中国中药杂志

活血通痹方通过调控凝血-骨代谢网络干预激素性股骨头坏死经脉痹阻证的临床与功效机制研究

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董芃萱 ¹^,² , 宓保宏 ¹^,² , 林娜 ³ , 张彦琼 ³^,^* , 陈卫衡 ¹^,²^,⁴^,^*

中国中药杂志 | 股骨头坏死动态血瘀新知及其系统干预前沿专题 2026,51(2): 323-331

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中国中药杂志 |股骨头坏死动态血瘀新知及其系统干预前沿专题 2026 , 51 (2) : 323 -331

活血通痹方通过调控凝血-骨代谢网络干预激素性股骨头坏死经脉痹阻证的临床与功效机制研究

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董芃萱¹^,², 宓保宏¹^,², 林娜³, 张彦琼³^,^*, 陈卫衡¹^,²^,⁴^,^*

作者信息

^1．北京中医药大学第三附属医院，北京 100029

^2．中医骨伤治疗与运动康复智能化教育部工程研究中心，北京 100029

^3．中国中医科学院中药研究所，北京 100700

^4．北京中医药大学骨伤科研究所，北京 100029

通讯作者:

陈卫衡，博士，主任医师，博士生导师，主要从事骨关节疾病的临床和基础研究，E-mail: drchenweiheng@163.com；

张彦琼，研究员，主要从事临床中药学研究，E-mail: yqzhang@icmm.ac.cn

Clinical and mechanistic study of Huoxue Tongbi Formula in intervening meridian blockage syndrome of steroid-induced osteonecrosis of femoral head by regulating coagulation-bone metabolism network

Peng-xuan DONG¹^,², Bao-hong MI¹^,², Na LIN³, Yan-qiong ZHANG³^,^*, Wei-heng CHEN¹^,²^,⁴^,^*

Affiliations

^1.the Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100029, China

^2.Engineering Research Center of Chinese Orthopaedic and Sports Rehabilitation Artificial Intelligence, Ministry of Education, Beijing 100029, China

^3.Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China

^4.Institute of Orthopedics and Traumatology, Beijing University of Chinese Medicine, Beijing 100029, China

出版时间: 2026-01-15 doi: 10.19540/j.cnki.cjcmm.20250930.501

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摘要

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探讨活血通痹方治疗激素性股骨头坏死（SONFH）经脉痹阻证患者的临床疗效及其作用机制。回顾性纳入40例SONFH经脉痹阻证患者，收集比较治疗前及治疗3个月后的人口学特征、临床疗效评分（疼痛VAS评分、髋关节屈曲功能评分）、Harris评分、髋关节内外旋功能、髋关节影像学评分［国际骨循环研究会（ARCO）分期、北京中医药大学X线评价（BUCMXE）、骨髓水肿、关节积液］、髋关节症状／证候评分、理化指标（血常规、凝血四项、血栓四项）。选取3例临床疗效显著患者治疗前后外周血样进行转录组测序，筛选差异表达基因（DEGs），并进行基因本体论（GO）功能富集、京都基因与基因组百科全书（KEGG）通路富集、蛋白-蛋白互作（PPI）网络分析。通过Spearman相关性分析鉴定与SONFH经脉痹阻证核心表型最相关的基因。结果显示，活血通痹方能显著改善患者临床疗效评分（疼痛VAS评分、髋关节屈曲功能评分）、Harris评分、髋关节内外旋功能（P<0.01），维持影像学评分稳定，改善多种血瘀相关临床症状（如髋关节痛、固定痛、下肢无力等）（P<0.05，P<0.001），显著降低凝血酶-抗凝血酶复合物（TAT）水平（P<0.01）。转录组学分析共筛选出368个DEGs（上调274个，下调94个）。GO功能富集显示，DEGs参与的生物过程主要有对肿瘤坏死因子产生的正调控、整合素介导的信号通路、中性粒细胞趋化性、调节肿瘤坏死因子的产生等；KEGG通路富集显示，DEGs主要参与造血细胞谱系、破骨细胞分化、补体和凝血级联反应、血小板激活等通路。PPI网络结合相关性分析鉴定出核心基因UBA52（r = 0.83，P<0.05）、RACK1（r = 0.88，P<0.05）、RPL19 （r = -0.87，P<0.05）与血瘀证评分显著相关；CD74与骨坏死病变评分（r = 0.95，P<0.05）和TAT（r = 0.88，P<0.05）显著相关。结果表明，活血通痹方通过调节造血、骨代谢（抑制破骨）、纠正高凝状态（抑制凝血活化）改善SONFH经脉痹阻证患者的临床症状与部分影像学指标，UBA52、RACK1、RPS3A等核心基因可能是连接血瘀证与凝血-骨代谢网络调控的关键分子。

关键词

活血通痹方 / 激素性股骨头坏死 / 经脉痹阻证 / 血瘀证 / 临床回顾性研究 / 转录组学

Abstract

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This study aims to investigate the clinical efficacy and underlying mechanism of Huoxue Tongbi Formula in treating patients with steroid-induced osteonecrosis of the femoral head (SONFH) with meridian blockage syndrome. A total of 40 patients with SONFH and meridian blockage syndrome were retrospectively enrolled. Demographic data, clinical efficacy scores (pain and hip joint function), Harris scores, hip joint range of motion, imaging indices (ARCO stage, BUCMXE, bone marrow edema, and joint effusion), symptom/syndrome scores, and coagulation-related physiochemical indices (complete blood count, four coagulation tests, and four thrombosis tests) were collected and compared before treatment and after three months of treatment. Peripheral blood samples from three patients with significant efficacy were subjected to transcriptome sequencing before and after treatment to screen differentially expressed genes (DEGs). GO and KEGG enrichment and PPI network analysis were performed. Genes most relevant to the core phenotype of SONFH with meridian blockage syndrome were identified using Spearman correlation analysis. The results showed that Huoxue Tongbi Formula significantly improved the clinical efficacy scores (including pain and hip joint flexion function), Harris scores, and range of internal and external rotation of the hip (P<0.01). It also maintained stable imaging indices, alleviated various blood stasis-related clinical symptoms (hip pain, fixed pain, lower limb weakness) (P<0.05, P<0.001), and significantly reduced thrombin-antithrombin complex (TAT) levels (P< 0.01). Transcriptome analysis identified 368 DEGs (274 upregulated and 94 downregulated). GO functional enrichment revealed that the biological processes involved by DEGs mainly include positive regulation of tumor necrosis factor production, integrin-mediated signaling pathways, neutrophil chemotaxis, and regulation of tumor necrosis factor production. KEGG enrichment analysis revealed that these DEGs were primarily involved in pathways such as hematopoietic cell lineage, osteoclast differentiation, complement and coagulation cascades, and platelet activation. PPI network analysis combined with correlation analysis identified core genes UBA52 (r=0.83, P<0.05), RACK1 (r=0.88, P<0.05), and RPL19 (r=-0.87, P<0.05) were significantly correlated with blood stasis syndrome scores. CD74 was significantly correlated with osteonecrotic lesions (r=0.95, P<0.05) and TAT (r=0.88, P<0.05). These findings indicate that Huoxue Tongbi Formula ameliorates clinical symptoms and certain imaging indices in SONFH patients with meridian blockage syndrome by regulating hematopoiesis and bone metabolism (inhibiting osteoclast activity) and correcting hypercoagulability (inhibiting coagulation activation). Core genes such as UBA52, RACK1, and RPS3A may be key molecules linking blood stasis syndrome to the regulation of the coagulation-bone metabolism network.

Key words

Huoxue Tongbi Formula / steroid-induced osteonecrosis of the femoral head / meridian blockage syndrome / blood stasis syndrome / clinical retrospective study / transcriptomics

引用本文

董芃萱, 宓保宏, 林娜, 张彦琼, 陈卫衡. 活血通痹方通过调控凝血-骨代谢网络干预激素性股骨头坏死经脉痹阻证的临床与功效机制研究. 中国中药杂志, 2026 , 51 (2) : 323 -331 . DOI: 10.19540/j.cnki.cjcmm.20250930.501

Peng-xuan DONG, Bao-hong MI, Na LIN, Yan-qiong ZHANG, Wei-heng CHEN. Clinical and mechanistic study of Huoxue Tongbi Formula in intervening meridian blockage syndrome of steroid-induced osteonecrosis of femoral head by regulating coagulation-bone metabolism network[J]. Chinese Journal of Traditional Chinese Medicine, 2026 , 51 (2) : 323 -331 . DOI: 10.19540/j.cnki.cjcmm.20250930.501

基金

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国家自然科学基金重点项目(82030122)
国家自然科学基金面上项目(82474548)

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2026年第51卷第2期

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文章信息

doi: 10.19540/j.cnki.cjcmm.20250930.501

接收时间：2025-08-13
首发时间：2026-06-25
出版时间：2026-01-15

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收稿日期：2025-08-13

基金

国家自然科学基金重点项目(82030122)

国家自然科学基金面上项目(82474548)

作者信息

^1．北京中医药大学第三附属医院，北京 100029

^2．中医骨伤治疗与运动康复智能化教育部工程研究中心，北京 100029

^3．中国中医科学院中药研究所，北京 100700

^4．北京中医药大学骨伤科研究所，北京 100029

通讯作者:

陈卫衡，博士，主任医师，博士生导师，主要从事骨关节疾病的临床和基础研究，E-mail: drchenweiheng@163.com；

张彦琼，研究员，主要从事临床中药学研究，E-mail: yqzhang@icmm.ac.cn

参考文献

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https://castjournals.cast.org.cn/joweb/zgzyzz/CN/10.19540/j.cnki.cjcmm.20250930.501

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2种不同金属材料的力学参数

科 Family	属数 Number of genus	种数 Number of species	占总种数比例 Percentage of total species (%)	属 Genus	种数 Number of species	占总种数比例 Percentage of total species (%)
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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