[1]吴丛姿,金红婷,童培建.从髓论治膝骨关节炎[J].中医正骨,2021,33(01):52-55.
点击复制

从髓论治膝骨关节炎()
分享到:

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年01期
页码:
52-55
栏目:
学术探讨
出版日期:
2021-01-20

文章信息/Info

作者:
吴丛姿1金红婷2童培建3
(1.浙江中医药大学第一临床医学院,浙江 杭州 310053; 2.浙江中医药大学骨伤研究所,浙江 杭州 310053; 3.浙江省中医院,浙江 杭州 310006)
关键词:
骨关节炎 间质干细胞
摘要:
膝骨关节炎(knee osteoarthritis,KOA)是一种慢性退行性病变,多见于中老年人群。中医学认为“肾主骨生髓”,该理论对KOA的治疗具有重要的指导意义; 但是临床上既往多侧重于从肾虚角度治疗该病,而忽视了作为连接肾与骨的髓这一关键环节的作用。本文介绍了髓的内涵与生物学基础,分析了肾、髓、骨之间的联系,从干细胞角度论述了KOA的发病机制,总结了从髓论治KOA的方法,以期为临床治疗KOA提供理论依据。

参考文献/References:

[1] HARRELL C R,MARKOVIC B S,FELLABAUM C,et al.Mesenchymal stem cell-based therapy of osteoarthritis:Current knowledge and future perspectives[J].Biomed Pharmacother,2019,109:2318-2326.
[2] 王斌,邢丹,董圣杰,等.中国膝骨关节炎流行病学和疾病负担的系统评价[J].中国循证医学杂志,2018,18(2):134-142.
[3] 张紫嫣,黄雅薇,张新雪,等.“肾髓系统”的理论渊源[J].世界科学技术-中医药现代化,2017,19(5):744-748.
[4] 张荣华,欧阳菁.肾主骨生髓理论与骨髓间充质干细胞骨向分化[J].中医杂志,2006,47(10):730-732.
[5] 王连,侯鹏,蒋涛,等.不同来源间充质干细胞在膝关节软骨修复中的临床研究进展[J].中国骨伤,2017,30(6):581-586.
[6] 胡雪琴,金红婷,肖鲁伟,等.“浙派中医”骨伤学家肖鲁伟辨治“髓系骨病”的学术经验[J].浙江中医药大学学报,2019,43(10):1071-1073.
[7] 卞琴,沈自尹,王拥军.骨髓间充质干细胞在中医理论中的归属[J].中国中医基础医学杂志,2011,17(7):794-797.
[8] 张进,徐志伟,陈群,等.干细胞与中医基础理论中的先天之精学说[J].中国临床康复,2006,10(7):189-192.
[9] 刘幸明,赵永杰,蔡俊笙,等.补肾中药对老化间充质干细胞内外微环境改变及其分化方向调控的影响[J].中成药,2019,41(9):2233-2236.
[10] 刘锌,杜斌,孙光权,等.右归饮诱导骨髓间充质干细胞修复兔激素型股骨头坏死的实验研究[J].世界中西医结合杂志,2019,14(6):809-814.
[11] XIA C,ZOU Z,FANG L,et al.Bushenhuoxue formula promotes osteogenic differentiation of growth plate chondrocytes through β-catenin-dependent manner during osteoporosis[J].Biomed Pharmacother,2020,127:110.
[12] 胡雪琴,金红婷,施振宇,等.髓病理论及其在骨病学中的应用[J].中医正骨,2018,30(11):39-42.
[13] 沈自尹.“肾的研究”通过“与时俱进”而不断进取[J].中国中西医结合杂志,2015,35(8):946-949.
[14] XU T T,JIN H T,TONG P J.Essence of “Shen(Kidney)controlling bones”:conceptual analysis based on hypothalamic-pituitary-adrenal-osteo-related cells axis[J].Chin J Integr Med,2018,24(11):806-808.
[15] WEIVODA M M,RUAN M,HACHFELD C M,et al.Wnt signaling inhibits osteoclast differentiation by activating canonical and noncanonical cAMP/PKA pathways[J].J Bone Miner Res,2016,31(1):65-75.
[16] ELANGO J,RAHMAN S U,HENROTIN Y,et al.Parathyroid hormone-related protein(PTHrP)accelerates soluble RANKL signals for downregulation of osteogenesis of bone mesenchymal stem cells[J].J Clin Med,2019,8(6):836.
[17] TIERNEY E G,MCSORLEY K,HASTINGS C L,et al.High levels of ephrinB2 over-expression increases the osteogenic differentiation of human mesenchymal stem cells and promotes enhanced cell mediated mineralisation in a poly-ethyleneimine-ephrinB2 gene-activated matrix[J].J Control Release,2013,165(3):173-182.
[18] CRANE J L,CAO X.Bone marrow mesenchymal stem cells and TGF-β signaling in bone remodeling[J].J Clin Inves,2014,124(2):466-472.
[19] 孙雪莲,刘渊.从中医“肾主骨”理论出发防治骨关节炎[J].西部中医药,2016,29(3):48-50.
[20] CAMERNIK K,MIHELIC A,MIHALIC R,et al.Comprehensive analysis of skeletal muscle- and bone-derived mesenchymal stem/stromal cells in patients with osteoarthritis and femoral neck fracture[J].Stem Cell Res Ther,2020,11(1):146.
[21] MCGONAGLE D,BABOOLAL T G,JONES E.Native joint-resident mesenchymal stem cells for cartilage repair in osteoarthritis[J].Nat Rev Rheumatol,2017,13(12):719-730.
[22] BARNETT R.Osteoarthritis[J].Lancet,2018,391(10134):1985.
[23] LI G,YIN J,GAO J,et al.Subchondral bone in osteoarthritis: insight into risk factors and microstructural changes[J].Arthritis Res Ther,2013,15(6):223.
[24] 李西海,叶蕻芝.从肾通于脑初探下丘脑-垂体-靶腺轴与骨关节炎的关系[J].中华中医药杂志,2019,34(6):2342-2345.
[25] ZHEN G,CAO X.Targeting TGFβ signaling in subchondral bone and articular cartilage homeostasis[J].Trends Pharmacol Sci,2014,35(5):227-236.
[26] CHEN W,SUN Y,GU X,et al.Conditioned medium of mesenchymal stem cells delays osteoarthritis progression in a rat model by protecting subchondral bone, maintaining matrix homeostasis, and enhancing autophagy[J].J Tissue Eng Regen Med,2019,13(9):1618-1628.
[27] SADEGHI F,VAHEDNIA E,NADERI MESHKIN H,et al.The effect of adrenocorticotropic hormone on alpha-2-macroglobulin in osteoblasts derived from human mesenchymal stem cells[J].J Cell Mol Med,2020,24(8):4784-4790.
[28] SUN L,TAMMA R,YUEN T,et al.Functions of vasopressin and oxytocin in bone mass regulation[J].Proc Natl Acad Sci U S A,2016,113(1):164-169.
[29] ZAIDI M,NEW M I,BLAIR H C,et al.Actions of pituitary hormones beyond traditional targets[J].J Endocrinol,2018,237(3):R83-R98.
[30] 袁家骏,罗程,黄毅,等.口服自拟补肾活血汤治疗早期膝骨关节炎的临床研究[J].中医正骨,2017,29(8):26-32.
[31] 刘源香.髓的中医文献研究[D].济南:山东中医药大学,2013.
[32] 孙荣新.右归饮加减内服联合玻璃酸钠关节腔内注射治疗膝骨关节炎(脾肾阳虚型)的临床疗效观察[D].合肥:安徽中医药大学,2018.
[33] 田惠萍,刘莹,王海洋,等.膝骨关节炎的中医药治疗临床研究进展[J].风湿病与关节炎,2018,7(1):67-71.
[34] MCALINDON T E,BANNURU R R,SULLIVAN M C,et al.OARSI guidelines for the non-surgical management of knee osteoarthritis[J].Osteoarthritis Cartilage,2014,22(3):363-388.
[35] OKUMACHI E,LEE S Y,NIIKURA T,et al.Comparative analysis of rat mesenchymal stem cells derived from slow and fast skeletal muscle in vitro[J].Int Orthop,2015,39(3):569-576.
[36] PERS Y M,QUENTIN J,FEIRREIRA R,et al.Injection of adipose-derived stromal cells in the knee of patients with severe osteoarthritis has a systemic effect and promotes an anti-inflammatory phenotype of circulating immune cells[J].Theranostics,2018,8(20):5519-5528.
[37] 张圣扬,吕帅洁,丁权威,等.自体脂肪干细胞关节腔内注射治疗膝关节骨关节炎的随机对照研究[J].中华骨科杂志,2018,38(23):1426-1434.
[38] CHAHAL J,GóMEZ-ARISTIZBAL A,SHESTOPALOFF K,et al.Bone marrow mesenchymal stromal cell treatment in patients with osteoarthritis results in overall improvement in pain and symptoms and reduces synovial inflammation[J].Stem Cells Transl Med,2019,8(8):746-757.
[39] WANG P E,DONG R,WANG B L,et al.Genome-wide microRNA screening reveals miR-582-5p as a mesenchymal stem cell-specific microRNA in subchondral bone of the human knee joint[J].J Cell Physiol,2019,234(12):21877-21888.
[40] NI Z,ZHOU S,LI S,et al.Exosomes:roles and therapeutic potential in osteoarthritis[J].Bone Res,2020,8:25.
[41] LIAN W S,WU R W,LEE M S,et al.Subchondral mesenchymal stem cells from osteoarthritic knees display high osteogenic differentiation capacity through microRNA-29a regulation of HDAC4[J].J Mol Med(Berl),2017,95(12):1327-1340.

相似文献/References:

[1]樊庆阳,任凯晶.定制3D打印切模辅助全膝关节置换术治疗 膝骨关节炎合并股骨干骨折畸形愈合[J].中医正骨,2015,27(11):37.
[2]刘晓雅,孙永强,刘国杰.主动快速康复锻炼对全膝关节置换术后关节活动度的影响[J].中医正骨,2015,27(09):73.
[3]郑春松,叶蕻芝,李西海,等.透骨消痛胶囊中补肾柔肝药和活血祛风药治疗 骨关节炎作用方式的计算机模拟比较[J].中医正骨,2015,27(07):6.
 ZHENG Chunsong,YE Hongzhi,LI Xihai,et al.Comparison of the mode of action of Bushen Rougan(补肾柔肝)drugs versus Huoxue Qufeng(活血祛风)drugs contained in Tougu Xiaotong Jiaonang(透骨消痛胶囊)for the treatment of osteoarthritis:A computer simulation study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):6.
[4]宋兵华,孙俊英,倪增良,等.全膝关节置换术前CT测量股骨后髁角的临床意义[J].中医正骨,2015,27(07):38.
[5]郑春松,叶蕻芝,李西海,等.独活寄生汤含药血清对白细胞介素1β诱导的 退变关节软骨细胞中基质金属蛋白酶 和环氧化酶2表达的影响[J].中医正骨,2015,27(12):1.
 ZHENG Chunsong,YE Hongzhi,LI Xihai,et al.Impact of Duhuo Jisheng Tang(独活寄生汤)medicated serum on expression of matrix metalloproteinase and cyclooxygenase 2 in degenerative articular chondrocytes induced by interleukin-1 beta[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):1.
[6]王金良,孙京涛,李玲,等.骨水泥联合螺钉修复全膝关节置换术中 胫骨平台内侧骨缺损[J].中医正骨,2015,27(12):55.
[7]冯荣,王平,李炳奇,等.铍针刺络拔罐结合中药口服治疗膝骨关节炎合并 原发性血小板增多症1例[J].中医正骨,2015,27(12):73.
[8]蔡云仙.围手术期耳穴按压联合平衡针疗法 在全膝关节置换术后镇痛中的应用[J].中医正骨,2015,27(06):41.
[9]张荣,王健.人工全膝关节置换术的围手术期心理护理[J].中医正骨,2015,27(05):77.
[10]喻长纯,杨明路,王战朝.不同手术方式治疗胫骨平台骨折畸形愈合的体会[J].中医正骨,2015,27(03):37.
[11]孟维娜,明立功,王新德,等.关节镜下清理联合腓骨近1/3段截骨治疗膝骨关节炎[J].中医正骨,2015,27(11):40.
[12]明立功,孟维娜,王新德,等.腓骨近端截骨治疗内侧间室膝骨关节炎的近期疗效观察[J].中医正骨,2015,27(10):25.
[13]张杰,王人彦,张玉柱.膝骨关节炎的治疗进展[J].中医正骨,2015,27(10):68.
[14]梁朝,蔡静怡,闫立,等.针刀疗法改善膝骨关节炎早期疼痛症状的疗效评价[J].中医正骨,2015,27(09):9.
 LIANG Zhao,CAI Jingyi,YAN Li,et al.Evaluation of the curative effect of needle-knife therapy for relieving knee pain in patients with early knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):9.
[15]王建武,党建军,李强,等.四联疗法治疗膝骨关节炎[J].中医正骨,2015,27(08):44.
[16]刘红娟,郭会利,郭树农.云克联合中药治疗膝骨关节炎的护理[J].中医正骨,2015,27(08):75.
[17]陈卫衡.探索建立系统的膝骨关节炎中医临床科研范式 和理论体系[J].中医正骨,2015,27(07):1.
[18]帅波,沈霖,杨艳萍,等.加味青娥丸治疗膝骨关节炎的作用机制研究[J].中医正骨,2015,27(07):15.
 SHUAI Bo,SHEN Lin,YANG Yanping,et al.Study on the mechanism of action of Jiawei Qing'e Wan(加味青娥丸)for the treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):15.
[19]梅其杰,袁长深,段戡,等.壮药骨痹方烫熨联合运动疗法治疗膝骨关节炎的临床研究[J].中医正骨,2015,27(07):27.
 MEI Qijie,YUAN Changshen,DUAN Kan,et al.Clinical study of the curative effect of hot compressing and rubbing with packet of Gubi Fang(骨痹方)combined with exercise therapy in the treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):27.
[20]王丹辉,张燕,刘丽娟,等.重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白 关节腔注射联合中药薰洗治疗膝骨关节炎的临床研究[J].中医正骨,2015,27(07):31.
 WANG Danhui,ZHANG Yan,LIU Lijuan,et al.Clinical study on intra-articular injection of TypeⅡrecombinant human tumor necrosis factor receptor-Fc fusion protein combined with Chinese herbal steaming and washing therapy for treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):31.

备注/Memo

备注/Memo:
基金项目:国家自然科学基金项目(81873324); 浙江省中医药科技计划项目(2018ZZ011,2021ZZ014)
通讯作者:童培建 E-mail:tpjzjtcm@139.com
更新日期/Last Update: 2021-01-20