选择性5-羟色胺再摄取抑制剂对骨代谢影响的研究进展

Research progress on the effect of selective 5-hydroxytryptamine serotonin reuptake inhibitors on bone metabolism

选择性5-羟色胺(5-HT)再摄取抑制剂(SSRIs)是一种广泛应用于临床的新型抗抑郁药。常用的SSRIs有氟西汀、帕罗西汀、舍曲林、氟伏沙明、西酞普兰、艾司西酞普兰。近年来SSRIs与骨代谢具有密切关系,基础研究表明SSRIs的暴露可通过影响成骨细胞和破骨细胞的增殖和功能进行骨代谢的调节。临床研究亦观察到SSRIs会导致骨质疏松症、骨密度降低、骨折风险增加,但由于不同SSRIs的分子结构、代谢特点不同及其在不同组织浓度的差异性,导致实验未得出一致结论。因国内外文献采取SSRIs的实验浓度和药物持续作用时间不同,其对骨代谢的影响和具体内在机制尚未明确。文章主要从细胞水平研究、动物模型研究及临床研究三方面就SSRIs对骨代谢的影响进行综述。

Selective 5-hydroxytryptamine(5HT)Serotonin Reuptake Inhibitor(SSRIs)is a new type of antidepressants widely used in clinic.The commonly used SSRIs are fluoxetine,paroxetine,sertraline,fluvoxamine,citalopram,and escitalopram.In recent years,SSRIs have a close relationship with bone metabolism.Basic studies have shown that SSRIs exposure can regulate bone metabolism by affecting the proliferation and function of osteoblasts and osteoclasts.Clinical studies have also observed that SSRIs can lead to osteoporosis,decreased bone density and increased risk of fracture.However,due to the different molecular structure and metabolic characteristics of different SSRIs and their differences in different tissue concentrations,no consistent conclusions have been drawn in the experiments.Due to the different concentrations of SSRIs and the duration of drug action in domestic and foreign literatures,the effect of SSRIs on bone metabolism and the specific internal mechanism are not clear yet.In this paper,the effects of SSRIs on bone metabolism were reviewed from three aspects,such as cellular level studies,animal model studies and clinical studies.