中医药通过OPG/RANKL/RANK系统干预类风湿关节炎骨破坏的研究进展  

Research Progress of TCM in Intervention of Rheumatoid Arthritis Bone Destruction Through OPG/RANKL/RANK System

作　　者：周志锋 郭会卿[2] 曹玉举 崔朋涛 袁都户 ZHOU Zhifeng;GUO Huiqing;CAO Yuju;CUI Pengtao;YUAN Duhu(Henan University of Chinese Medicine,Zhengzhou Henan China 450046;Henan Provincial Hospital of Chinese Medicine,Zhengzhou Henan China 450002;Zhengzhou Orthopedic Hospital of Chinese Medicine,Zhengzhou Henan China 4500)

机构地区：[1]河南中医药大学,河南郑州450046 [2]河南省中医院,河南郑州450002 [3]郑州中医骨伤病医院,河南郑州450016

出　　处：《中医学报》2023年第1期77-82,共6页Acta Chinese Medicine

基　　金：河南省中医药重点实验室建设项目{豫卫中医函〔2021〕30号}。

摘　　要：骨保护素/核因子-κB受体活化因子配体/核因子-κB受体活化因子(osteoprotegerin/receptoractivatorof NF-κB ligand/receptor activator of nuclear factor-κB,OPG/RANKL/RANK)系统与类风湿关节炎(rheumatoid arthritis,RA)骨破坏关系密切,调控OPG/RANKL/RANK系统已经成为治疗RA骨破坏新的靶点和思路。中医药治疗RA历史悠久,大量实验研究证明了中医药联合西药能够发挥增效减毒的作用,但现有研究仍存在不足之处,如缺乏拔罐、穴位埋线、刺络放血等中医特色疗法干预骨破坏的研究;部分动物实验方案设计有待完善;临床试验研究缺乏放射学变化相关指标的应用;临床研究样本量较小,治疗周期较短,结果准确性不足,缺乏远期随访。今后需进一步挖掘中医特色疗法,进行试验方案设计时充分考虑到剂量与研究结果的可能相关性,加强大样本、多中心的临床研究,延长研究周期,设计合理的跟踪随访机制,在疗效评价中引入骨侵蚀的超声评分、改良Sharp评分等指标,以提高研究结果的可信度,为中医药干预RA骨破坏提供更为有利的证据。Osteoprotegerin/receptoractivator of NF-κB ligand/receptor activator of nuclear factor-κB(OPG/RANKL/RANK)system and rheumatoid arthritis(RA)is closely related to bone destruction,and the regulation of the OPG/RANKL/RANK system has become a new target and idea for the treatment of RA bone destruction.Traditional Chinese medicine has a long history of treating RA,and many experimental studies have proved that traditional Chinese medicine combined with western medicine can play a synergistic and detoxifying role,but the existing research still has shortcomings,such as the lack of research on bone destruction with TCM characteristic therapies such as cupping,acupoint thread burial,and bloodletting.The design of some animal experiment protocols needs to be improved;lack of use of indicators related to radiological changes in clinical trials;Clinical studies have small sample sizes,short treatment cycles,insufficient accuracy of results,and lack of long-term follow-up.Therefore,in the future,it is necessary to further explore the exploration of TCM characteristic therapies,fully consider the possible correlation between dose and research results when designing experimental protocols,strengthen large-sample and multi-center clinical research,extend the research period,design a reasonable follow-up mechanism,and introduce ultrasound scores and improved Sharp scores of bone erosion in the efficacy evaluation to improve the credibility of the research results and provide more favorable evidence for TCM intervention in RA bone destruction.

关 键 词：类风湿关节炎骨破坏 中医药 OPG/RANKL/RANK系统 骨代谢 

分 类 号：R259[医药卫生—中西医结合]