基于肠–骨轴理论讨论补肾健脾法干预 骨质疏松症的生物学机制

Discussion on the Biological Mechanism of Kidney-Tonifying and Spleen-Strengthening Therapy in Intervening Osteoporosis Based on the Gut-Bone Axis Theory

摘要: 骨质疏松症(osteoporosis, OP)是一种以骨量减少、骨微结构破坏及骨脆性增加为主要特征的全身性代谢性骨病。近年来，肠–骨轴(gut-bone axis, GBA)在OP发病机制中的作用受到广泛关注。肠道菌群可通过调节营养吸收、肠黏膜屏障、免疫炎症反应及代谢产物生成等途径影响骨代谢稳态。中医学认为，OP的基本病机与“肾主骨”“脾主运化”“脾肾相资”密切相关，其理论内涵与GBA机制具有一定一致性。本文围绕GBA调控骨代谢的现代机制，综述中医“脾肾相关”理论与肠道微生态的联系，重点总结单味中药、活性成分及补肾健脾复方通过调节肠道菌群结构、改善肠屏障功能、抑制肠源性炎症、恢复免疫平衡及促进短链脂肪酸(short-chain fatty acids, SCFAs)等有益代谢物生成以防治OP的研究进展，并对当前研究局限与未来方向进行分析，以期为中医药防治OP的机制研究与临床转化提供参考。

Abstract: Osteoporosis (OP) is a systemic metabolic bone disease characterized by reduced bone mass, deterioration of bone microarchitecture, and increased bone fragility. In recent years, the gut-bone axis (GBA) has emerged as an important perspective for understanding the pathogenesis of OP. Gut microbiota can influence bone metabolic homeostasis through multiple pathways, including the regulation of nutrient absorption, intestinal barrier integrity, immune and inflammatory responses, and microbial metabolite production. In traditional Chinese medicine (TCM), the pathogenesis of OP is closely associated with the theories that “the kidney governs bones”, “the spleen governs transportation and transformation”, and “the spleen and kidney mutually reinforce each other”. These concepts are broadly consistent with the modern understanding of the GBA. Based on the biological mechanisms by which the GBA regulates bone metabolism, this review summarizes the relationship between the TCM theory of spleen-kidney correlation and intestinal microecology. It further reviews recent progress in the prevention and treatment of OP using single herbs, active compounds, and formulas that tonify the kidney and strengthen the spleen, with particular focus on their roles in modulating gut microbiota composition, improving intestinal barrier function, suppressing gut-derived inflammation, restoring immune balance, and promoting beneficial metabolites such as short-chain fatty acids (SCFAs). Current limitations and future research directions are also discussed. This review provides a reference for further mechanistic studies and the clinical translation of TCM in the prevention and treatment of OP based on the GBA.