光生物调节及糖皮质激素治疗类固醇肌病的前景

Photobiomodulation for glucocorticoid-induced steroid myopathy

目的:综述糖皮质激素引起类固醇肌病的机制及其传统治疗方法和具有前景的光生物调节疗法。资料来源:应用计算机检索Medline、Ovoid和Springer1970/2007与糖皮质激素类固醇肌病及其疗法相关的文章,检索词“glucocorticoid,myopathy,therapy,low intensity laser therapy”,并限定文章语言为English。同时在中国全文数据库中检索,检索词“糖皮质激素,类固醇肌病”,并限定文章语言为中文。资料选择:对资料进行初审,纳入标准:糖皮质激素引起类固醇肌病的机制及其主要疗法的文献。排除标准:重复性研究。资料提炼:共收集到133篇相关文献。在选择和分析的基础上,排除重复或类似研究,最终提炼出48篇文献进行分类整理。资料综合:长期使用或大量使用糖皮质激素可以导致类固醇肌病的发生。通过糖皮质激素受体介导的信号转导,糖皮质激素可以正向或者负向调节相关基因的表达,从而产生如加快蛋白降解和减慢蛋白合成等相关效应。细胞模型或动物模型的实验表明,糖皮质激素可以从对骨骼肌能量代谢、氨基酸平衡、蛋白质代谢和成肌等方面的干扰而破坏骨骼肌细胞的内稳态,这可能是糖皮质激素引起类固醇肌病的机制。激活MAPKs信号途径或G蛋白耦联受体信号途径可能抑制糖皮质激素的信号转导。结论:激素疗法和运动疗法可以治疗类固醇肌病。光生物调节作用可以激活细胞MAPKs信号途径和G蛋白耦联受体信号途径,提示光生物调节作用是治疗类固醇肌病的一种潜在的疗法。

OBJECTIVE： To review the possible mechanism of glucocorticoid inducing steroid myopathy, and compare its routine therapy with the promising photobiomodulation. DATA SOURCES： An online search of Medline, Ovoid and Springer databases was undertaken to identify the articles of glucocorticoid inducing steroid myopathy and the corresponding therapies published in English from 1970 to 2007 by using the keywords of ＂glucocorticoid, myopathy, therapy, low intensity laser therapy＂. Similarly, the relevant articles published in Chinese were also searched from the Chinese National Knowledge Infrastructure with the keywords of ＂glucocorticoid, steroid myopathy＂. STUDY SELECTION： After the primary check, the articles related to the mechanism of glucocorticoid inducing steroid myopathy and its therapies were selected. The repetitive studies were excluded. DATA EXTRACTION： Totally 133 articles were collected and 48 articles of them were used in this review after the repeated or similar researches were deleted. DATA SYNTHESIS： Long-term or high-dose glucocorticoid treatment can result in steroid myopathy. After being activated by glucocorticoid, glucocorticoid receptors can mediate several gene expressions positively or negatively, which is followed by many biological responses such as accelerating protein breakdown and slowing down protein synthesis. The results of cell or animal model studies show that glucocorticoid interferes with energy metabolism, amino acid balance, protein metabolism of skeletal muscle cells and myogenesis so as to spoil the cellular homeostasis, which may be the mechanism of glucocorticoid inducing steroid myopathy. The MAPKs signals or G protein coupled receptor signals may depress the signal transduction of glucocorticoid and its receptors. CONCLUSION： Hormone therapy and appropriate training can reduce the intensity of steroid myopathy. Photobiomodulation can activate the signal transduction involved in MAPKs or G protein coupled receptors, indicating the potential application of photobiomodulation to treat steroid myopathy,