基于“骨肉不相亲”理论探讨腰椎间盘退行性疾病与椎旁肌减少症共病机制  

Discussion on Pathogenesis of Comorbidity of Lumbar Degenerative Disc Disease and Paravertebral Sarcopenia Based on Theory of“Bone and Flesh Not Match”

作　　者：崔海舰[1,2] 姚啸生 戚晓楠[2] 郑洪新 王禹[2] 王思微[2] 黄英韬 CUI Haijian;YAO Xiaosheng;QI Xiaonan;ZHENG Hongxin;WANG Yu;WANG Siwei;HUANG Yingtao(Liaoning University of Traditional Chinese Medicine,Shenyang 110847,Liaoning,China;The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110032,Liaoning,China)

机构地区：[1]辽宁中医药大学,辽宁沈阳110847 [2]辽宁中医药大学附属医院,辽宁沈阳110032

出　　处：《中华中医药学刊》2025年第1期102-107,共6页Chinese Archives of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(82174398);国家自然科学基金青年科学基金项目(82305275);辽宁省教育厅科学技术研究青年项目(JYTQN2023456);辽宁省名中医传承工作室建设项目(辽中医药综合字[2022]12号)。

摘　　要：腰椎间盘退行性疾病(LDDD)和骨骼肌减少症(简称肌少症)是老年人常见的增龄性运动系统疾病,严重影响老年人的健康。肌少症在脊柱区域表现为椎旁肌减少。临床发现椎旁肌减少症和LDDD常呈现共病状态,相互影响,互为因果。基础研究提示二者具有相似的发病基础和病理机制。LDDD临床上多是对症治疗,尚缺乏逆转椎间盘退变的有效手段。肌少症常见的干预手段有抗阻运动和营养补充,但缺少有效的治疗药物。中医将LDDD和肌少症分别归为“腰痛”“腰脊痛”“痿证”“虚劳”等。中医对二者相互关系有深刻认识,以“骨肉不相亲”理论高度概括其肌骨共病的病理状态。认为脾肾亏虚是其共同的发病机制,补益脾肾是基本治法。但中医药研究亟待采用真实世界研究丰富理论,循证医学研究验证疗效,基础实验研究深入揭示其共病的机理和阐释疗效的机制,为深化中医药相关理论和发明新药提供新思路。Lumbar degenerative disc disease(LDDD)and sarcopenia are common age-related motor system diseases in the elderly,which seriously affect the health of the elderly.The reduction of paravertebral muscle is the manifestation of sarcopenia in the spine,and clinical findings show the paravertebral sarcopenia and LDDD often present comorbidity status,mutual influence and mutual causality.Basic research suggests that the two have similar pathogenesis and pathological mechanisms.LDDD is mostly treated symptomatically in clinical practice,and there is still a lack of effective means to reverse intervertebral disc degeneration.The common intervention methods for sarcopenia include resistance exercise and nutritional supplementation,but there is a lack of effective therapeutic drugs.Traditional Chinese medicine(TCM)classifies LDDD as“lumbago”and“spinalgia”and paravertebral sarcopenia as“Wei syndrome”and“consumptive disease”.TCM has a profound understanding of the relationship between the two,and highly summarizes the pathological state of its comorbidity with the theory of“bone and flesh not match”.It is believed that the deficiency of spleen and kidney is the common pathogenesis.Tonifying spleen and kidney is the basic treatment method.However,the research on traditional Chinese medicine urgently needs to adopt real-world research to enrich theories and evidence-based medicine research to verify therapeutic effects and basic experimental research to deeply reveal the mechanisms of comorbidities and explain the mechanisms of therapeutic effects,providing new ideas for deepening the relevant theories of traditional Chinese medicine and inventing new drugs.

关 键 词：腰椎间盘退行性疾病 肌少症 椎旁肌减少症 骨肉不相亲 共病 

分 类 号：R274.981.53[医药卫生—中西医结合]