基于“虚气留滞”探讨膝骨关节炎低度炎症环境的病机及中药治疗进展

Exploration of Pathogenesis of Low Inflammatory Environment in Knee Osteoarthritis Based on"Deficiency of Qi and Stagnation"and Progress of Traditional Chinese Medicine Treatment

膝骨关节炎(KOA)可致膝关节呈现广泛的低度炎症,中医药可改善其炎症环境,减缓KOA的发展。中医的“虚气留滞”理论与KOA低度炎症环境相契合,可认为是KOA低度炎症的基本病机,其中虚气失荣、肝肾亏虚、气血失养为KOA发病之本,留滞不通、寒湿(湿热)瘀阻、邪瘀留滞为发病之标,故临证时应注意补虚通滞、扶正祛邪、补肾活血。而中药多具有补益肝肾气血、活血化瘀、祛风寒湿功效,可通过下调白细胞介素(IL)-1β、IL-6、肿瘤坏死因子-α等炎症因子,改善低度炎症环境,恢复关节功能。故未来应高度关注KOA潜在的低度炎症环境,全面、深刻地理解其病理机制,并进一步挖掘中药治疗的具体机制。

Knee osteoarthritis(KOA)can cause extensive low inflammation of the knee joint.Traditional Chinese medicine(TCM)can improve its inflammatory environment and slow down the development of KOA.The TCM theory of"deficiency of qi and stagnation"is consistent with the low inflammatory environment of KOA and can be considered as the basic pathogenesis of low inflammation of KOA,in which the deficiency of qi,the deficiency of liver and kidney,and the disharmony of qi and blood are the root cause of KOA,while the stagnation and obstruction of cold and dampness(damp-heat),blood stasis are the symptom reasons of KOA.Therefore,in clinical practice,attention should be paid to tonifying deficiency and dredging stagnation,strengthening healthy qi and eliminating evil,tonifying kidney and activating blood circulation.Chinese medicine is mostly effective in tonifying liver and kidney qi and blood,invigorating blood stasis,dispelling wind,cold and dampness,and can improve the low inflammatory environment and restore joint function by down-regulating inflammatory factor indicators such as interleukin(IL)-1β,IL-6 and tumor necrosis factor-α.Therefore,in the future,attention should be focused on the potential low inflammatory environment in KOA,aiming to comprehensively and profoundly understand its pathological mechanisms,and further explore the specific mechanisms of TCM treatment.