【目的】 观察解毒补肾活血方对肝豆状核变性（HLD）相关骨关节损害症状的改善作用及其对骨代谢指标的影响，探讨其 疗效和作用机制。【方法】 选取2022年3月至2022年8月入住安徽中医药大学第一附属医院神经内科一病区的符合HLD相关 骨关节损害诊断的57例患者为研究对象，采用随机数字表法将患者随机分为观察组29例和对照组28例。对照组在常规驱铜 的基础上给予阿法骨化醇软胶囊+阿仑膦酸钠片方案治疗，观察组在对照组的基础上联合解毒补肾活血方治疗，疗程为 8 周。观察2组患者治疗前后Oswestry功能障碍指数（ODI）评分、疼痛数字评分量表（NRS）评分和骨密度值的变化情况以评估 总体疗效，同时对2组患者治疗前后的血清白细胞介素1β（IL-1β）、白细胞介素6（IL-6）、β型胶原C端肽（β-CTX）、1，25- 双羟维生素 D3[1，25-（OH）2D3]进行检测，以观察其对骨代谢指标的影响。【结果】（1）治疗后，2 组患者的 ODI 评分、疼痛 NRS评分均较治疗前明显降低（P＜0.05），且观察组的降低幅度均明显优于对照组，差异均有统计学意义（P＜0.05）。（2）治疗 后，2组患者的双股骨（股骨颈）和腰椎第 2 ~ 第 4椎体（L2-L4）的骨密度值均较治疗前升高（P＜0.05），且观察组的升高幅度 均明显优于对照组，差异均有统计学意义（P＜0.05）。（3）治疗后，2组患者的血清IL-1β、IL-6、β-CTX水平均较治疗前明显 降低（P＜0.05），血清1，25-（OH）2D3水平均较治疗前明显升高（P＜0.05），且观察组对血清IL-1β、IL-6、β-CTX水平的降低 幅度及对血清1，25-（OH）2D3水平的升高幅度均明显优于对照组，差异均有统计学意义（P＜0.05）。【结论】 解毒补肾活血方对 HLD相关骨关节损害症状具有一定的改善作用，能显著减轻患者的骨关节疼痛，改善患者的骨密度和关节功能，其作用机 制可能与一定程度改善相关骨代谢指标有关。

Objective To investigate the efficacy and mechanism of Jiedu Bushen Huoxue Prescription in intervening bone and joint damage associated with hepatolenticular degeneration（HLD） by investigating its effect on improving HLD-related bone and joint damage symptoms and on bone metabolism indicators. Methods From March 2022 to August 2022，a total of 57 patients diagnosed with HLD-related bone and joint damage admitted to the First Department of Neurology， the First Affiliated Hospital of Anhui University of Chinese Medicine were selected as the study subjects. The patients were randomly divided into an observation group（29 cases） and a control group（28 cases） using a random number table. The control group was given conventional decopper therapy combined with Alfacalcidol Soft Capsules and Alendronate Sodium Tablets，while the observation group was given additional treatment with Jiedu Bushen Huoxue Prescription based on the control group’s regimen. The treatment course lasted 8 weeks. Before and after treatment， changes in the Oswestry Disability Index（ODI） score， Numerical Rating Scale（NRS） pain score， and bone mineral density（BMD） values in the two groups were observed to evaluate overall efficacy. Additionally，serum levels of interleukin 1β（IL-1β），interleukin 6（IL-6）， C-terminal telopeptide of type I collagen （β-CTX），and 1，25-dihydroxyvitamin D3 [1，25-（OH）2D3] in the two groups were measured before and after treatment to observe the impact on bone metabolism indicators. Results （1）After treatment，the ODI scores and NRS pain scores in both groups were significantly decreased compared to those before treatment （P＜0.05），and the decrease in the observation group was more obvious than that in the control group（P＜0.05）.（2）After treatment，the BMD values of the bilateral femoral neck and lumbar vertebrae 2-4（L2-L4） in both groups were significantly increased compared to those before treatment （P＜0.05），and the increase in the observation group was more obvious than that in the control group （P＜0.05）.（3） After treatment， the serum levels of IL-1β，IL-6，and β-CTX in both groups were significantly decreased （P＜0.05），while the serum levels of 1，25-（OH）2D3 were significantly increased （P＜0.05） compared to those before treatment. The decrease in IL-1β，IL-6，and β-CTX levels and the increase in 1，25-（OH）2D3 levels in the observation group were superior to those in the control group（P＜0.05）. Conclusion Jiedu Bushen Huoxue Prescription has certain effect on improving the symptoms of the patients with HLD-related bone and joint damage，and it is effective on significantly alleviating bone and joint pain and improving BMD and joint function. Its mechanism may be related to the improvement of relevant bone metabolism indicators.

R277.7；R742.4

安徽省自然科学基金项目（编号：2208085MH271）