淋巴回流功能与类风湿性关节炎相关性及中医药调控机制的研究进展

A Research Progress on the Correlation Between Lymphatic Reflux and Rheumatoid Arthritis and the Regulatory Effect of Traditional Chinese Medicine

类风湿关节炎是一种慢性、进行性、系统性和自身免疫性的炎症性关节疾病,以发病率高、难治愈为特征。如果治疗不当,可导致不可逆的关节畸形,将会严重影响患者的工作能力和生活质量。近年来,越来越多的研究证实炎症刺激关节周围组织和局部转运淋巴结的淋巴管增生的同时,也会造成集合淋巴管结构和功能异常,并导致关节周围淋巴回流功能障碍。类风湿关节炎炎症下淋巴管回流功能障碍,促进淋巴回流,减轻关节炎症的观点,与中医"痹"证"不通则痛,通则不痛"的观点相一致。另外,中药复方独活寄生汤可以改善淋巴回流功能,促进淋巴管生成,减轻关节炎症。中药有效组分阿魏酸抑制肿瘤坏死因子α刺激淋巴管内皮细胞产生的一氧化氮,减轻一氧化氮对淋巴管平滑肌细胞的损伤,改善慢性炎症下的淋巴回流功能,从而减轻关节炎症。有效组份三七总皂苷可以刺激淋巴管内皮细胞产生VEGF-C促进淋巴管生成。这些研究结果提示起蠲痹作用的中医药很有可能通过调控淋巴回流功能改善类风湿关节炎。本文回顾了淋巴回流功能与炎症性关节炎相关性,讨论现阶段中医药调控淋巴回流功能改善炎症性关节炎的进展,以期为临床治疗类风湿关节炎提供新的思路,为基础研究的进一步发展提供方向,为中医痹证理论提供新的解释。

Rheumatoid arthritis（RA） is a chronic, progressive, systematic, autoimmunity and inflammatory joint disease with high morbidity and low recovery rate. Inappropriate treatment may result in the irreversible joint deformity and seriously affect the ability to work and quality of life of RA patients. In recent years, a growing number of studies have certified that inflammation activated lymphangiogenesis in the tissue around the joints and local transport lymph node, resulting in the abnormal structure and disfunction of lymphatic collection. The dysfunction of lymphatic drainage in RA and the view of promoting lymphatic drainage in order to reduce inflammation of the joint chimed with ＂Bi＂ theory, namely pain caused by obstruction can be mitigated by clearing the obstruction, in traditional Chinese medicine. It was reported that Du Huo Ji Sheng decoction alleviated arthritis by promoting lymphatic recycle and lymphangiogenesis. Previous studies showed that Chinese medicine effective componαent of ferulic acid inhibited NO expression in lymphatic endothelial cells stimulated by tumor necrosis factor for relieving the injury of lymphatic vascular smooth muscle cells and improving lymphatic reflux function. Panax notoginseng saponins promoted lymphangiogenesis by increasing the release of VEGF-C from lymphatic endothelial cells. These resultes indicated that＂ Juanbi＂ effect of traditional Chinese medicine may produced by regulating lymphatic drainage in the joints in RA. This paper reviewed the relationship between lymphatic drainage function and inflammatory arthritis and discussed the effects of Chinese medicine on lymphatic reflux function and related progress on inflammatory arthritis in expectation of providing the novel approaches for clinical treatments of RA and a new interpretation of Bi theory.