基于肠-关节轴探讨中药治疗类风湿关节炎的研究进展

Chinese Medicines Treat Rheumatoid Arthritis via Gut-joint Axis:A Review

类风湿关节炎(RA)是以局部关节疼痛为主要临床表现的系统性自身免疫性疾病,是中医临床治疗的优势病种之一。RA的起病不仅与基因等先天因素相关,而且与饮食、微生物感染等环境因素相关。肠道是人体重要的消化器官和免疫器官,定植其中的微生物促进了肠道的物质代谢、屏障保护和免疫调节功能。随着对RA发病和治疗研究的深入,肠道的结构和功能异常与RA发病、进展具有的潜在联系不断被揭示。临床和实验研究表明,RA关节炎症与受损的肠道屏障功能、失调的免疫细胞及紊乱的肠道菌群几乎同时可见。“肠-关节轴”理论与中医的整体观念高度一致。在近期对中药治疗RA的药理研究中,人们发现治疗RA的有效中药复方及成分同时发挥了抑制炎症、保护关节和维持肠道功能的作用。因此,该文总结了“肠-关节轴”的基本内涵和中药通过调节肠道菌群结构、改善微生物代谢来发挥肠道的屏障保护和免疫调节作用,从而缓解RA的机制。该综述为RA中“肠-关节轴”的深入研究提供了借鉴。

Rheumatoid arthritis(RA)is a systemic autoimmune disease with local joint pain as the main clinical manifestation.It is one of the diseases specifically responding to traditional Chinese medicine(TCM).The occurrence of RA is not only related to innate factors like genetic disorder but also associated with environmental factors,such as diets and microbial infection.The intestine,a vital human organ with digestive and immune functions,is a place where microorganisms colonize and exert intestinal metabolism-improving,barrier-protecting,and immunomodulatory effects.As the research on the onset and treatment of RA is deepening,the potential relationship of intestinal structural and functional abnormalities with the pathogenesis and progression of RA has been revealed.As clinical and experimental studies indicated,joint inflammation coexists with the impaired barrier function,imbalanced immune cells,and disordered gut microbiota.The theory of the gut-joint axis in the pathogenesis,progression,and treatment of RA is highly consistent with the holistic view in TCM.The recent pharmacological studies have shown that Chinese medicine prescriptions and active components can inhibit inflammation,protect joints,and maintain the intestinal function.This article summarizes the basic connotation of the gut-joint axis in RA and the mechanism by which TCM protect the intestinal barrier and modulate the immunity by regulating the gut microbiota structure and improving microbial metabolism in the treatment of RA.This review gives insights into the future research on the gut-joint axis in RA.