中医药调控氧化应激治疗骨质疏松症的研究进展

Role of Oxidative Stress in Osteoporosis and Treatment by Traditional Chinese Medicine:A Review

骨质疏松症(OP)是一种全身代谢性骨骼疾病,随着社会老龄化加重,已成为我国中老年人群首要健康问题。衰老、铁负载及雌激素缺乏等使机体氧化与抗氧化系统平衡被打破,活性氧物种增加介导氧化应激损害DNA、脂质和蛋白质等大分子物质,从而加速细胞凋亡,还可诱导OP、肥胖症及神经退行性病变等疾病的发生。近年来研究发现,氧化应激在OP发病机制中具有重要意义,氧化应激可调控骨髓间充质干细胞、成骨细胞和破骨细胞相关信号通路、细胞因子及蛋白质表达而减弱骨髓间充质干细胞成骨分化能力、抑制成骨细胞矿化和促进破骨细胞活化、增殖和成熟,导致骨吸收和形成之间动态失衡扰乱骨重建而促进了OP的进展。目前,临床多使用抗骨吸收、促进骨合成及激素类等西药治疗为主,因其治疗周期长、可并发严重胃肠道反应,低钙血症及骨坏死等风险,导致患者依从性差,以至于OP的治疗效果不如预期。中医药治疗OP因其具有多通路、多靶点协同作用,疗效显著,和常规西药相比其价格低廉、不良反应较少,广泛应用于临床。随着中医药现代化快速发展,发现其在抗氧化应激治疗OP方面显现出独特优势,可通过调节不同信号通路而发挥作用,为OP的治疗提供了新思路、开辟了新篇章。因此,笔者通过查阅近年来国内外相关文献资料,总结氧化应激在OP中的作用机制及相关中医药治疗进展作一综述,以期为进一步研究奠定基础。

Osteoporosis(OP)is a systemic metabolic bone disease.Amid population aging,OP has become a major health problem for the middle-aged and the elderly in China.Aging,iron load,and estrogen deficiency break the balance between oxidation and antioxidant systems,and the increase of reactive oxygen species mediates oxidative stress to damage DNA,lipids,proteins and other macromolecules,thus accelerating cell apoptosis and inducing OP,obesity,and neurodegenerative disorders.It has been found that oxidative stress is of great significance in the pathogenesis of OP.Oxidative stress regulates the signaling pathways,cytokines,and proteins related to the mesenchymal stem cells,osteoblasts,and osteoclasts,thereby weakening the osteogenic differentiation of mesenchymal stem cells,inhibiting osteoblast mineralization,and promoting the activation,proliferation,and maturation of osteoclasts.As a result,the dynamic imbalance between bone resorption and bone formation occurs,influencing bone remodeling and promoting the progression of OP.At the moment,anti-bone resorption drugs,bone formation-promoting drugs,and hormones are mainly used in clinical settings in western medicine.However,due to the long treatment cycle and the occurrence of serious gastrointestinal reactions,hypocalcemia,osteonecrosis,and others,patients show poor compliance and thus the effect is not as expected.Traditional Chinese medicine(TCM)demonstrates remarkable effect on OP attributing to the multi-pathway and multi-target characteristics.With low price and few adverse reactions,TCM is widely applied in clinical practice in comparison with western medicine.TCM has unique advantages in the treatment of OP by regulating oxidative stress.It exerts the therapeutic effect on OP by modulating different signaling pathways,providing new mindset for the treatment of this disease.Therefore,through literature research,this study summarized the research on mechanism of oxidative stress in OP and the treatment by TCM,which is expected to lay a foundation for further research.