进化医学与慢性炎症性疾病中的骨质流失——一种与炎症相关的骨质减少理论
Evolutionary medicine and bone loss in chronic inflammatory diseases--A theory of inflammation-related osteopenia.
作者信息
Straub Rainer H, Cutolo Maurizio, Pacifici Roberto
机构信息
Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Department of Internal Medicine I, University Hospital Regensburg, 93042 Regensburg, Germany.
Department of Internal Medicine and Medical Specialties, University of Genova, Genova, Italy.
出版信息
Semin Arthritis Rheum. 2015 Oct;45(2):220-8. doi: 10.1016/j.semarthrit.2015.04.014. Epub 2015 Apr 30.
OBJECTIVE
Bone loss is typical in chronic inflammatory diseases such as rheumatoid arthritis, psoriasis, ankylosing spondylitis, systemic lupus erythematosus, multiple sclerosis, inflammatory bowel diseases, pemphigus vulgaris, and others. It is also typical in transplantation-related inflammation and during the process of aging. While we recognized that bone loss is tightly linked to immune system activation or inflamm-aging in the form of acute, chronic active, or chronic smoldering inflammation, bone loss is typically discussed to be an "accident of inflammation."
METHODS
Extensive literature search in PubMed central.
RESULTS
Using elements of evolutionary medicine, energy regulation, and neuroendocrine regulation of homeostasis and immune function, we work out that bone waste is an adaptive, evolutionarily positively selected program that is absolutely necessary during acute inflammation. However, when acute inflammation enters a chronic state due to the inability to terminate inflammation (e.g., in autoimmunity or in continuous immunity against microbes), the acute program of bone loss is a misguided adaptive program.
CONCLUSIONS
The article highlights the complexity of interwoven pathways of osteopenia.
目的
骨质流失在类风湿性关节炎、银屑病、强直性脊柱炎、系统性红斑狼疮、多发性硬化症、炎症性肠病、寻常型天疱疮等慢性炎症性疾病中很典型。在移植相关炎症以及衰老过程中也很典型。虽然我们认识到骨质流失与免疫系统激活或以急性、慢性活动性或慢性隐匿性炎症形式存在的炎症衰老紧密相关，但骨质流失通常被认为是“炎症的意外结果”。
方法
在PubMed中央数据库进行广泛的文献检索。
结果
运用进化医学、能量调节以及内稳态和免疫功能的神经内分泌调节等要素，我们得出骨质流失是一种适应性的、在进化上被正向选择的程序，在急性炎症期间绝对必要。然而，当急性炎症由于无法终止炎症（例如在自身免疫或对微生物的持续免疫中）而进入慢性状态时，骨质流失的急性程序就是一个被误导的适应性程序。
结论
本文强调了骨质减少交织途径的复杂性。
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