雌激素与骨关节炎

Estrogen and osteoarthritis

雌激素与骨关节炎联系紧密。骨关节炎主要是累及软骨、软骨下骨的全身性关节炎性疾病,而雌激素及其受体可通过多种途径作用于关节软骨或软骨下骨,影响其代谢或凋亡进而直接或间接影响着骨关节炎的发生、发展过程。结合国内外最近文献资料,雌激素在流行病学、临床及实验研究三方面多个层次与骨关节炎紧密相关,但具体相关性存在很大的分歧,然而绝大多数研究都认为E2缺乏可破坏软骨,几乎所有的动物实验都认为E2直接或间接与OA相关,特别是临床研究已将E2替代治疗用于临床,E2或其调节剂可有效缓解OA患者疼痛,并略微降低患病率和减少关节置换发生率。并且笔者以为结合最新OA病机和最近E2与OA关系的再认识,从分子免疫学和生物力学角度,研究E2通过局部炎性破坏或骨与软骨代谢诱导途径的某一方面探求对OA的影响将有助于进一步认识其作用机理,有利于开发针对特异靶点作用的药物。本文主要就流行病学、临床及实验研究三方面对雌激素与骨关节炎的最新研究进展做一综述。

Estrogen is closely associated with osteoarthritis. Osteoarthritis（ OA） is a disease of systemic arthritis mainly involving cartilage and subchondral bone. Estrogen and its receptors affect the metabolism or apoptosis of articular cartilage and subchondral bone,and could directly or indirectly affect the occurrence and development of osteoarthritis process through a variety of ways.Based on recent literature from China and overseas,estrogen has multiple-level close relationship with OA at three aspects epidemiology,clinical and experimental studies. There are differences among the specific correlations,however,the majority of studies have suggested that the deficiency of E2 can damage the cartilage,and almost all of the animal experiments have suggested that E2 is directly or indirectly associated with OA. In particular clinical studies have suggested the clinical application of E2 replacement therapy. E2 or its regulators can effectively relieve pain in patients with OA,and slightly reduce the prevalence rate and reduce the incidence rate of joint replacement. We consider that combining the latest progress on OA pathogenesis with the recognition of the relationship between OA and E2,from the aspects of molecular immunology and biomechanics to understand the associations of E2 with induced local inflammatory or destruction of bone and cartilage metabolism,as a research approach to OA will contribute to a better understanding of the mechanism,which will be constructive to the development of drugs for specific targets. In this paper,we reviewed the latest progress in the study of estrogen and osteoarthritis in three aspects： epidemiology,clinical and experimental research.