中医外治法调控类风湿关节炎相关通路研究进展

Research progress into the regulation of rheumatoid arthritis-related pathways by external treatment with traditional Chinese medicines

类风湿关节炎(rheumatoid arthritis, RA)是一种自身免疫性疾病,常以对称性小关节疼痛为早期临床表现,迁延难愈逐渐加重,常常累及多个关节最终造成关节炎畸形,使患者失去劳动能力。分子信号通路一直以来都是研究RA防治的关注焦点,研究发现RA病程发生发展与Janus激酶-信号转导与转录激活因子(JAK-STAT)信号通路、丝裂原活化蛋白激酶(MAPKs)信号通路、核因子κB(NF-κB)信号通路、NOD样受体蛋白3(NLRP3)信号通路、Toll样受体(TLRs)信号通路、Wnt信号通路、Notch信号通路、缺氧诱导因子1-α与血管内皮生长因子(HIF-1α/VEGF)信号通路、程序性死亡因子1与配体1(PD-1/PD-L1)信号通路、磷脂酰肌醇3-激酶(PI3K)/蛋白激酶B(Akt)/哺乳动物雷帕霉素靶蛋白(mTOR)信号通路均有密切联系。近些年来中医外治法基于以上信号通路治疗RA的研究逐渐增多,逐步深入。本文通过查阅相关资料与报道,阐述以上通路与RA发病、防治的关系,并总结中医外治法调控以上信号通路防治类风湿性关节的研究成果,以期为临床选用中医外治法为治疗选择提供科学依据。

Rheumatoid arthritis(RA)is an autoimmune disease with an early clinical manifestation of symmetric small joint pain,which gradually worsens and often involves multiple joints,ultimately result ing in arthritic deformities and loss of labor capacity.Molecular signaling pathways have been a focus of research regarding the prevention and treatment of RA,and the progression of RA has been shown to be closely related to various signaling pathways,including the Janus kinase-signal transducer and activator of transcription,mitogen-activated protein kinase,NOD-like receptor protein 3,Toll-like receptor,Wnt,Notch,hypoxia-inducible factor 1-αand vascular endothelial growth factor,programmed death factor 1 and ligand 1,and phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin signaling pathways.Increasing recent studies have investigated the external treatment of RA using traditional Chinese medicines based on the above signaling pathways.In this paper,we review the relevant data and reports to explain the relationship between the above pathways and the pathogenesis and prevention of RA.We also summarize the research result regarding the modulation of these signaling pathways by external treatment with traditional Chinese medicines aimed at preventing and treating rheumatoid joints,with a view to providing a scientific basis for the clinical selection of these treatments.