针刀治疗膝骨关节炎的分子生物学机制研究进展

A review on the molecular biological mechanism of acupotomy in the treatment of knee osteoarthritis

膝骨性关节炎(Knee Osteoarthritis,KOA)作为临床最常见的骨关节退行性病变,好发于中老年人,因其发病率逐年升高,病程的不可逆,加之病因、发病机制的复杂,成为当前临床亟待解决的难题。近年来,针刀作为一种将传统针灸针和西医手术刀有机结合的独特疗法,以其轻便灵巧、安全高效的特点,在众多KOA疗法中独树一帜。随着针刀治疗KOA机制研究的不断深入,诸多研究发现其与基质金属蛋白酶及其抑制物、细胞因子及蛋白介导的级联反应密切相关。针刀治疗不仅可使KOA模型兔软骨组织中原本高表达含量的基质金属蛋白酶降低,延缓软骨损伤速度、改善关节退变进程,还可调节KOA患者血清及关节液中白细胞介素、肿瘤坏死因子-α、转化生长因子-β等相关细胞因子含量,抑制炎症因子的表达,延缓细胞外基质蛋白的降解,以减少对其关节软骨的纤维结构破坏。此外,针刀疗法通过介导对软骨细胞代谢发挥关键作用的信号通路,调控其相关蛋白及基因的表达水平,减轻关节韧带损伤,促进关节修复。基于此,文章从上述分子机制角度出发,就针刀调控KOA软组织结构、功能可塑性等方面的最新研究进行综述,通过基础研究了解该干预背后的科学原理,以期为今后临床KOA针刀疗法的选择提供更为可靠的理论依据。

Knee osteoarthritis(KOA),as the most common osteojoint degenerative disease in clinic,tends to occur in middle aged and elderly people.With the aging of the population,its incidence is increasing year by year.In addition,its course of disease is irreversible,and its etiology and pathogenesis are complex,which has become an urgent clinical problem to be solved.In recent years,acupotomology,as a unique therapy that organically combines traditional acupuncture needle and Western scalpel,is unique among many knee osteoarthritis therapies with its characteristics of lightness,dexterity,safety and efficiency.With the deepening of the research on the mechanism of acupotomy treatment of knee osteoarthritis,many studies have found that it is closely related to matrix metallo proteinases and their inhibitors,cytokines and protein-mediated cascades.Acupotomy treatment can not only reduce the matrix metallo proteinases which are originally highly expressed in the cartilage tissue of knee osteoarthritis model rabbits,but also delay the speed of cartilage injury and improve the process of joint degeneration.It can also regulate the contents of interleukin,tumor necrosis factor-α,transforming growth factor-βand other related cytokines in the serum and joint fluid of knee osteoarthritis patients,inhibit the expression of inflammatory factors and delay the degradation of extracellular matrix proteins,so as to reduce the damage to the fibrous structure of the articular cartilage.In addition,acupotomology regulates the expression levels of related proteins and genes by mediating the signaling pathway that plays a key role in the metabolism of chondrocytes,alleviates joint ligament injury and promotes joint repair.Based on this,from the perspective of the above molecular mechanism,this paper reviews the latest research on the regulation of acupotomology on the soft tissue structure and functional plasticity of knee osteoarthritis,and understands the scientific principle behind this intervention through basic research,with a prospect of providing a more reliable theoretical basis for the clinical selection of knee osteoarthritis acupotomology in the future.