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[中医药干预骨质疏松症及相关疼痛性疾病的回顾性研究]

[Retrospective study on intervention of traditional Chinese medicine in osteoporosis and related pain diseases].

作者信息

Li Yi-Run, Li Li, Gao Yin-Qiu, Dong Cui-Ling, Xiong Xing-Jiang, Yang Xiao-Chen

机构信息

Pain Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences Beijing 100053, China Beijing University of Chinese Medicine Beijing 100029, China.

Cadre Health Care Office, Guang'anmen Hospital, China Academy of Chinese Medical Sciences Beijing 100053, China.

出版信息

Zhongguo Zhong Yao Za Zhi. 2025 Jun;50(11):3180-3188. doi: 10.19540/j.cnki.cjcmm.20250213.702.

Abstract

Osteoporosis(OP) is a metabolic bone disorder characterized by reduced bone mass and degenerative bone tissue. Osteoporotic pain(OPP) is its most common clinical symptom, significantly affecting the quality of life of patients. With the limitations of modern medical treatments and the intensification of aging, it is imperative to explore more cost-effective interventions for OPP. This paper, based on databases such as China National Knowledge Infrastructure(CNKI), VIP, Wanfang, BioMed, and Web of Science, uncovered the connection between the pathogenesis of OPP in traditional Chinese medicine(TCM) and modern medical mechanisms and retrospectively summarized the basic and clinical research methods and evidence of TCM prescriptions in the treatment of OP and related pain diseases. Studies have shown that TCM prescriptions, focusing on treatments such as nourishing the kidney, strengthening the spleen, and activating blood circulation to remove blood stasis, can significantly improve pain symptoms, increase bone mineral density(BMD), and adjust bone metabolic indicators such as C-terminal telopeptide of type Ⅰ collagen(CTX), serum bone Gla-protein(S-BGP), and alkaline phosphatase(ALP). The mechanisms of action of TCM prescriptions in treating OP and improving OPP symptoms were related to signaling pathways such as Wnt/β-catenin, nuclear factor kappa-B(NF-κB), mitogen-activated protein kinase(MAPK), phosphatidylinositol 3-kinase(PI3K)/protein kinase B(Akt), and the osteoprotegerin(OPG)/receptor activator of NF-κB(RANK)/receptor activator of NF-κB ligand(RANKL) axis. Further strengthening the accumulation and analysis of clinical data, rigorously designing and conducting randomized controlled trials of TCM treatments for OPP with large sample sizes, standardizing outcome measures in basic and clinical research by using methods such as the core outcome set(COS), and incorporating mass spectrometry and omics approaches to uncover more potential active components and mechanisms may contribute to a deeper exploration of the advantages and essence of TCM prescriptions in the treatment of OPP.

摘要

骨质疏松症(OP)是一种以骨量减少和骨组织退变为特征的代谢性骨病。骨质疏松性疼痛(OPP)是其最常见的临床症状,严重影响患者的生活质量。随着现代医学治疗手段的局限性以及老龄化的加剧,探索更具成本效益的OPP干预措施势在必行。本文基于中国知网(CNKI)、维普、万方、生物医学数据库(BioMed)和科学引文索引(Web of Science)等数据库,揭示了中医(TCM)对OPP发病机制与现代医学机制之间的联系,并回顾性总结了中医方剂治疗OP及相关疼痛性疾病的基础和临床研究方法及证据。研究表明,以补肾、健脾、活血化瘀等治疗为主的中医方剂,可显著改善疼痛症状,提高骨密度(BMD),并调节骨代谢指标,如Ⅰ型胶原C端肽(CTX)、血清骨钙素(S - BGP)和碱性磷酸酶(ALP)。中医方剂治疗OP及改善OPP症状的作用机制与Wnt/β - 连环蛋白、核因子κB(NF - κB)、丝裂原活化蛋白激酶(MAPK)、磷脂酰肌醇3 - 激酶(PI3K)/蛋白激酶B(Akt)以及骨保护素(OPG)/核因子κB受体激活剂(RANK)/核因子κB受体激活剂配体(RANKL)轴等信号通路有关。进一步加强临床数据的积累和分析,严格设计并开展大样本的中医治疗OPP随机对照试验,采用核心结局集(COS)等方法规范基础和临床研究中的结局指标,并结合质谱和组学方法揭示更多潜在的活性成分和机制,可能有助于更深入地探索中医方剂治疗OPP的优势和精髓。

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