中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (34): 5521-5527.doi: 10.12307/2024.831

• 组织构建综述 tissue construction review • 上一篇    下一篇

激光治疗膝骨关节炎多途径生物效应的可能机制

娄鑫奇1，钟  浩1，王熹宇1，冯皓宇2，李鹏翠3，卫小春3，王艳芹1，武晓刚1，陈维毅1，薛艳茹2   

  1. 1太原理工大学生物医学工程学院，山西省太原市  030024；2山西白求恩医院(山西医学科学院同济山西医院)，山西医科大学第三医院，山西省太原市  030032；3骨与软组织损伤修复山西省重点实验室，山西省太原市  030001
  • 收稿日期:2023-12-12 接受日期:2024-01-22 出版日期:2024-12-08 发布日期:2024-03-14
  • 通讯作者: 薛艳茹，博士，讲师，山西白求恩医院(山西医学科学院同济山西医院)，山西医科大学第三医院，山西省太原市 030032 武晓刚，博士，教授，太原理工大学生物医学工程学院，山西省太原市 030024
  • 作者简介:娄鑫奇，2000年生，山西省运城市人，汉族，2024年太原理工大学生物医学工程学院毕业，硕士，主要从事骨组织生物力学方面的研究。
  • 基金资助:
    国家自然科学基金(12272250，11972242)，项目负责人：武晓刚；中国博士后科学基金(2020M680913)，项目负责人：武晓刚；山西省留学归国基金(2022-081)，项目负责人：武晓刚；山西省基础研究计划(202203021212254)，项目负责人：薛艳茹

Possible mechanisms of multi-pathway biological effects of laser therapy for knee osteoarthritis

Lou Xinqi1, Zhong Hao1, Wang Xiyu1, Feng Haoyu2, Li Pengcui3, Wei Xiaochun3, Wang Yanqin1, Wu Xiaogang1, Chen Weiyi1, Xue Yanru2   

  1. 1College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi Province, China; 2Shanxi Bethune Hospital (Tongji Shanxi Hospital, Shanxi Academy of Medical Sciences), Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China; 3Shanxi Provincial Key Laboratory for Repair of Bone and Soft Tissue Injury, Taiyuan 030001, Shanxi Province, China
  • Received:2023-12-12 Accepted:2024-01-22 Online:2024-12-08 Published:2024-03-14
  • Contact: Xue Yanru, PhD, Lecturer, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China Wu Xiaogang, PhD, Professor, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi Province, China
  • About author:Lou Xinqi, Master, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi Province, China
  • Supported by:
    National Natural Science Foundation of China, Nos. 12272250 and 11972242 (both to WXG); China Postdoctoral Science Foundation, No. 2020M680913 (to WXG); Shanxi Overseas Returned Scholarship Fund, No. 2022-081 (to WXG); Shanxi Provincial Basic Research Program, No. 202203021212254 (to XYR)

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摘要：


文题释义：

激光疗法：将激光光束直接照射到人体组织中，以产生一系列的生物效应，从而实现治疗目的。
膝骨关节炎：为临床常见的关节损伤及结构退化的慢性退行性疾病。患者膝关节活动障碍，生活质量严重下降。


背景：激光疗法是一种无创、无痛的治疗手段，由于它操作简单和非侵入性的特点，被认为是治疗骨关节炎的适用方法。目前，激光疗法对组织的作用机制尚不明确，并且其临床应用的研究结果仍存在争议。

目的：回顾总结激光疗法治疗膝骨关节炎在细胞水平、动物实验和临床疗效方面的最新研究进展，探讨激光介导多途径生物效应的可能机制，从而为进一步研究激光治疗膝骨关节炎提供理论基础。
方法：在中国知网、万方数据、维普和PubMed数据库对2018-2023年发表的有关激光疗法治疗膝骨关节炎的文献进行检索，以“激光疗法，低强度激光疗法，高强度激光疗法，光生物调节，膝关节骨关节炎，软骨细胞”为中文检索词，以“laser therapy，low level laser therapy，high level laser therapy，photobiomodulation，knee osteoarthritis，chondrocytes”为英文检索词。加上手工检索的14 篇文献，最终纳入70篇文献进行综述。

结果与结论：①激光疗法治疗膝骨关节炎主要分为高强度激光和低强度激光两种类型，激光参数和治疗方案的不同会对激光疗效产生直接影响；在使用适当的参数时，低强度激光在细胞实验、动物模型以及临床疗效方面都显示出积极的作用；高强度激光在膝骨关节炎治疗中的研究较少，但一些初步的临床研究结果显示出积极的效果；②细胞实验表明，低强度激光可促进软骨细胞增殖和软骨基质合成，从而降低炎症反应；③动物实验表明，低强度激光可以减少促炎症因子的释放，促进软骨基质合成，抑制基质降解，有效改善软骨组织的修复过程；低强度激光还能减轻膝骨关节炎过程中的氧化应激损伤，缓解疼痛；④在临床试验中，低强度激光和高强度激光均可以减轻患者疼痛，改善功能活动；激光疗法与运动治疗方式联合使用可能会提高治疗效果；⑤激光可能通过光生物效应或热力学效应影响细胞内的信号传导和细胞功能，为激光促进关节软骨再生提供了直接证据。

https://orcid.org/0009-0009-9229-3712(娄鑫奇)

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: 激光疗法, 低强度激光, 高强度激光, 膝关节骨关节炎, 软骨修复, 软骨细胞

Abstract: BACKGROUND: Laser therapy is a non-invasive and painless treatment that is considered to be an effective method suitable for the treatment of osteoarthritis due to its simplicity and non-invasive nature. Currently, the mechanism of action of laser therapy is unclear and the results of studies on its clinical application are controversial. 
OBJECTIVE: To review and summarize the latest research progress of laser therapy on chondrocytes, animal experiments and clinical efficacy, and to explore the possible mechanism of laser-mediated multi-pathway biological effects, so as to provide a theoretical basis for further research on the laser treatment of osteoarthritis of the knee joint.
METHODS: A literature search was performed in CNKI, WanFang Data, VIP and PubMed databases for relevant literature published from 2018 to 2023, with “laser therapy, low level laser therapy, high level laser therapy, photobiomodulation, knee osteoarthritis, chondrocytes” as the search terms in Chinese and English, respectively. Together with 14 articles searched manually, 70 articles were finally included for review.
RESULTS AND CONCLUSION: Laser therapy in the treatment of knee osteoarthritis is mainly categorized into two types: low-level laser therapy and high-level laser therapy. Differences in laser parameters and treatment protocols have a direct impact on laser efficacy. When appropriate parameters are used, low-level lasers show positive effects in cellular experiments, animal models, and clinical efficacy. High-level lasers have been less studied in the treatment of knee osteoarthritis, but some preliminary clinical studies have shown positive results. Cell experiments have shown that low-level laser promotes chondrocyte proliferation and cartilage matrix synthesis, thereby reducing inflammatory response. Animal experiments have shown that low-level laser can reduce the release of pro-inflammatory factors, promote cartilage matrix synthesis, inhibit matrix degradation, and effectively improve the repair process of cartilage tissue. Low-level laser is also able to reduce oxidative stress damage and relieve pain in knee osteoarthritis. In clinical trials, both low- and high-level laser can reduce patients’ pain and improve functional activities. The combination of laser therapy and exercise therapy modalities may improve the therapeutic effect. Lasers may affect intracellular signaling and cellular functions through photobiological or thermodynamic effects. This provides direct evidence that laser promotes articular cartilage regeneration.

Key words: laser therapy, low-level laser, high-level laser, knee osteoarthritis, cartilage repair, chondrocyte

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