中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (30): 4868-4874.doi: 10.3969/j.issn.2095-4344.1407

• 生物材料综述 biomaterial review • 上一篇    下一篇

富血小板血浆与脉冲电磁场联合应用治疗骨关节炎：理论与临床研究的进展

向小娜1，2，余  曦2，刘  岩2，蒋红英2，何成奇2，何红晨2
  

  1. 1四川大学华西临床医学院，四川省成都市  610041；2四川大学华西医院康复医学科，四川省成都市  610041
  • 收稿日期:2019-05-11 出版日期:2019-10-28 发布日期:2019-10-28
  • 通讯作者: 何红晨，男，副主任，博士，四川大学华西医院康复医学科，四川省成都市 610041
  • 作者简介:向小娜，女，1995年生，汉族，硕士在读，主要从事骨关节基础与临床、下肢机器人研究。
  • 基金资助:

    四川省科技厅应用基础研究(2017JY0342)，项目负责人：何红晨；四川大学青年教师科研启动基金(20826041A4195)，项目负责人：何红晨

Pulsed electromagnetic fields and platelet rich plasma therapy for treatment of osteoarthritis: theoretical progress and clinical research

Xiang Xiaona1,2, Yu Xi2, Liu Yan2, Jiang Hongying2, He Chengqi2, He Hongchen2
  

  1. 1 West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China; 2Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2019-05-11 Online:2019-10-28 Published:2019-10-28
  • Contact: He Hongchen, MD, Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • About author:Xiang Xiaona, Master candidate, West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China; Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Supported by:

    Applied Basic Research Foundation of Sichuan Science and Technology Department, No. 2017JY0342 (to HHC); Sichuan University Young Teachers Scientific Research Startup Fund, No. 20826041A4195 (to HHC)

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摘要：

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文题释义：
富血小板血浆：是自体的新鲜全血经离心后分离出来的富含血小板的血浆浓缩物，血小板通过脱颗粒作用，释放大量具有生物活性的生长因子促进组织修复。
骨关节炎：指由多种因素引起关节软骨纤维化、皲裂、溃疡及脱失而导致的以关节疼痛为主要症状的退行性疾病，病因尚不明确，其发生与年龄、肥胖、炎症、创伤及遗传因素等有关，病理特点为关节软骨变性破坏、软骨下骨硬化或囊性变、关节边缘骨质增生、滑膜病变、关节囊挛缩、韧带松弛或挛缩及肌肉萎缩无力等。
 
 
背景：骨关节炎是影响人类健康最常见的关节疾患之一，最新的诊疗指南写入物理治疗与关节腔内注射，其中脉冲电磁场治疗与富血小板血浆注射治疗极具潜力，但作用机制及其能否联合使用促进骨关节炎患者康复尚不清楚。
目的：总结目前脉冲电磁场联合富血小板血浆注射治疗骨关节炎的相关基础研究带来的理论进展，以及临床应用研究现状。
方法：以“Wnt，β-catenin，NF-κB，TLRs，PEMFs，PRP，platelet-rich plasma，OA，osteoarthritis”为关键词，检索了2009至2019年EMbase，Medline，CENTRAL以及万方数据库中相关文献。初检得到文章448篇，筛选后对其中49篇文章进行分析。
结果与结论：①脉冲电磁场增加细胞中Ca2+浓度改变膜电位，可能引起细胞死亡，也可能在骨形成点沉积、加速骨与软骨的形成；脉冲电磁场对髓核细胞分泌白细胞介素1和肿瘤坏死因子α有抑制作用；②富血小板血浆中有非活性的多种生长因子存在，可帮助软骨分化，从而达到保护关节的作用，同时降低了体液和细胞免疫反应；富血小板血浆中的炎症调节因子抑制软骨细胞核因子通路激活的炎症反应，从而抑制白细胞介素1介导的无菌性炎症因子的表达和软骨基质的降解；③Toll样受体介导骨髓细胞分化能影响骨代谢，激活的Wnt/β-连环蛋白信号通路可减少骨吸收，同时增加骨形成，Wnt/β-连环蛋白信号传导的介质和下游效应子在骨关节炎中增加；④上述研究证实，目前研究发现两者联合治疗骨关节炎的可能机制包括：共同抑制白细胞介素1及肿瘤坏死因子α等炎症因子表达，通过Wnt/β-连环蛋白信号通路协同促进血管内皮生长因子分泌、可能共同调控Toll样受体表达，但尚无研究对比富血小板血浆注射治疗与脉冲电磁场在骨关节炎的疗效，未来除对两者作用机制的研究之外，或许可以将两者结合应用于骨关节炎患者。

关键词: Wnt, 骨代谢, 脉冲电磁场, 富血小板血浆, 血管内皮生长因子, 骨关节炎, Wnt/β-连环蛋白, 细胞核因子通路, Toll样受体, 综述

Abstract:

BACKGROUND: Osteoarthritis is one of the most common joint diseases affecting human health. Pulsed electromagnetic fields and platelet rich plasma therapy have great potential for physical therapy. However, the precise mechanism of action and whether their combination can promote the rehabilitation of osteoarthritis remain poorly understood.
OBJECTIVE: To summarize the theoretical progress of the basic research on the treatment of osteoarthritis by pulsed electromagnetic fields and platelet rich plasma therapy, and the current situation of clinical research.
METHODS: A computer-based search of EMbase, MedLine, CENTRAL and Wanfang databases were performed for relevant articles published from 2009 to 2019 with the search terms “Wnt, β-catenin, NF-κB, TLRs, PEMFs, PRP, platelet-rich plasma, OA, osteoarthritis”. Initially, 448 articles were retrieved, and finally 49 eligible articles were included for final analysis.
RESULTS AND CONCLUSION: Pulsed electromagnetic fields increased Ca2+ concentration in cells, altered membrane potential, caused apoptosis or deposit, and accelerated the formation of bone and cartilage. Pulsed electromagnetic fields inhibited the secretion of interleukin-1β and tumor necrosis factor-α by nucleus pulposus cells. There were many non-active growth factors in platelet rich plasma which helped cartilage differentiation, protected the joints and reduced the humoral and cellular immune response. The inflammatory regulators in platelet rich plasma inhibited the inflammatory response of chondrocytes by nuclear factor-κB pathway activation, thus inhibiting the expression of aseptic inflammatory factor mediated by interleukin-1 and the degradation of cartilage matrix. Toll-like receptors mediated bone marrow cell differentiation can affect bone metabolism. Activating Wnt/β-catenin pathway reduced bone absorption, increased bone formation, and increased Wnt/β-catenin signaling-conducted medium and down-stream effectors in osteoarthritis. These results suggest that pulsed electromagnetic fields in combination with platelet rich plasma therapy treated osteoarthritis through co-inhibiting the expression of inflammatory factors such as interleukin-1 and tumor necrosis factor-α, promoting the secretion of vascular endothelial growth factors via the Wnt/β-catenin pathway, and co-regulating the expression of Toll-like receptors. However, little is reported on the efficacy of platelet rich plasma therapy versus pulsed electromagnetic fields on osteoarthritis. Future studies will address on the mechanism of the platelet rich plasma therapy versus pulsed electromagnetic fields and application of their combination in the treatment of osteoarthritis.

Key words: Wnt, bone metabolism, pulsed electromagnetic fields, platelet rich plasma, vascular endothelial growth factor, osteoarthritis, Wnt/β-catenin, nuclear factor pathway, Toll-like receptor, review

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