Objective :To study the effect of Huoxue Zhitong decontion ( 活 血 止 痛 汤 ) on the expression of the mitochondria-initiated apoptosis pathway and transmembrane protein Ⅰ and Ⅱ of the epidural scar tissue.Methods: A total of 60 New Zealand rabbits (weight: 2.5-3.0 kg) were randomly divided into four groups, sham operation group (A, n= 15 ), control group ( B, n= 15 ), sodium hyaluronate group (C, n= 15 ), Huoxue Zhitong decoction group ( D, n= 15 ).Except for group A, 1.0 cm× 1.0 cm dura mater uncovered area laminectomy was performed at L4 and L5,covered with 0.5 ml sodium hyaluronate in group C ,covered with same amount of saline in group B and D.First 2 weeks after operation,animals in group D were lavaged with 2.5 ml/kg Huoxue Zhitong decoction by once a day for 14 day.Five rabbits of each group selected randomly were killed in the 2,4,8 weeks after laminectomy.The specimens were prepared for determination of the expression of Fas and FasL at scar tissue by semiquantitative reverse transcription-polymerase chain reaction (RT-PCR).The degree of scar adhesion was evaluated according by Rydell method.Results:The adhesion area in group B was larger than that of group C and D in the 4th and 8th week.However,the number of fibroblasts and inflammatory cells in group D was the least among the three groups in the 8th week.At 2,4,8 weeks after operation, as compared with group B the expression of Fas, Fas L of group C and D were decreased (P＜0.05).Especially, at 2 weeks,as compared with group C the expression of this two cytokines of group D was significant decreased (P＜0.05) ,too.In group C and D the duramater adhesion was decreased (P＜0.05).The proliferation of fibroblasts and fibroblastic function were inhibited (P＜0.05).Conclusion: Huoxue Zhitong decoction is able to down-regulated the expression of Fas, FasL, which inhibited the proliferation of fibroblasts, the fibroblastic function and the synthesis of extracellular matrix in the epidural scar tissue.It is an effective way of reducing peridural scat formation and prevent the failed back surgery syndrome.%目的:探讨中药活血止痛汤对硬膜外瘢痕中Ⅰ型跨膜糖蛋白(Fas)与自身配体Ⅱ型跨膜糖蛋白(FasL)基因表达水平的影响.方法:雌性新西兰白兔60只(体重2.5～3.0 kg)按随机数目表分成假手术组(A)、空白对照组(B)、透明质酸钠组(C)和活血止痛汤组(D),每组15只.除A组外,其余各组手术切除L4.5椎板,造成1.0 cm×1.0 cm硬脊膜裸露区,C组于硬膜囊外均匀地涂上一层透明质酸钠约0.5 ml,B、D组以等量生理盐水处理,术后2周内D组予活血止痛汤(2.5 ml/kg,每天1次,连续14 d)灌胃.术后第2、4、8周末每组各处死5只,按Rydell法评定粘连程度,并通过逆转录酶链反应(reverse transcription polymerase chain reaction,RT-PCR)测定其硬膜外癜痕组织中Fas、FasL的表达水平.结果:大体观察显示.第4周时,C、D两组较B组粘连轻,第8周时,B、C、D3组粘连程度都有加重,B组几乎都无法与硬膜完整分离,D组粘连加重最轻.RT-PCR检测发现各组在各个时期均与A组存在显著性差异(P<0.01).术后第2周末时,C组和D组Fas和FasL的表达水平均明显低于B组(P<0.05);第4周时,各组Fas、FasL的表达水平均达到高峰,而C组和D组的表达有明显差异性(P<0.05);第8周末时,D组基因的表达不仅与B组存在显著性差异(P<0.05).而且与C组也存在显著性差异(P<0.05).结论:活血止痛汤通过下调Fas、FasL的表达,减少了成纤维细胞增殖和胶原等细胞外基质(extraeellular matrix,ECM)的沉积,达到了预防硬膜外瘢痕增生、粘连的效果.
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