自体骨髓抽吸浓缩物治疗膝骨性关节炎的作用及机制

Action and mechanism of autologous bone marrow aspiration concentrate in the treatment of knee osteoarthritis

背景:目前,虽然临床上用于治疗膝骨性关节炎的方法很多,但传统的治疗方式所得到的临床益处较为局限。近年来,关节腔内注射自体骨髓抽吸浓缩物治疗膝骨性关节炎的研究颇多。目的:综述自体骨髓抽吸浓缩物治疗膝骨性关节炎的作用及机制。方法:以“骨髓抽吸浓缩物、膝骨性关节炎、骨髓间充质干细胞、转化生长因子β、血小板衍生生长因子”为中文检索词,在中国知网、万方、维普数据库检索相关文献;以“bone marrow aspirate concentrate,BMAC,knee osteoarthritis,KOA,Bone marrow mesenchymal stem cells,BMSCs,transforming growth factorβ,TGF-β,Platelet derived growth factor,PDGF”为英文检索词,在PubMed及Web of Science数据库检索相关文献;检索时间为各数据库建库至2021年8月;根据纳入和排除标准,最终纳入60篇文献进行综述。结果与结论:①自体骨髓抽吸浓缩物中各种成分在治疗膝骨性关节炎时均可发挥重要作用,主要体现在骨髓间充质干细胞可向软骨细胞分化,转化生长因子β促进软骨细胞增殖,血小板衍生生长因子可调节间充质干细胞的迁移、分化、矿化,胰岛素样生长因子1、成纤维细胞生长因子18及骨形态发生蛋白可保护修复关节软骨。②多项研究证实了关节腔内注射骨髓抽吸浓缩物的临床作用,可以缓解膝骨性关节炎患者疼痛,改善活动度,降低其对止疼药的依赖,而且能促进关节软骨再生。③骨髓抽吸浓缩物来源于自体,无免疫排斥,并且制作简便,成本较低,是临床治疗早期膝骨性关节炎的有效途径。但是,骨髓抽吸浓缩物治疗膝骨性关节炎的作用机制尚不明晰,将有待于进一步的研究探索。

BACKGROUND:At present,although there are many clinical methods for the treatment of knee osteoarthritis,unfortunately,the clinical benefits of traditional treatment methods are limited.In recent years,there are many studies on intra-articular injection of autologous bone marrow aspiration concentrate in the treatment of knee osteoarthritis.OBJECTIVE:To review effect and mechanism of autologous bone marrow aspiration concentrate in the treatment of knee osteoarthritis.METHODS:Using“bone marrow aspiration concentrate,knee osteoarthritis,bone marrow mesenchymal stem cells,transforming growth factorβ,platelet derived growth factor”as Chinese search terms,relevant articles were searched in the databases of CNKI,Wanfang,and VIP.Using“bone marrow aspirate concentrate,BMAC,knee osteoarthritis,KOA,bone marrow mesenchymal stem cells,BMSCs,transforming growth factorβ,TGF-β,platelet derived growth factor,PDGF”as English search terms,relevant articles were searched in PubMed and Web of Science databases.The retrieval time was from database establishment to August 2021.According to the inclusion and exclusion criteria,60 articles were finally included for review.RESULTS AND CONCLUSION:(1)Various components in the autologous bone marrow aspiration concentrate can play an important role in the treatment of knee osteoarthritis,which is mainly reflected in the differentiation of bone marrow mesenchymal stem cells into chondrocytes.Transforming growth factorβpromotes the proliferation of chondrocytes,and platelet-derived growth factors can regulate the migration,differentiation,and mineralization of mesenchymal stem cells.Insulin-like growth factor 1,fibroblast growth factor 18,and bone morphogenetic protein can protect and repair articular cartilage.(2)Many studies have confirmed that intra-articular injection of bone marrow aspiration concentrate can not only alleviate the pain of patients with knee osteoarthritis,improve mobility,and reduce their dependence on painkillers,but also promote the regeneration of articular cartilage.(3)Bone marrow aspiration concentrate comes from autologous,has no immune rejection,is easy to make,and has low cost.It is an effective way to treat early knee osteoarthritis.Nevertheless,the mechanism of bone marrow aspiration concentrate in the treatment of knee osteoarthritis is still unclear and needs further research and exploration.