细胞因子在肌腱愈合中的研究进展

Progress in the study on cytokines in tendon healing

目的:在肌腱损伤修复中,细胞因子有多种独特作用,细胞因子之间的协同作用及其与其他生长因子之间的作用在肌腱损伤修复的过程中具有重要的意义。资料来源:应用计算机检索Medline数据库1990-01/2004-08期间的相关文章,检索词为“cytokines”和“tendon,injury,healing”,限定文章语言种类为英文。同时计算机检索万方数据资源系统与中国期刊全文数据库1994-01/2004-08期间的相关文章,检索词“细胞因子,肌腱损伤,修复”,限定文章语言种类为中文。资料选择:对资料进行初审,选取资料包括细胞因子在肌腱损伤愈合方面的基础和临床相关文献,筛除明显不随机实验的研究,对剩余的文献开始查找全文,进一步判断为随机对照实验。纳入标准:为随机对照实验,采用单盲,双盲或非盲法;实验包含平行对照组。排除标准:重复性实验研究。资料提炼:共收集到20篇关于细胞因子在肌腱损伤愈合方面的基础和临床相关实验文章,11篇实验文章纳入标准。排除的9篇实验均为重复的同一研究。资料综合:11篇实验文章包括几种主要细胞因子在肌腱损伤修复中的作用及其不同的分子机制。转化生长因子β、类胰岛素生长因子Ⅰ、成纤维细胞生长因子、血小板源性生长因子等在肌腱损伤修复中可能有以下几种独特作用:①减少炎症反应。②使瘢痕组织形成降至最小程度。③促进正常组织的功能恢复。细胞因子促进肌腱损伤的修复是一个极其复杂的过程,实验已证明几种细胞因子联合作用对促进软组织损伤修复的效果往往优于单一因子。结论:细胞因子促进肌腱损伤的修复是一个极其复杂的过程。鉴于细胞因子的广泛性和复杂性,要将其作为临床用药治疗软组织损伤疾病,尚受诸多因素的制约:如细胞因子的配伍、药物剂型、给药方式、在人体内的稳定性、免疫排斥性等,尚需加强对细胞因子基础和临床研究的逐步深入去解决。

OBJECTIVE： Cytokines have various unique properties in repair of tendon injury. Cooperation among cytokine and association with other growth factors play an important role in tendon healing. DATA SOURCES： An online search of Medline database was undertaken by using the keywords of “cytokines, tendon, injury, healing” to identify the relevant articles published in English from January 1990 to August 2004. Meanwhile, Wanfang database and Chinese journals full-text database were scanned with computer to search relevant articles published from January 1994 to August 2004, and the keywords were “cytokines, tendon injury, healing” with language limited to Chinese. STUDY SELECTION： After the above search, relevant articles about the basic and clinical study of cytokines in tendon healing were selected, while tlhe obvious non-randomized trials were excluded, and then the full texts of the selected articles were searched for randomized controlled study. Inclusion criteria： randomized controlled study with single-blind, double-blind or non-blind method; experiment including parallel control groups. Exclusion criteria： repetitive experiment study. DATA EXTRACTION： Twenty articles about the basic and clinical study of cytokines in tendon healing were collected, and 13 of them were in accordance with the inclusion criteria, while the other 9 studies lading excluded were all repetitive studies. DATA SYNTHESIS： The 11 selected articles included the effects of several major cytokines in tendon healing, and their different molecular mechanisms. Transforming growth factor beta, insulin-like growth fachor 1, fibroblast growth factor and platelet derived growth factor plaid quite important roles in tendon healing： ①reducing inflammation; ②minimizing sear tissue formation; ③promoting functional restoration of the normal tissue. It is a complicatinn process that cytokines are involved in the repair of tendon injury, and it is verified that combination of several kinds of cytokines plays a better role in promoting the repair of soft tissue injury as compared with one kind of cytokine. CONCLUSION： It is a complicated process that cytokines are involved in tendon healing. It is difficult that cytokines serve as clinical drug administration for treatment of soft tissue injury because of their universality and complication. Multiple factors that restrict the clinical application of cytokines include dispensation of cytokines, drug dosage type, administration manner, internal stability, immunological rejection, etc. which needs further basic and clinical studies on cytokines.