骨转移癌痛发病机制及中医药防治研究进展  

Pathogenesis of Bone Metastasis-caused Pain and Its Prevention and Treatment with Traditional Chinese Medicine:A Review

作　　者：赖桂花 王菲[1,2] 聂多锐 周芳 安桂琳[1,2] 伍卓珺[1,2] 白倩文 曹建雄 LAI Guihua;WANG Fei;NIE Duorui;ZHOU Fang;AN Guilin;WU Zhuojun;BAI Qianwen;CAO Jianxiong(Hunan University of Chinese Medicine,Changsha 410208,China;The First Hospital of Hunan University of Chinese Medicine,Changsha 410007,China;Hunan Academy of Traditional Chinese Medicine Affiliated Hospital,Changsha 410006,China)

机构地区：[1]湖南中医药大学,长沙410208 [2]湖南中医药大学第一附属医院,长沙410007 [3]湖南省中医药研究院附属医院,长沙410006

出　　处：《中国实验方剂学杂志》2023年第11期231-239,共9页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：湖南省重点研发计划项目(2018SK2127);湖南省中医药科研计划项目(201946);湖南中医药大学中西医结合一流学科开放基金项目(2020ZXYJH44);湖南中医药大学研究生创新课题项目(2022CX26)。

摘　　要：骨转移癌痛是癌症最常见的并发症之一,其发病率随着癌症总体患病率增加而逐年升高,严重影响癌症患者的生活质量及生存期。骨转移癌痛是一种同时具备炎性疼痛和神经病理性疼痛特征而又异于2种类型的特殊疼痛,因此其发病机制非常复杂,深入了解其发病机制具有十分重要的意义。目前骨转移癌痛发病机制的研究多集中在破骨细胞活化、骨微环境的变化、胶质细胞活化、脊髓神经元活化、微小RNA失调等方面。现代医学治疗骨转移癌痛以三阶梯止痛药物、双膦酸盐类药物、骨转移灶的姑息性放疗及介入治疗为主,短期止痛疗效确切,但由于其不良作用、成瘾性及耐药性等问题未获得满意的长期疗效。研究表明中医药治疗骨转移癌痛有确切的疗效,不仅具有安全性高、增效减毒、增强患者免疫力等优点,而且可通过多成分、多靶点及多通路发挥协同治疗的作用,使其在防治骨转移癌痛方面具有独特的优势,成为众医家学者的研究重点。该文系统整理了近年国内外文献库中有关骨转移癌痛发病机制及中医药(中药复方、单药及单体)干预的研究文献,将从抑制破骨细胞活化、胶质细胞活化及脊髓神经元活化、调控疼痛介质及微小RNA异常表达及抗肿瘤等方面详细综述,以期进一步阐明骨转移癌痛的发病机制,并为中医药有效防治骨转移癌痛提供更全面的思路与方法。Bone metastasis-caused pain(BMP)is a common complication of cancer,and the incidence has been on the rise with the increase in the overall prevalence of cancer,threatening the survival and quality of life of patients.BMP is a kind of special pain with the characteristics of inflammatory pain and neuropathic pain,but is different from the two.Therefore,its pathogenesis is very complicated,and it is of great significance to understand the pathogenesis.The currently available studies mainly focused on osteoclast activation,changes in the bone microenvironment,glial cell activation,spinal cord neuron activation,and miRNA dysregulation.Modern therapies include the three-step analgesics,bisphosphonates,palliative radiotherapy,and interventional therapy for bone metastases,which show definite efficacy in short term.However,the long-term effect is unsatisfactory due to the adverse reactions,addiction,and drug resistance.Studies have shown that traditional Chinese medicine(TCM)has definite curative effect on BMP,which is safe,enhances efficacy,reduces toxicity,and boosts immunity.Moreover,it exerts the effect through multiple components,multiple targets,and multiple pathways.As a result,it has unique advantages in the prevention and treatment of BMP and has become a research focus.This paper summarizes the research on the pathogenesis of BMP,the intervention of TCM(compound Chinese medicine prescriptions,Chinese medicinals,and monomers from Chinese medicinals),and the mechanisms of TCM,such as inhibiting osteoclast activation,glial cell activation,and spinal cord neuron activation,regulating pain mediators and abnormal expression of microRNA,and antitumor,which is expected to further clarify the pathogenesis of BMP and provide ideas and methods for the effective prevention and treatment of BMP with TCM.

关 键 词：骨转移癌痛 发病机制 中医药 研究进展 

分 类 号：R22[医药卫生—中医基础理论] R242[医药卫生—中医学] R2-031R287R285.5