exhibited remarkable up-regulation of fibrosis-related molecules (α-SMA,COL1A1,COL3A1) at both protein and mRNA levels (P<0.05), and activation of the TGF-β/Smad signaling pathway when compared to the blank control group. While LIFU intervention inhibited the expression of TGF-β-induced upregulation of fibrotic indicators (α-SMA,COL1A1,COL3A1) and the activation of TGF-β/Smad signaling pathway (P<0.05).

Conclusion‍

LIFU can effectively improve knee arthrofibrosis in rats, which potentially through the inhibition of fibroblast activation and modulation of the TGF-β/Smad signaling pathway.

, authors=Qiuyu TANG, Lin MAO, Dingqun BAI, Weiwei YI, authorsList=Qiuyu TANG, Lin MAO, Dingqun BAI, Weiwei YI, authorCompany=null, correspAuthors=Weiwei YI, authorNote=null, correspAuthorsNote=null, copyrightStatement=© 2025 Journal of Army Medical University, copyrightOwner=Editorial Office of Journal of Army Medical University, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322218803195400367, articleId=1322218801651896483, tenantId=1146029695717560320, journalId=1319373162502258839, language=CN, title=低强度聚焦超声对大鼠膝关节僵硬的改善作用及机制研究, columnId=1322185528879993170, journalTitle=陆军军医大学学报, columnName=基础医学, runingTitle=null, highlight=null, articleAbstract=
目的

评估低强度聚焦超声(low-intensity focused ultrasound,LIFU)对大鼠膝关节僵硬中的疗效,并探究其发挥作用的潜在机制。

方法

选取购自重庆医科大学动物房的15只8周龄、体质量为250~300 g的SD雄性大鼠,按随机数字表法将其分为3组:空白对照组(n=5)、僵硬对照组(n=5)和僵硬超声组(n=5)。选取僵硬对照组和僵硬超声组大鼠建立膝关节僵硬模型,僵硬超声组行LIFU(频率1 MHz、功率1.5 W,20 min/次,5次/周)干预4周。分别于干预后第0、14、28天检测3组大鼠膝关节的屈伸活动度,并对其关节后囊进行组织学分析。分离培养大鼠膝关节原代滑膜成纤维细胞,根据是否进行TGF-β(10 ng/mL)诱导和LIFU干预,将其分为4组:空白对照组、LIFU组、TGF-β组及TGF-β+LIFU组,检测各组细胞纤维化相关指标及TGF-β/Smad通路表达的变化。

结果

在动物实验中,LIFU干预14 d时,僵硬超声组大鼠的膝关节屈伸活动度较僵硬对照组有所改善(P<0.05),LIFU干预28 d时,僵硬超声组大鼠的膝关节屈伸活动度较僵硬对照组改善明显(P<0.05);同时,僵硬超声组大鼠膝关节后囊纤维化水平较僵硬对照组改善明显,纤维化相关指标(α-SMA,TGF-β)的表达水平下降(P<0.05)。在细胞实验中,TGF-β组较空白对照组显著促进纤维化相关指标(α-SMA,COL1A1,COL3A1)蛋白和mRNA的表达(P<0.05),并激活了TGF-β/Smad信号通路;而LIFU干预后,TGF-β+LIFU组较TGF-β组显著抑制TGF-β诱导的纤维化相关指标(α-SMA,COL1A1,COL3A1)的表达(P<0.05)及TGF-β/Smad信号通路的激活。

结论

LIFU能够有效改善大鼠膝关节僵硬情况,其作用机制可能与抑制成纤维细胞活化及调控TGF-β/Smad信号通路有关。

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易威威,E-mail:
YI Weiwei,E-mail:
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A:大鼠膝关节造模及干预流程;B:大鼠膝关节ROM测量示意图;C:不同时间点2组大鼠膝关节平均ROM统计 a:P<0.05

, figureFileSmall=bFF34KAWREZ0jn7uxBeMvg==, figureFileBig=BxGC9zHPPGvgl1IuLmNPNw==, tableContent=null), ArticleFig(id=1322218807595225297, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322218801651896483, language=EN, label=null, caption=null, figureFileSmall=RvsPmGbYeABNtPXQqnf7ow==, figureFileBig=en5My1xZduYMMU7lzw8tJg==, tableContent=null), ArticleFig(id=1322218807666528466, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322218801651896483, language=CN, label=图2, caption=LIFU对膝关节僵硬大鼠关节后囊纤维化的影响

A:HE和Masson染色检测大鼠膝关节后囊纤维化情况;B、C:免疫组化染色检测大鼠膝关节后囊α-SMA和TGF-β的蛋白表达及阳性比例统计 a:P<0.05

, figureFileSmall=RvsPmGbYeABNtPXQqnf7ow==, figureFileBig=en5My1xZduYMMU7lzw8tJg==, tableContent=null), ArticleFig(id=1322218807754608851, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322218801651896483, language=EN, label=null, caption=null, figureFileSmall=+cWz/25PrdjDUnANx9I7SQ==, figureFileBig=D63CJ7gVi5nETTTHZMecYg==, tableContent=null), ArticleFig(id=1322218807880437972, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322218801651896483, language=CN, label=图3, caption=免疫荧光染色检测LIFU对原代滑膜成纤维细胞纤维化蛋白表达的影响

A:免疫荧光染色检测各组细胞中α-SMA蛋白表达;B:免疫荧光染色检测各组细胞中COL1A1蛋白表达

, figureFileSmall=+cWz/25PrdjDUnANx9I7SQ==, figureFileBig=D63CJ7gVi5nETTTHZMecYg==, tableContent=null), ArticleFig(id=1322218808127901909, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322218801651896483, language=EN, label=null, caption=null, figureFileSmall=silGRYO49dYYFagd4tQf+w==, figureFileBig=BzA/AKUIXYsShuqJ9s1p5A==, tableContent=null), ArticleFig(id=1322218808215982294, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322218801651896483, language=CN, label=图4, caption=LIFU对原代滑膜成纤维细胞纤维化相关蛋白及mRNA表达的影响

a:P<0.05

, figureFileSmall=silGRYO49dYYFagd4tQf+w==, figureFileBig=BzA/AKUIXYsShuqJ9s1p5A==, tableContent=null), ArticleFig(id=1322218808295674071, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322218801651896483, language=EN, label=null, caption=null, figureFileSmall=SuyRFd81cHtmPgLAM65gsg==, figureFileBig=uQTU8CptpuGv8Z8ub8nuYQ==, tableContent=null), ArticleFig(id=1322218808387948760, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322218801651896483, language=CN, label=图5, caption=LIFU对原代滑膜成纤维细胞TGF-β/Smad通路激活的影响

A:免疫荧光染色检测各组细胞中p-Smad2/3蛋白表达;B、C:Western blot检测各组细胞中p-Smad2/3、Smad2/3和Smad4蛋白相对表达量及灰度值统计 a:P<0.05

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低强度聚焦超声对大鼠膝关节僵硬的改善作用及机制研究
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唐秋雨 , 毛琳 , 白定群 , 易威威
陆军军医大学学报 | 基础医学 2025,47(11): 1208-1216
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陆军军医大学学报 |基础医学 2025 , 47 (11) : 1208 -1216
低强度聚焦超声对大鼠膝关节僵硬的改善作用及机制研究
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唐秋雨, 毛琳, 白定群, 易威威
作者信息
  • 1重庆医科大学附属第一医院康复医学科,重庆市卫生健康委物理医学与精准康复重点实验室,重庆
通讯作者:
易威威,E-mail:
YI Weiwei,E-mail:
Therapeutic effect and underlying mechanism of low-intensity focused ultrasound on knee arthrofibrosis in rats
Qiuyu TANG, Lin MAO, Dingqun BAI, Weiwei YI
Affiliations
  • 1Department of Rehabilitation Medicine,Key Laboratory of Physical Medicine and Precision Rehabilitation of Chongqing Health Commission,the First Affiliated Hospital of Chongqing Medical University,Chongqing,China
出版时间: 2025-06-15 doi: 10.16016/j.2097-0927.202501064
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目的

评估低强度聚焦超声(low-intensity focused ultrasound,LIFU)对大鼠膝关节僵硬中的疗效,并探究其发挥作用的潜在机制。

方法

选取购自重庆医科大学动物房的15只8周龄、体质量为250~300 g的SD雄性大鼠,按随机数字表法将其分为3组:空白对照组(n=5)、僵硬对照组(n=5)和僵硬超声组(n=5)。选取僵硬对照组和僵硬超声组大鼠建立膝关节僵硬模型,僵硬超声组行LIFU(频率1 MHz、功率1.5 W,20 min/次,5次/周)干预4周。分别于干预后第0、14、28天检测3组大鼠膝关节的屈伸活动度,并对其关节后囊进行组织学分析。分离培养大鼠膝关节原代滑膜成纤维细胞,根据是否进行TGF-β(10 ng/mL)诱导和LIFU干预,将其分为4组:空白对照组、LIFU组、TGF-β组及TGF-β+LIFU组,检测各组细胞纤维化相关指标及TGF-β/Smad通路表达的变化。

结果

在动物实验中,LIFU干预14 d时,僵硬超声组大鼠的膝关节屈伸活动度较僵硬对照组有所改善(P<0.05),LIFU干预28 d时,僵硬超声组大鼠的膝关节屈伸活动度较僵硬对照组改善明显(P<0.05);同时,僵硬超声组大鼠膝关节后囊纤维化水平较僵硬对照组改善明显,纤维化相关指标(α-SMA,TGF-β)的表达水平下降(P<0.05)。在细胞实验中,TGF-β组较空白对照组显著促进纤维化相关指标(α-SMA,COL1A1,COL3A1)蛋白和mRNA的表达(P<0.05),并激活了TGF-β/Smad信号通路;而LIFU干预后,TGF-β+LIFU组较TGF-β组显著抑制TGF-β诱导的纤维化相关指标(α-SMA,COL1A1,COL3A1)的表达(P<0.05)及TGF-β/Smad信号通路的激活。

结论

LIFU能够有效改善大鼠膝关节僵硬情况,其作用机制可能与抑制成纤维细胞活化及调控TGF-β/Smad信号通路有关。

关节僵硬  /  低强度聚焦超声  /  成纤维细胞  /  膝关节损伤
Objective

To assess the therapeutic efficacy of low-intensity focused ultrasound (LIFU) on knee arthrofibrosis in rats and explore its underlying mechanisms.

Methods

Fifteen male SD rats (8 weeks old, weighing 250~300 g) were randomly divided into a blank control group, a model group, and an ultrasound treatment group, with 5 animals in each group. Rat model of knee joint stiffness was established in the model and ultrasound treatment group. The rats in the ultrasound group received LIFU intervention (frequency: 1 MHz, power: 1.5 W, 20 min per session, 5 times/week) for 4 weeks. The knee ranges of motion (ROM, flexion and extension) were measured in all 3 groups at 0, 14 and 28 d after intervention. Histological analysis was conducted for the morphological changes in the posterior capsular area of the knee. After the synovial fibroblasts were primary isolated from rat knee joints, the cells were divided into blank control, LIFU, TGF-β (10 ng/mL), and TGF-β+LIFU groups. Changes in fibrosis-related indicators and the TGF-β/Smad signaling pathway were assessed in each group.

Results

In the animal experiments, LIFU intervention for 14 d resulted in significantly improved flexion-extension ROM in knee joints when compared with the rats in the model group (P<0.05), and the improvement was more obvious at 28 d after intervention (P<0.05). After 28 d of LIFU intervention, the fibrosis of the posterior capsule of the knee joint was notably improved in the ultrasound group than the model group, and the expression levels of fibrosis-related indicators (α-SMA,TGF-β) were decreased (P<0.05). In the cellular experiments, the TGF-β group exhibited remarkable up-regulation of fibrosis-related molecules (α-SMA,COL1A1,COL3A1) at both protein and mRNA levels (P<0.05), and activation of the TGF-β/Smad signaling pathway when compared to the blank control group. While LIFU intervention inhibited the expression of TGF-β-induced upregulation of fibrotic indicators (α-SMA,COL1A1,COL3A1) and the activation of TGF-β/Smad signaling pathway (P<0.05).

Conclusion‍

LIFU can effectively improve knee arthrofibrosis in rats, which potentially through the inhibition of fibroblast activation and modulation of the TGF-β/Smad signaling pathway.

arthrofibrosis  /  low-intensity focused ultrasound  /  fibroblast cells  /  knee joint injury
唐秋雨, 毛琳, 白定群, 易威威. 低强度聚焦超声对大鼠膝关节僵硬的改善作用及机制研究. 陆军军医大学学报, 2025 , 47 (11) : 1208 -1216 . DOI: 10.16016/j.2097-0927.202501064
Qiuyu TANG, Lin MAO, Dingqun BAI, Weiwei YI. Therapeutic effect and underlying mechanism of low-intensity focused ultrasound on knee arthrofibrosis in rats[J]. Journal of Army Medical University, 2025 , 47 (11) : 1208 -1216 . DOI: 10.16016/j.2097-0927.202501064
关节僵硬是一种以关节活动范围受限为主要表现的常见病症,通常由关节周围软组织伸展性降低或刚度增加引起,常伴有关节变形、功能丧失及疼痛,其发病率较高,如不能及时防治将会进一步导致关节强直或永久性残疾,严重影响患者的生活质量,对家庭和社会造成巨大的经济负担[1-3]。现有治疗方法主要包括持续被动活动、药物治疗和手术治疗等,效果有限或副作用较大[4-7],因此,寻找一种安全、有效的治疗策略具有重要意义。
低强度聚焦超声(low-intensity focused ultrasound,LIFU)是聚焦超声技术的一种,主要利用超声波的机械作用、温热作用及空化作用帮助消除关节肿胀、松解粘连和控制炎症反应,具有非损伤性、高穿透力与时空分辨等优势,常用于缓解神经病理性疼痛、调节神经镇痛物质的释放和减少局部炎症因子,是一种安全、无创的物理治疗手段[8-13]。本课题组前期临床试验表明,LIFU可有效改善创伤后膝关节功能障碍患者的关节活动受限[14],但其具体机制尚缺乏研究。因此,本研究通过构建LIFU干预大鼠膝关节僵硬模型,探究其对成纤维细胞活化的影响,旨在揭示LIFU治疗关节僵硬的功效及潜在机制,为临床治疗提供理论依据。
采用8周龄SD雄性大鼠(体质量250~300 g),共15只,建立大鼠膝关节僵硬模型。选择2周龄SD乳鼠,共20只,用以分离培养大鼠膝关节原代滑膜成纤维细胞。所有动物购自重庆医科大学动物房,将大鼠饲养于标准笼中,置于温控室内,12 h明/暗循环,自由进食饮水。动物实验方案已经重庆医科大学动物伦理委员会批准(IACUC-CQMU-2023-0338),实验过程中严格遵循动物伦理规范。
LIFU仪器购自重庆海扶医疗科技股份有限公司;HE染色液和Masson染色液均购自武汉赛维尔生物科技有限公司;Ⅰ型胶原酶购自德国BioFroxx公司;胎牛血清(FBS)购自武汉普诺赛生命科技有限公司;青-链霉素和MEM-α培养基购自美国Gibco公司;TGF-β购自美国PeproTech公司;抗α-SMA、COL3A1、COL1A1、p-Smad2/3、Smad2/3和Smad4的抗体均购自成都正能生物技术有限责任公司;RNA提取试剂盒、PCR引物、反转录和荧光定量PCR试剂盒均购自湖南艾科瑞生物工程有限公司。
将15只SD大鼠按随机数字表法分为3组(n=5):空白对照组、僵硬对照组和僵硬超声组,对僵硬对照组和僵硬超声组大鼠进行膝关节僵硬造模。结合文献[15],大鼠膝关节僵硬采用膝关节屈曲内固定模型。腹腔麻醉后,分离出大鼠股骨和胫骨,中段穿孔,使用灭菌尼龙线穿过并拉紧,使股骨和胫骨捆绑固定。固定4周后,拆除固定线,当造模大鼠膝关节的屈伸活动度较正常大鼠活动受限范围>50°时,即造模成功。造模成功后,僵硬超声组予以LIFU干预,超声波频率1 MHz,功率1.5 W,20 min/次,每周5次,干预4周。除麻醉期间外,所有大鼠在笼内自由活动。
分别于LIFU干预第0、14、28天,测量3组动物膝关节屈伸方向的被动关节活动度(range of motion,ROM)。将器械轴心紧贴膝关节活动轴心,固定臂与股骨长轴平行,移动臂与胫骨长轴平行。全部采用4 N·cm的力矩进行测量,拉伸膝关节使其达到生理限制,同时避免损伤关节周围的软组织,测量3次,取平均值。
大鼠麻醉后处死,分离其膝关节,固定、脱钙、石蜡包埋后,矢状位取5 μm连续切片。部分切片进行HE染色和Masson染色,其他切片进行免疫组织化学染色,经抗原修复、去除酶活性、封闭、一抗二抗孵育、显色后,对关节后囊中α-SMA和TGF-β进行染色评估。
获取大鼠的膝关节滑膜组织,采用Ⅰ型胶原酶消化法从滑膜组织中分离原代滑膜成纤维细胞,并于37 ℃、5%CO2条件下,使用含10%FBS和1%青-链霉素的MEM-α培养基进行培养,待细胞融合度达90%时进行传代。
TGF-β是重要的促纤维化细胞因子,因此用TGF-β(10 ng/mL)处理原代滑膜成纤维细胞以模拟关节僵硬环境。LIFU干预原代滑膜成纤维细胞的频率为1 MHz,功率为1.5 W,共干预20 min。在后续细胞实验中,根据是否进行TGF-β诱导和LIFU干预,将其分为4组:空白对照组、LIFU组、TGF-β组及TGF-β+LIFU组。
对干预处理后的细胞进行固定、通透、封闭、一抗二抗孵育、复染封片后,通过荧光显微镜观察,分析细胞中α-SMA、COL1A1及p-Smad2/3的荧光强度和核内外表达情况。
使用RNA提取试剂盒提取各组原代滑膜成纤维细胞总RNA,对其进行反转录和荧光定量PCR(SYBR Green法),分析α-SMA、COL1A1、COL3A1的相对表达量。以GAPDH作为内参基因,每个指标进行3次独立重复,采用2-∆∆Ct法计算基因相对表达量。
使用含有磷酸酶和蛋白酶抑制剂的RIPA缓冲液提取原代成纤维细胞总蛋白。取30 μg蛋白提取液,按照标准步骤进行Western blot检测。使用抗α-SMA、COL3A1、COL1A1、p-Smad2/3、Smad2/3和Smad4的抗体孵育。以GAPDH为内参蛋白,Image J软件分析蛋白条带的灰度值。
使用GraphPad Prism 10.1.2进行数据处理与图形绘制,符合正态分布的计量资料以x¯±s表示,多组间比较采用单因素方差分析,2组间比较采用非配对t检验评估组间差异。P<0.05为差异具有统计学意义。
为探究LIFU对大鼠膝关节纤维化的作用,建立大鼠膝关节僵硬模型(图1A)。分别于超声治疗第0、14和28天进行膝关节屈伸方向活动度测量(图1B)。造模成功后第0天,僵硬超声组和僵硬对照组大鼠膝关节ROM较空白对照组均存在受限情况,但僵硬超声组平均ROM与僵硬对照组比较,差异无统计学意义;LIFU干预第14天,僵硬超声组平均ROM较僵硬对照组有所改善(P<0.05);LIFU干预后第28天,结果显示僵硬超声组平均ROM较僵硬对照组改善明显(P<0.05,图1C)。
进一步对大鼠膝关节进行组织学检测,HE染色和Masson染色结果表明,与空白对照组比较,僵硬对照组大鼠关节后囊明显增厚、纤维排列紊乱、纤维化程度加重;经LIFU干预后,僵硬超声组大鼠的膝关节后囊厚度和纤维化程度较僵硬对照组减轻(图2A)。免疫组化染色结果也显示,僵硬对照组较空白对照组膝关节纤维化相关指标α-SMA和TGF-β阳性染色的平均光密度值均有所增加,而在LIFU干预后,僵硬超声组大鼠膝关节后囊α-SMA和TGF-β阳性染色的平均光密度值较僵硬对照组明显减少(P<0.05,图2B、C)。
为进一步探索LIFU对滑膜成纤维细胞的影响,体外培养大鼠原代滑膜成纤维细胞,使用TGF-β诱导原代滑膜成纤维细胞促纤维化转化,然后予以LIFU进行干预。免疫荧光结果表明,当予以TGF-β刺激原代滑膜成纤维细胞后,TGF-β组细胞内α-SMA及COL1A1蛋白的荧光强度较空白对照组明显增加,而LIFU干预后,TGF-β+ LIFU组中细胞内α-SMA及COL1A1蛋白的荧光强度较TGF-β组显著降低(图3)。结果证实LIFU能有效抑制TGF-β诱导的原代滑膜成纤维细胞活化。
Western blot结果显示,当加入TGF-β处理时,TGF-β组原代滑膜成纤维细胞内纤维化标志物α-SMA、COL1A1和COL3A1蛋白表达较空白对照组明显增加,而当予以LIFU干预后,TGF-β+LIFU组细胞内纤维化标志物蛋白表达较TGF-β组明显降低(P<0.05,图4A、B)。RT-qPCR结果也表明,在加入TGF-β处理后,TGF-β组原代滑膜成纤维细胞纤维化标志物mRNA表达量较空白对照组明显增加,而进行LIFU干预后,TGF-β+LIFU组细胞mRNA的表达量较TGF-β组显著下降(P<0.05,图4C)。对未加入TGF-β的细胞进行LIFU干预时,LIFU组细胞内α-SMA、COL1A1和COL3A1的蛋白和mRNA表达水平与空白对照组相比均差异无统计学意义。结果表明,LIFU能在转录和翻译水平上抑制TGF-β诱导的原代滑膜成纤维细胞促纤维化相关因子的表达。
免疫荧光结果表明,与空白对照组比较,TGF-β组细胞核内p-Smad2/3的荧光强度显著增强,而当采用LIFU干预后TGF-β+LIFU组细胞核内p-Smad2/3水平较TGF-β组显著降低(图5A)。Western blot结果进一步证实,TGF-β组Smad2/3磷酸化比例和Smad4蛋白相对表达量显著高于空白对照组(P<0.05),而TGF-β+LIFU组较TGF-β组Smad2/3磷酸化比例和Smad4蛋白的表达显著降低(P<0.05,图5B、C)。LIFU组与空白对照组比较,TGF-β/Smad信号通路相关蛋白表达差异无统计学意义。结果表明,LIFU抑制TGF-β诱导的原代滑膜成纤维细胞纤维化可能是通过TGF-β/Smad通路实现。
关节僵硬常见于因肌肉骨骼疾病需要制动治疗的患者,或因脑卒中、帕金森病等神经系统疾病导致活动能力受限的患者。该病症临床发病率较高,不仅严重影响了患者的生活,也极大地增加了社会负担[16-17]。LIFU是一种安全、无创的物理治疗手段,研究表明,LIFU能够有效减轻心脏的纤维化程度,改善心功能[8-11,18-19],但目前其对关节僵硬的疗效尚不明确。关节僵硬主要临床表现为关节活动范围受限,恢复关节活动度是治疗该病症的重要目标。本研究通过构建大鼠膝关节僵硬模型,检测LIFU干预第0、14、28天各组大鼠的屈伸关节活动度。结果显示,LIFU干预后能明显改善关节僵硬大鼠膝关节的屈伸方向活动度,证明了LIFU能有效改善大鼠的膝关节僵硬情况。
成纤维细胞作为关节纤维化的核心效应细胞,在多种病理刺激下,能够转变为增殖活跃的肌成纤维细胞。TGF-β作为促纤维化细胞因子可直接诱导成纤维细胞向肌成纤维细胞活化[20]。活化后的肌成纤维细胞不仅大量分泌Ⅰ型和Ⅲ型胶原蛋白,还促进胶原纤维的过度沉积,引起细胞外基质逐渐积累,导致组织硬化与收缩,最终引发关节组织的纤维化[21]。研究表明,通过抑制α-SMA、TGF-β和胶原蛋白的表达能够有效抑制关节纤维化的发展进程[22-23]。本研究中,膝关节纤维化的大鼠经过LIFU干预后,关节后囊中α-SMA和TGF-β表达均明显降低,表明LIFU对纤维化相关基因的表达有一定的影响。在细胞水平上,也证实LIFU能够抑制TGF-β诱导的原代滑膜成纤维细胞的活化,在转录和翻译水平均能降低α-SMA、COL1A1和COL3A1基因的表达,从而抑制纤维化的发展。以上均证明了LIFU可能通过抑制成纤维细胞的活化发挥抗纤维化作用。
大量研究表明,抑制TGF-β信号通路已被证明能减缓纤维化的发展[24]。TGF-β依赖的Smad信号通路在纤维化进程中起到关键作用,其中Smad2、Smad3和Smad4是促进TGF-β介导的纤维化的主要下游调节因子[25-28]。本研究通过细胞体外实验证实了LIFU能降低成纤维细胞TGF-β/Smad信号通路蛋白中p-Smad2/3和Smad4分子的表达,表明LIFU可能通过调节TGF-β/Smad信号通路的表达抑制原代滑膜成纤维细胞活化,从而改善关节僵硬。而在无TGF-β刺激条件下,LIFU对成纤维细胞的活化及TGF-β/Smad信号通路无明显抑制作用,这也说明LIFU仅能改善病理刺激下产生的关节纤维化的进程。
综上所述,LIFU可能通过抑制TGF-β/Smad信号通路,有效减轻TGF-β诱导的滑膜成纤维细胞活化,从而改善膝关节僵硬症状,为关节纤维化的防治提供了潜在的治疗策略。然而,本研究也存在一定局限性:①动物实验样本量较少,可能影响结果的代表性;②本研究未能深入探讨TGF-β/Smad信号通路的具体分子机制。因此,未来需要扩大样本量并结合临床研究进一步验证和完善相关分子作用机制。

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2025年第47卷第11期
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doi: 10.16016/j.2097-0927.202501064
  • 接收时间:2025-01-23
  • 首发时间:2026-10-28
  • 出版时间:2025-06-15
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  • 收稿日期:2025-01-23
  • 修回日期:2025-03-09
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    1重庆医科大学附属第一医院康复医学科,重庆市卫生健康委物理医学与精准康复重点实验室,重庆

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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