中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (17): 2763-2771.doi: 10.12307/2023.403

• 组织构建综述 tissue construction review • 上一篇    

激素性股骨头坏死的中医药治疗机制

武瑞骐1，崔  伟2，杨启培1，周  毅1，张  璇3   

  1. 1广西中医药大学附属瑞康医院，广西壮族自治区南宁市  530000；2广西中医药大学附属瑞康医院田阳院区骨科，广西壮族自治区百色市 533600；3广西中医药大学骨伤学院，广西壮族自治区南宁市  530001
  • 收稿日期:2022-05-18 接受日期:2022-07-04 出版日期:2023-06-18 发布日期:2022-10-25
  • 通讯作者: 崔伟，男，主任医师，教授，硕士生导师，广西中医药大学附属瑞康医院田阳院区骨科，广西壮族自治区百色市 533600
  • 作者简介:武瑞骐，男，1998年生，海南省海口市人，汉族，广西中医药大学在读硕士，主要从事脊柱、骨关节创伤性疾病的中医防治研究。
  • 基金资助:
    广西自然科学基金项目(2021GXNSFAA196033)，项目负责人：张璇；广西研究生教育创新计划资助项目(YCSY2020080)，项目负责人：周毅

Therapeutic mechanism of traditional Chinese medicine in the treatment of hormone-induced necrosis of the femoral head

Wu Ruiqi1, Cui Wei2, Yang Qipei1, Zhou Yi1, Zhang Xuan3   

  1. 1Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning 530000, Guangxi Zhuang Autonomous Region, China; 2Department of Orthopedics, Tianyang Branch, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Baise 533600, Guangxi Zhuang Autonomous Region, China; 3College of Orthopedic Injury, Guangxi University of Chinese Medicine, Nanning 530001, Guangxi Zhuang Autonomous Region, China
  • Received:2022-05-18 Accepted:2022-07-04 Online:2023-06-18 Published:2022-10-25
  • Contact: Cui Wei, Chief physician, Professor, Master’s supervisor, Department of Orthopedics, Tianyang Branch, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Baise 533600, Guangxi Zhuang Autonomous Region, China
  • About author:Wu Ruiqi, Master candidate, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning 530000, Guangxi Zhuang Autonomous Region, China
  • Supported by:
    Natural Science Foundation of Guangxi Zhuang Autonomous Region, No. 2021GXNSFAA196033 (to ZX); Guangxi Postgraduate Education Innovation Program, No. YCSY2020080 (to ZY)

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摘要：

文题释义：
激素性股骨头坏死：长期或过量应用糖皮质激素，使股骨头血液供应受损，多种骨细胞死亡，进而破坏骨小梁微结构，引发股骨头出现 不可逆塌陷，最终导致髋关节功能障碍的一类疾病。
骨髓间充质干细胞：是一种中胚层来源的多能干细胞，具有优良的成骨分化能力，被广泛应用于骨组织工程。目前骨髓间充质干细胞的成骨、成脂分化异常被认为是激素性股骨头坏死的诱发因素之一。
背景：近年来中国传统中医药在预防和治疗股骨头坏死方面的研究较多，并发现多种单味中药、中药单体及中药复方可以通过靶向信号分子调控骨代谢、脂质代谢和氧化应激相关信号通路预防和治疗股骨头坏死，已成为了时下研究热点。
目的：通过阐述国内外中医药对激素性股骨头坏死方面的研究进展，以期为激素性股骨头坏死的治疗提供一些思路。
方法：以中文检索词“糖皮质激素、股骨头坏死、发病机制、信号通路、中药复方、氧化应激”检索中国知网、维普、万方、中国生物医学文献数据库；以英文检索词“Glucocorticoids，ANFH，Pathogenesis，Signal path，Chinese Medicine compound，oxidative stress ”等检索PubMed、Embase 及Web of Science 数据库，筛选有关中药复方及有效成分干预激素性股骨头坏死信号通路的文献，按照入选及排除标准共纳入71篇文献进行综述分析。
结果与结论：①中医药可能通过多个信号通路来治疗激素性股骨头坏死；②三七总皂苷、骨碎补总黄酮和白藜芦醇葡萄糖甙通过干预Wnt/β-catenin信号通路调控β-catenin蛋白数量以及β-catenin-TCF/LEF复合体形成过程来促进成骨细胞增殖分化，抑制破骨细胞形成；③生血补髓方、温阳补肾方和骨痹通消方通过干预OPG/RANK/RANKL通路维持成骨-破骨细胞动态平衡和骨稳态；④葛根素、红景天苷、大蒜素和淫羊藿苷通过干预PI3K/Akt信号通路影响相关骨性细胞的增殖、凋亡及股骨头微血管内皮细胞成血管的过程；⑤人参皂苷，通过干预Keapl-Nrf2-ARE信号通路，可下调超氧化物歧化酶和过氧化氢酶的表达，从而减弱氧化应激损伤；⑥天麻素、叶黄素和黄芪甲苷Ⅳ通过干预Nrf2/HO-1促进成骨细胞增殖分化，改善氧化物质水平；⑦柚皮苷和虎杖苷通过干预Nrf2/ARE信号通路恢复了骨髓间质干细胞的成骨/成脂分化平衡用等；⑧中医药调控骨性细胞氧化应激反应是其治疗激素性股骨头坏死的另一种重要途径。
https://orcid.org/0000-0003-2729-307X(武瑞骐)；https://orcid.org/0000-0003-2011-7508(崔伟)
中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 中药复方, 骨代谢, 脂质代谢, 骨髓间充质干细胞, 成骨细胞, 破骨细胞, 氧化应激, 信号通路, 综述

Abstract: BACKGROUND: In recent years, there have been many studies on the prevention and treatment of femoral head necrosis with traditional Chinese medicine. A variety of single Chinese medicines, Chinese medicine monomers and Chinese medicine compounds can regulate bone metabolism, lipid metabolism, and oxidative stress by targeting signaling molecules. The prevention and treatment of femoral head necrosis by translation-related signaling pathways has become a research hotspot.
OBJECTIVE: To expound the global research progress in hormone-induced femoral head necrosis treated with Chinese medicine, in order to provide some ideas for the treatment of hormone-induced femoral head necrosis.
METHODS: CNKI, WanFang, VIP, SinoMed, PubMed, Embase, and Web of Science databases were searched with the search terms “glucocorticoids, avascular necrosis of the femoral head, ANFH, pathogenesis, signal path, Chinese medicine compound, oxidative stress” in Chinese and English. Literature was retrieved on Chinese medicine compounds and active ingredients for intervention of the signaling pathway related to hormone-induced femoral head necrosis. A total of 71 documents were included according to the inclusion and exclusion criteria.
RESULTS AND CONCLUSION: Chinese medicine may treat hormone-induced femoral head necrosis through multiple signaling pathways. Total saponins of Panax notoginseng, total flavonoids of Rhizoma Drynariae, and resveratrol glucoside promote osteoblast proliferation and differentiation and inhibit osteoclast formation by regulating the level of β-catenin protein and the formation of β-catenin-TCF/LEF complex via the Wnt/β-catenin signaling pathway. Recipes for invigorating blood and reinforcing marrow, warming yang and tonifying kidney, and relieving bone bi-syndrome maintain osteoblast-osteoclast dynamic balance and bone homeostasis by regulating the OPG/RANK/RANKL pathway. Puerarin, salidroside, allicin, and icariin influence the proliferation and apoptosis of osseous cells and angiogenesis of microvascular endothelial cells in the femoral head via the PI3K/Akt signaling pathway. Ginsenosides can down-regulate the expressions of superoxide dismutase and catalase by interfering with the Keapl-Nrf2-ARE signaling pathway, thereby attenuating oxidative stress damage. Gastrodin, lutein, and astragaloside IV can promote the proliferation and differentiation of osteoblasts by intervening Nrf2/HO-1 signaling, thereby improving the level of oxidative substances. Naringin and polygonin balance the osteogenic/adipogenic differentiation of bone marrow mesenchymal stem cells via the Nrf2/ARE signaling pathway. Traditional Chinese medicine can regulate oxidative stress response of osteocytes, which is another important way to treat hormone-induced necrosis of the femoral head.

Key words: Chinese medicine compound, bone metabolism, lipid metabolism, bone marrow mesenchymal stem cell, osteoblast, osteoclast, oxidative stress, signaling pathway, review

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