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文献分析关于物质的组合:氨基葡萄糖+软骨素在骨关节炎治疗中的应用。

Literature Analysis Regarding the Combination of Substances: Glucosamine + Chondroitin in the Treatment of Osteoarthritis.

机构信息

Centrum Medyczne Kształcenia Podyplomowego, Warszawa, Polska.

Wojskowy Instytut Medyczny - Państwowy Instytut Badawczy Klinika Reumatologii.

出版信息

Ortop Traumatol Rehabil. 2022 Dec 31;24(6):407-416. doi: 10.5604/01.3001.0016.2326.

Abstract

An essential component of joint quality is cartilage. Therefore, the protection of this is a prerequisite for maintaining the condition of each joint. The assessment of the presence of articular cartilage is shown by X-ray of both joints in the standing position. Cartilage protection is possible for 1, 2 and 3 degree of cartilage damage according to the Kellgren and Lawrence scale.The challenge for the physician is to identify the cause of OA in accordance with the principles of Evidence Based Orthopedics/Traumatology, and not merely treat symptomatically, which is usually ineffective.In order to objectively present treatment methods, indications and the period of their implementation, it is biologically reasonable to refer to the needs of cartilage tissue resulting from the analysis of the causes of its damage and indications for justified methods of its protection.Biomechanical and biological elements are important in the process of implementing articular cartilage protection.The biomechanical elements are: limb axis disorders, differences in length, distortions at the level of the support quadrilateral, pelvic triangle and shoulder triangle, as well as balance disorders resulting from disturbances in the segmental proportion of the Fi number according to Leonardo da Vinci.There are many biological elements of the discussed disorder and they concern: the state of articular cartilage structure, matrix structure, matrix biophysical elements, molecular sponge mechanism, chondrocytes, cartilage nutrition and the severity of osteoarthritis (OA).The improvement of the conditions of the biological elements of damaged articular cartilage is considered fundamental and concerns the positive impact on numerous cartilage matrix proteins by chondroprotection. This element of treatment consists in the use of chondroitin sulphate and glucosamine as a drug, administered together in the appropriate dose and for a long time depending on the degree of degradation of the articular cartilage, usually from several to several months. The combination of chondroitin sulfate with glucosamine causes the activation of a much larger number of matrix proteins than each of the preparations separately.The pharmacokinetics of chondroitin sulfate and glucosamine are positive and favor their chondroprotective effect.The pharmacoproteomics of chondroitin sulfate and glucosamine administered together result from the activation of as many joint cartilage matrix proteins as possible. The development of proteomic techniques creates completely new therapeutic possibilities and is used to study the action of individual molecules.A clinically significant fact is that both chondroitin and glucosamine are natural, endogenous components of bone tissue and articular cartilage, so the use of both drugs is biologically compatible and results in numerous elements of cartilage protection.

摘要

关节质量的一个重要组成部分是软骨。因此,保护软骨是维持每个关节健康的前提。关节软骨的存在可以通过站立位的双侧关节 X 线检查来评估。根据 Kellgren 和 Lawrence 分级,对于 1、2 和 3 度的软骨损伤,可以进行软骨保护。根据循证骨科/创伤学的原则,医生的挑战是确定骨关节炎的病因,而不仅仅是对症治疗,这通常是无效的。为了客观地呈现治疗方法、适应证及其实施期限,根据软骨组织损伤原因的分析和保护软骨组织的合理方法的适应证,参考软骨组织的生物需求是合理的。生物力学和生物学因素在实施关节软骨保护的过程中很重要。生物力学因素包括:肢体轴的紊乱、长度差异、支撑四边形水平的扭曲、骨盆三角和肩部三角,以及根据达芬奇 Fi 段比例失调引起的平衡障碍。该疾病存在许多生物学因素,它们涉及:关节软骨结构的状态、基质结构、基质生物物理因素、分子海绵机制、软骨细胞、软骨营养和骨关节炎 (OA) 的严重程度。改善受损关节软骨的生物学因素的条件被认为是根本的,涉及到对软骨保护的众多软骨基质蛋白的积极影响。这种治疗方法包括使用硫酸软骨素和氨基葡萄糖作为药物,根据关节软骨退化的程度,在适当的剂量下并在很长的时间内联合使用,通常为数周至数月。硫酸软骨素与氨基葡萄糖联合使用会激活比单独使用每种药物更多的基质蛋白。硫酸软骨素和氨基葡萄糖的药代动力学是积极的,有利于其软骨保护作用。硫酸软骨素和氨基葡萄糖联合使用的药代蛋白组学导致尽可能多的关节软骨基质蛋白被激活。蛋白组学技术的发展创造了全新的治疗可能性,并用于研究单个分子的作用。一个具有临床意义的事实是,硫酸软骨素和氨基葡萄糖都是骨骼组织和关节软骨的天然内源性成分,因此两种药物的联合使用在生物学上是相容的,并产生许多软骨保护作用的元素。

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