基于血管再生机制探讨中西医治疗膝骨关节炎  

Exploring the Mechanisms of Angiogenesis in Integrated Traditional Chinese and Western Medicine Treatment for Knee Osteoarthritis

作　　者：LE Thi Quynh 蔡永刚 任花梅 李玮琦 周友龙[1,2] LE Thi Quynh;CAI Yonggang;REN Huamei;LI Weiqi;ZHOU Youlong(Henan University of Chinese Medicine,Zhengzhou,Henan,China,450046;The Third Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou,Henan,China,450008)

机构地区：[1]河南中医药大学,河南郑州450046 [2]河南中医药大学第三附属医院,河南郑州450008

出　　处：《河南中医》2025年第5期788-795,共8页Henan Traditional Chinese Medicine

基　　金：河南省特色骨干学科中医学学科建设项目(STG-ZYX02-202115,STG-ZYXKY-2020032);河南省重点科学基金项目(232300421128)。

摘　　要：膝骨关节炎(knee osteoarthritis,KOA)是常见的关节疾病,以关节软骨的退行性变和关节边缘的骨质增生为主要特征。当关节炎发病时,软骨下骨中破骨细胞活跃,骨重塑增加,软骨下骨板通透性增加,血管侵入软骨,出现血管新生,进而加剧炎症反应和软骨退化,加速膝骨关节炎的进展。基于血管再生机制,抑制软骨中的血管新生是目前的研究方向,通过阻断异常血管新生的过程,可保护关节腔内的稳定状态、减少促炎介质的释放、分解代谢酶的降解及调节生长因子的产生来延缓软骨破坏和退化的过程并且保护软骨自修复的环境、减轻滑膜炎症及疼痛。但目前的研究仍存在许多问题:(1)机制复杂性:血管再生与KOA之间的具体作用机制尚未完全明确。血管新生、血管通透性增加、血管周围炎症等多因素交织,使得精准干预变得复杂;(2)生物标志物缺乏:目前尚缺乏特异性和敏感性高的生物标志物来准确评估血管再生的活跃程度及KOA的进展阶段,限制了个性化治疗策略的制定;(3)治疗方法的不良反应:靶向抑制血管再生的药物可能带来全身性不良反应,如影响正常组织的血液供应,导致伤口愈合延迟或其他器官功能受损等;(4)长期疗效与安全性:尽管短期临床试验显示疗效确切,但长期治疗的安全性和有效性仍需进一步验证,包括是否会引发耐药性或疾病反复发作等问题;(5)中西医结合的标准化:中西医结合治疗虽显示潜力,但缺乏统一的标准和指南,不同医生的处方差异大,影响了治疗的一致性和可重复性。今后,应深入研究血管再生与KOA的相互作用机制,寻找并验证血管再生相关的特异性生物标志物,建立中西医结合治疗KOA的标准化指南,开展多中心临床试验,验证中西医结合治疗KOA的疗效和安全性。Knee osteoarthritis(KOA)is a common joint disease characterized by degenerative changes in articular cartilage and osteophyte formation at joint margins.During arthritis progression,abnormal angiogenesis is activated,leading to vascular hyperplasia in the subchondral bone and intra-cartilage regions.This exacerbates inflammatory responses and cartilage degradation,accelerating KOA progression.Current research focuses on inhibiting intra-cartilage angiogenesis based on angiogenesis mechanisms.Blocking abnormal angiogenesis may protect joint stability,reduce pro-inflammatory mediator release,degrade catabolic enzymes,regulate growth factor production,delay cartilage destruction,preserve the self-repair environment,alleviate synovitis,and mitigate pain.However,challenges in present research still remain as follows:(1)Mechanism Complexity:The specific interactions between angiogenesis and KOA are unclear.Factors such as angiogenesis,increased vascular permeability,and perivascular inflammation complicate targeted interventions.(2)Lack of Specific Biomarkers:Highly sensitive and specific biomarkers to assess angiogenesis activity and KOA progression are lacking,hindering personalized treatment strategies.(3)Adverse Reactions of Therapeutic Approaches:Angiogenesis-inhibiting drugs may cause systemic side effects,such as impairing normal tissue vascularization,delaying wound healing,or damaging organ function,etc.(4)Long-Term Efficacy and Safety:Despite positive short-term clinical outcomes,long-term safety and efficacy require further validation,including risks of drug resistance or disease relapse,etc.(5)Standardization of Integrated Therapies:While integrated traditional Chinese and Western medicine shows potential,inconsistent standards and prescription variability limit treatment consistency and reproducibility.Therefore,future research should conduct in-depth research on the interaction mechanisms between angiogenesis and KOA,identify and validate specific angiogenesis-related biomarkers,establish standardized gui

关 键 词：膝骨关节炎 血管再生 软骨破坏 软骨退化 滑膜炎 关节疼痛 中西医结合疗法 

分 类 号：R274.843[医药卫生—中医骨伤科学]