基于“活血生骨”理论探讨激素性股骨头坏死的中医论治
Discussion on the Traditional Chinese Medicine Treatment of Steroid-Induced Avascular Necrosis of the Femeral Head Based on the Theory of “Activating Blood and Promoting Bone”
DOI: 10.12677/TCM.2024.133061, PDF,    国家自然科学基金支持
作者: 严锦贤*, 宋红梅, 张 宽, 郑文炜, 周季萱, 倪立坚#:福建中医药大学附属第二人民医院,福建 福州;福建省医疗机构中药制剂重点实验室,福建 福州 ;王和鸣:福建中医药大学,福建 福州
关键词: 激素性股骨头坏死活血生骨病因病机王和鸣成血管–成骨偶联Steroid-Induced Avascular Necrosis of the Femeral Head Activating Blood and Promoting Bone Eti-ology and Pathogenesis Wang Heming Angiogenesis-Osteogenesis Coupling
摘要: 激素性股骨头坏死(SANFH)是一种由长期或大剂量应用糖皮质激素引发的疾病,机制不清,危害极大。本文旨在探讨王和鸣教授提出的“活血生骨”理论在SANFH治疗中的应用和科学内涵。首先,回顾了SANFH的中医病因病机和现代致病机制,强调脾肾亏虚、痰瘀互结等中医病因在SANFH发病中的重要作用。然后,详细阐述“活血生骨”理论与传统“补益肝肾、活血化瘀”治则的关系,以及其与现代医学“成血管–成骨偶联”理论在治疗SANFH上的深度相互关联和作用。最后,总结基于“活血生骨”理论的中药复方在治疗SANFH方面的显著效果以及作用机制。本文的研究结果为后续SANFH的防治研究和新药研发提供了理论参考和借鉴,强调了中医“活血生骨”理论在SANFH治疗中的重要指导意义。
Abstract: Steroid-Induced Avascular Necrosis of the Femeral Head (SANFH) is a disease caused by long-term or high-dose application of glucocorticoids. The mechanism is unclear and it is extremely harmful. This article aims to explore the application and scientific connotation of the “activating blood and promoting bone” theory proposed by Professor Wang Heming in the treatment of SANFH. First, the TCM etiology and modern pathogenic mechanisms of SANFH are reviewed, emphasizing the im-portant role of TCM etiology such as spleen and kidney deficiency, phlegm and blood stasis in the pathogenesis of SANFH. Then, the relationship between the theory of “activating blood and promot-ing bone” and the traditional treatment principle of “tonifying the liver and kidneys, promoting blood circulation and removing blood stasis” is elaborated, as well as its deep correlation and effect with the modern medical “angiogenesis-osteogenesis coupling” theory in the treatment of SANFH. Finally, the significant effects and mechanisms of traditional Chinese medicine compounds based on the theory of “activating blood and promoting bone” in the treatment of SANFH are summarized. The research results of this article provide theoretical reference and reference for subsequent pre-vention and treatment research on SANFH and the development of new drugs, emphasizing the im-portant guiding significance of the traditional Chinese medicine theory of “activating blood and promoting bone” in the treatment of SANFH.
文章引用:严锦贤, 宋红梅, 张宽, 郑文炜, 周季萱, 倪立坚, 王和鸣. 基于“活血生骨”理论探讨激素性股骨头坏死的中医论治[J]. 中医学, 2024, 13(3): 390-396. https://doi.org/10.12677/TCM.2024.133061

参考文献

[1] 李云隆, 赵振群, 刘万林. 激素性股骨头缺血坏死中NLRP3/Akt/mTOR信号通路对自噬的调控[J]. 中国组织工程研究, 2019, 23(12): 1921-1929.
[2] 朱振宇, 李刚, 于浩, 等. 补肾活血胶囊治疗激素性股骨头坏死组方分析: 基于“虚” “瘀”理论[J]. 亚太传统医药, 2024, 20(1): 217-220.
[3] 龚高进, 黄海汛. 齐墩果酸调节Wnt/β-catenin信号通路减轻大鼠激素性股骨头坏死[J]. 中国组织工程研究, 2024, 28(27): 4373-4377.
[4] 徐成栋, 董晓俊, 李冬. 栀子苷调节HIF-1α/VEGF信号通路对激素性股骨头坏死大鼠的血管生成的影响[J]. 河北医学, 2023, 29(11): 1767-1772.
[5] 智林锋, 吴清君. 基于“虚气留滞”探讨股骨头坏死发病机制[J]. 中医学报, 2021, 36(9): 1890-1893.
[6] 何兴鹏, 郑利钦, 李鹏飞, 等. 两种肾虚证型去势模型大鼠骨小梁微观结构及骨代谢的差异[J]. 中国组织工程研究, 2022, 26(23): 3768-3772.
[7] 汪小敏, 曹林忠, 宋敏, 等. 从痰论治激素性股骨头坏死OPG/RANK/RANKL信号调控机制研究进展[J]. 中国中医药信息杂志, 2017, 24(10): 133-136.
[8] 宋晓钰, 李倩, 王璐璐, 等. 激素联合甲巯咪唑治疗甲亢危象伴乙肝肝衰竭1例[J]. 山东大学学报(医学版), 2024, 62(1): 76-81, 101.
[9] Fang, S.H., Li, Y.F., Jiang, J.R., et al. (2019) Relationship of α2-Macroglobulin with Steroid-Induced Femoral Head Necrosis: A Chinese Population-Based Association Study in Southeast China. Orthopaedic Surgery, 11, 481-486. [Google Scholar] [CrossRef] [PubMed]
[10] 左荣台, 关俊杰, 康庆林. 激素性股骨头坏死治疗研究进展[J]. 国际骨科学杂志, 2019, 40(3): 160-164.
[11] 吕亚军, 任立中, 李军, 等. 髓芯减压联合胶原基骨修复材料和血管内皮生长因子对兔股骨头坏死血管修复和微循环的影响[J]. 实用医学杂志, 2022, 38(23): 2927-2932.
[12] 芮仞, 娄悦, 张先姚, 等. 细胞凋亡在激素性股骨头坏死发病机制中的研究进展[J]. 山西中医学院学报, 2019, 20(1): 65-69.
[13] 李嘉程, 杨曦, 梁学振, 等. 激素性股骨头坏死mRNA与非编码RNA差异表达谱及竞争性内源RNA调控网络分析[J]. 解放军医学杂志, 2020, 45(12): 1230-1237.
[14] 温家福, 韦标方. 激素性股骨头坏死骨髓间充质干细胞成骨分化的研究进展[J]. 解放军医学杂志, 2020, 45(11): 1207-1214.
[15] 李颖, 纪莎, 高锦娟, 等. 星点设计-效应面法优化复方巴戟天生骨颗粒提取工艺[J]. 中药材, 2014, 37(10): 1863-1867.
[16] 于斌, 张晶萁, 滕雪琦, 等. 补肾类中药医治激素性股骨头坏死机制的研究进展[J]. 吉林中医药, 2023, 43(11): 1351-1355. [Google Scholar] [CrossRef
[17] 康斯文, 侯德才. 桃红四物汤对股骨头坏死患者BGP、BAP水平及血液流变学影响[J]. 辽宁中医药大学学报, 2021, 23(3): 139-142.
[18] Liu, Y.F., Chen, W.M., Lin, Y.F., Yang, R.C., Lin, M.W., Li, L.H., et al. (2005) Type II Collagen Gene Variants and Inherited Osteonecrosis of the Femoral Head. The New England Journal of Medicine, 352, 2294-2301. [Google Scholar] [CrossRef
[19] Riddle, R.C., Khatri, R., Schipani, E., et al. (2009) Role of Hypox-ia-Inducible Factor-1α in Angiogenic-Osteogenic Coupling. Journal of Molecular Medicine, 87, 583-590. [Google Scholar] [CrossRef] [PubMed]
[20] Geris, L., Gerisch, A., Sloten, J.V., et al. (2008) Angiogenesis in Bone Fracture Healing: A Bioregulatory Model. Journal of Theoretical Biology, 251, 137-158. [Google Scholar] [CrossRef] [PubMed]
[21] Eriksen, E.F., Eghbali-Fatourechi, G.Z. and Khosla, S. (2007) Re-modeling and Vascular Spaces in Bone. Journal of Bone and Mineral Research, 22, 1-6. [Google Scholar] [CrossRef] [PubMed]
[22] Goerke, S.M., Obermeyer, J., Plaha, J., Stark, G.B. and Finkenzeller, G. (2015) Endothelial Progenitor Cells from Peripheral Blood Support Bone Regeneration by Provoking an Angiogenic Response. Microvascular Research, 98, 40-47. [Google Scholar] [CrossRef] [PubMed]
[23] Ko, J.Y., Wang, F.S., Wang, C.J., et al. (2010) Increased Dickkopf-1 Expression Accelerates Bone Cell Apoptosis in Femoral Head Os-teonecrosis. Bone, 46, 584-591. [Google Scholar] [CrossRef] [PubMed]
[24] Yun, S.I., Yoon, H.Y., Jeong, S.Y., et al. (2009) Glucocorticoid Induces Apoptosis of Osteoblast Cells through the Activation of Glycogen Synthase Kinase 3β. Journal of Bone and Mineral Metabolism, 27, 140-148. [Google Scholar] [CrossRef] [PubMed]
[25] Ramasamy, S.K., Kusumbe, A.P., Wang, L., et al. (2014) Endo-thelial Notch Activity Promotes Angiogenesis and Osteogenesis in Bone. Nature, 507, 376-380. [Google Scholar] [CrossRef] [PubMed]
[26] Tang, C., Wang, Y., Lv, H., Guan, Z. and Gu, J. (2020) Caution against Corticosteroid-Based COVID-19 Treatment. The Lancet, 395, 1759-1760. [Google Scholar] [CrossRef
[27] 陈卫衡. 中医药防治新型冠状病毒肺炎后股骨头坏死专家共识[J]. 中医正骨, 2020, 32(3): 4-6.
[28] 李文顺, 孙克民, 王和鸣, 宫健伟, 李月平. 复方巴戟天合剂治疗股骨头缺血性坏死的临床研究[J]. 中国中医骨伤科杂志, 2006, 14(2): 48-50.
[29] 张安桢, 王和鸣, 林子顺. 活血化瘀法治疗股骨头无菌性坏死[J]. 福建中医药, 1981, 19(4): 12-15.
[30] 宋红梅, 吴斌, 魏迎辰, 李楠, 王和鸣. 温阳补肾方对兔激素性股骨头坏死血清OPG、RANK、RANKL的影响[J]. 中国中医骨伤科杂志, 2013, 21(12): 1-7.
[31] 孙克民, 王和鸣, 陈文列, 黄美雅. 复方巴戟天合剂对大鼠激素性股骨头缺血性坏死的组织学研究[J]. 湖南中医药大学学报, 2011, 31(7): 14-17.
[32] 孙克民, 王和鸣, 王平, 卢启贵, 黄东红, 裴代平. 复方巴戟天合剂对激素性股骨头坏死大鼠模型血液流变学和血脂的影响[J]. 中国中医骨伤科杂志, 2011, 19(5): 1-3.
[33] 王和鸣, 王力, 李楠. 巴戟天对骨髓基质细胞向成骨细胞分化过程Cbfα1表达的影响[J]. 中国中医骨伤科杂志, 2004, 12(6): 22-26, 29.
[34] 陈卫衡, 王和鸣. 温阳补肾中药促进骨髓基质细胞分化的实验研究进展[J]. 中国骨伤, 2011, 24(4): 352-356.
[35] 黄胜杰, 李媚, 王和鸣. 温阳补肾药对骨髓间充质干细胞促增殖的实验研究[J]. 中国中医骨伤科杂志, 2012, 20(10): 1-8.
[36] 杨黎丽, 黄胜杰, 李媚, 王和鸣. 温阳补肾药对抗骨髓间充质干细胞凋亡的实验研究[J]. 中医正骨, 2013, 25(2): 3-7.
[37] Wu, B., Dong, Z., Li, S. and Song, H. (2015) Steroid-Induced Ischemic Bone Necrosis of Femoral Head: Treatment Strategies. Pakistan Journal of Medical Sciences, 31, 471-476. [Google Scholar] [CrossRef] [PubMed]
[38] 孙克民, 王和鸣, 胡娟, 郑良朴. 复方巴戟天合剂对鸡胚绒毛尿囊膜血管生成的影响[J]. 福建中医药, 2010, 41(6): 43-45.
[39] 孙克民, 王和鸣, 林久茂. 复方巴戟天合剂对激素性股骨头坏死大鼠血管内皮生长因子表达的影响[J]. 中国实验方剂学杂志, 2011, 17(7): 117-120.
[40] 宋红梅. 温阳补肾方对兔激素性股骨头坏死VEGF及RANKL/RANK/OPG通路的影响[D]: [博士学位论文]. 福州: 福建中医药大学, 2015.