Integrative analysis of bone-formation associated genes and immune cell infiltration in osteoporosis, and the prediction of active ingredients in targeted traditional Chinese medicine

Objective To explore the differential expression and mechanisms of bone formation-related genes in osteoporosis(OP)leveraging bioinformatics and machine learning methodologies;and to predict the active ingredients of targeted traditional Chinese medicine(TCM)herbs.Methods The Gene Expression Omnibus(GEO)and GeneCards databases were employed to conduct a comprehensive screening of genes and disease-associated loci pertinent to the pathogenesis of OP.The R package was utilized as the analytical tool for the identification of differentially expressed genes.Least absolute shrinkage and selection operator(LASSO)logis-tic regression analysis and support vector machine-recursive feature elimination(SVM-RFE)algorithm were employed in defining the genetic signature specific to OP.Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses for the selected pivotal genes were conducted.The cell-type identification by estimating rela-tive subsets of RNA transcripts(CIBERSORT)algorithm was leveraged to examine the infiltra-tion patterns of immune cells;with Spearman’s rank correlation analysis utilized to assess the relationship between the expression levels of the genes and the presence of immune cells.Coremine Medical Database was used to screen out potential TCM herbs for the treatment of OP.Comparative Toxicogenomics Database(CTD)was employed for forecasting the TCM ac-tive ingredients targeting the key genes.AutoDock Vina 1.2.2 and GROMACS 2020 softwares were employed to conclude analysis results;facilitating the exploration of binding affinity and conformational dynamics between the TCM active ingredients and their biological targets.Results Ten genes were identified by intersecting the results from the GEO and GeneCards databases.Through the application of LASSO regression and SVM-RFE algorithm;four piv-otal genes were selected:coat protein(CP);kallikrein 3(KLK3);polymeraseγ(POLG);and transient receptor potential vanilloid 4(TRPV4).GO and KEGG pathway enrichment analy-ses revealed that these trait genes were predominantly engaged in the regulation of defense response activation;maintenance of cellular metal ion balance;and the production of chemokine ligand 5.These genes were notably associated with signaling pathways such as ferroptosis;porphyrin metabolism;and base excision repair.Immune infiltration analysis showed that key genes were highly correlated with immune cells.Macrophage M0;M1;M2;and resting dendritic cell were significantly different between groups;and there were signifi-cant differences between different groups(P<0.05).The interaction counts of resveratrol;curcumin;and quercetin with KLK3 were 7;3;and 2;respectively.It shows that the interac-tions of resveratrol;curcumin;and quercetin with KLK3 were substantial.Molecular docking and molecular dynamics simulations further confirmed the robust binding affinity of these bioactive compounds to the target genes.Conclusion Pivotal genes including CP;KLK3;POLG;and TRPV4;exhibited commendable significant prognostic value;and played a crucial role in the diagnostic assessment of OP.Resveratrol;curcumin;and quercetin;natural compounds found in TCM;showed promise in their potential to effectively modulate the bone-forming gene KLK3.This study provides a sci-entific basis for the interpretation of the pathogenesis of OP and the development of clinical drugs.

Effect of traditional Chinese medicine on rheumatoid arthritis bone destruction:A systematic review and meta-analysis

Objective:To systematically evaluate the efficacy of Traditional Chinese medicine for improving bone damage in rheumatoid arthritis(RA),and provide guidance for clinical treatment.Methods:computer retrieval China hownet database(CNKI),Chinese biomedical literature retrieval(SinoMed),ten thousand Data knowledge service system(WanFang Data),VIP full-text database(VIP),PubMed,MedLine and the cochrane library,collect relevant Chinese medicine for the treatment of rheumatoid arthritis,bone destruction randomized controlled trial(RCT),screening from built by researchers at the two libraries to literature in February 2020,to extract the required indicators,and incorporated into RevMan 5.2 analysis.Results:a total of 1291 patients were included in 14 RCTS.The results of meta-analysis showed that compared with the control group,The traditional Chinese medicine treatment group could improve the 25-hydroxyvitamin D of patients with RA bone damage,which was better than the western medicine control group,and the difference was statistically significant.TCM treatment group can improve the balance between osteoblasts and osteoclasts(nuclear factor B receptor activating factor;Bone mineral density;Bone alkaline phosphatase;Bone protectin;(osteocalcin),and was superior to the western medicine control group,the difference was statistically significant;(3)traditional Chinese medicine treatment group can improve RA patients with bone destruction of the balance of osteoblast and osteoclast(Ⅰtype collagen amino terminal propeptide before;Carboxy-terminal peptide of collagen;The effect of nuclear factor B receptor activator factor and bone protectin was similar to that of the western medicine control group,and the difference was not statistically significant.Conclusion:At present,the existing evidence can prove that Traditional Chinese Medicine in the treatment of rheumatoid arthritis bone damage has an exact effect,regulate the function of osteoblasts and osteoclasts,improve the level of bone metabolism of patients,prevent the progress of bone damage.

The mechanism and traditional Chinese medicine research of bone destruction and hypercalcemia in multiple myeloma

Multiple myeloma is a malignant proliferative disease of plasma cells. Its main feature is the malignant proliferation of monoclonal plasma cells and the secretion of a large number of monoclonal immunoglobulins. Because of the uncontrolled proliferation, extensive infiltration of malignant plasma cells, and the appearance and deposition of a large number of monoclonal immunoglobulins, normal polyclonal plasma cell proliferation and polyclonal immunoglobulin secretion are inhibited. It can cause extensive bone destruction, hypercalcemia, repeated infection, renal insufficiency, high viscosity syndrome and other clinical manifestations, which can alsolead to adverse consequences.In view of these unique clinical manifestations and pathological features of multiple myeloma, we systematically expounded the pathological characteristics of multiple myeloma and the treatment of traditional Chinese medicine from extensive bone destruction and hypercalcemia on the basis of Chinese and Western medicine. In order to provide theoretical support and clinical guidance for the treatment of multiple bone marrow tumors with bone destruction and hypercalcemia.

Review for treatment and signaling pathway regulation of kidney-tonifying traditional Chinese medicine on osteoporosis

The treatment and signaling pathway regulation effects of kidney-tonifying traditional Chinese medicine on osteoporosis have been widely studied,but without a systematic summary currently.This review comprehensively collected and analyzed the traditional Chinese medicine on the treatment and signaling pathway regulation of osteoporosis in recent ten years,such as Epimedium,Drynariae Rhizoma,Cnidium,Eucommia,Psoralen and Dipsacus.Based on the existing findings,we concluded the following conclusions:(1)kidney-tonifying traditional Chinese medicine treats osteoporosis mainly through BMP-Smads,Wnt/β-catenin,MAPK,PI3K/AKT signaling pathway to promote osteoblast bone formation and through OPG/RANKL/RANK,estrogen,CTSK signaling pathway to inhibit osteoclasts of bone resorption.(1)Epimedium,Drynariae Rhizoma,Cnidium and Psoralen up-regulate the key proteins and genes of BMP-Smads and Wnt/β-catenin signaling pathways to promote bone formation.(2)Epimedium,Drynariae Rhizoma,Cnidium,Eucommia,Psoralen,Dipsacusinhibit the bone resorption by mediating the OPG/RANKL/RANK signaling pathway.(2)Kidney-tonifying traditional Chinese medicine prevent and treat osteoporosis through a variety of ways:Icariin,Naringin,Osthol,Psoralen can regulate BMP-Smads,Wnt/β-catenin signaling pathway to promote bone formation,but also activate OPG/RANKL/RANK,CTSK and other signaling pathway to inhibit bone resorption.(3)The crosstalk of the signaling pathways and the animal experiments of the traditional Chinese medicine on the prevention and treatment of osteoporosis as well as their multi-target mechanism and comprehensive regulation need further clarification.

Traditional Chinese medicine manipulative reduction combined with percutaneous vertebroplasty for treating type Ⅲ Kummell's disease: A case report

BACKGROUND A patient with type Ⅲ Kummell’s disease had a ruptured posterior cortex of the fractured vertebral body, which caused spinal cord compression. An open surgery was considered the best choice of operation. However, the patient and her family refused open surgery and instead demanded a minimally invasive surgical treatment such as percutaneous vertebroplasty(PVP). After preoperative discussion, we finally adopted the novel therapy of traditional Chinese medicine manipulative reduction(TCMMR) combined with PVP.CASE SUMMARY A patient with type Ⅲ Kummell’s disease exhibiting bone block-induced spinal cord compression was admitted to our hospital. She suffered from a variety of medical disorders but refused open surgery, and instead asked for PVP surgery. TCMMR, in parallel with PVP, was used to restore the height of the compressed vertebral body and reduce the symptoms of spinal cord compression by the bone block in order to strengthen the vertebral body and prevent further collapse. The surgery was very successful. The height of the compressed vertebra was restored, and the symptom of spinal cord compression by bone block was reduced successfully via TCMMR. The fractured vertebra was solidified by the PVP. The pain visual analog score declined from preoperative 7 scores to postoperative 2 scores, and the Frankel spinal cord scale increased from preoperative D degree to postoperative E degree.CONCLUSION The new method has advantages in treating patients with type Ⅲ Kummell’s disease who cannot be treated with open surgery.

The prognosis and survival of integrated traditional Chinese and western medicine on glioma: a meta-analysis

Objective:To systematically access the effects of integrated traditional Chinese and western medicine treatment versus western medicine treatment alone in glioma.Methods:Published randomized controlled trials were included from electronic databases(Cochrane Library,Pubmed,Embase,Chinese National Knowledge Infrastructure,Wanfang database,Chinese Scientific Journal Database,Chinese Biomedical Literature Database.Deadline on January 30,2020).The Cochrane handbook was referred to evaluate the methodological quality.Curative efficacy,gastrointestinal side effects,bone marrow suppression,survival time and quality of life(Karnofsky)were compared between the two groups.Meta-analysis was conducted using Reveman 5.3 and Stata 14.0 software.Results:Twelve randomized controlled trials involved 886 cases were selected,including 446 cases in the trial group and 440 cases in the control group.The meta-analysis indicated that the overall efficacy of integrated traditional Chinese and western medicine showed significant improvement compared with western medicine alone.The effects included reduced tumor size(RR=1.32,95%CI(1.18,1.49),P<0.05),gastrointestinal adverse reactions(RR=0.42,95%CI(0.30,0.60),P<0.05),bone marrow suppression(RR=0.437,95%CI(0.282,0.677),P<0.05),and improved KPS score(SMD=0.632,95%CI(0.312,0.952),P<0.05).Conclusion:For patients with glioma,integrated traditional Chinese and western medicine treatment can be one of the options for a better treatment.

Review on the research of Chinese medicine promoting tissue regeneration

In the long history of the Chinese nation,traditional Chinese medicine has made great contributions to the protection of the health of the Chinese people.Given that many pathological processes can cause tissue damage,does Chinese medicine also promote tissue regeneration in the process of disease recovery?It has been found from recent research articles that traditional Chinese medicine can promote tissue regeneration in the treatment of diseases.The following is an illustration of the role of Chinese medicine in selected parts of the study.

斑马鱼模型在中医药防治骨质疏松应用的研究进展

随着骨质疏松(osteoporosis,OP)动物模型的不断发展,斑马鱼逐渐成为中医药防治OP的常用动物模型之一。文章整理了近五年来以斑马鱼作为动物模型在OP防治方面的运用,系统综述了不同种类斑马鱼OP模型的建立以及通过斑马鱼对单体中药、中药复方以及中成药对OP防治的药理、毒理的研究进展。以期对OP发病机制以及抗OP药物筛选、研究的动物模型选择提供新的思路与方法。

中药有效成分结合骨组织工程材料用于骨修复

背景:如何修复骨缺损一直以来是临床难题,中药有效成分在骨修复方面具有良好的生物活性与治疗效果,将中药有效成分与组织工程材料相结合在骨修复领域具有广阔的前景。不同中药有效成分与支架的组合在作用关系方面具有相似之处。目的:搜集常见的中药有效成分与支架材料组合的案例,基于七情配伍的启发将组织工程支架与中药有效成分类比为产生配伍关系的两类中药,以二者的作用关系为纲进行归纳总结。方法:检索1998年1月至2024年1月Pub Med和中国知网数据库中发表的相关文献,英文检索词:“traditional Chinese medicine,Chinese medicine,traditional Chinese medicine monomers,bone defect,bone repair,bone tissue engineering,tissue engineering,scaffold”,中文检索词:“中药,中药有效成分,中药单体,骨组织工程,骨组织工程支架,支架,组织工程,骨缺损,骨修复”,最终纳入88篇文献进行综述分析。结果与结论:(1)组织工程支架材料与中药有效成分各自均在骨修复领域有广泛的运用,二者在成骨方面优势明显但仍有许多缺陷,许多研究致力于将二者制备成复合材料,希望通过二者间的相互作用发挥减毒增效作用。(2)一些药物与材料在成骨、抗菌、促血管生成方面能互相促进,增强原有的效果,受到传统方剂配伍观念的启发,文章将其归纳为“相须”关系,并举实例佐证。(3)一些药物能提高材料的强度,而某些材料能对负载于其上的药物实现缓释控释效果、增加载药量与稳定性,或是进行靶向递送,文章将这种单方面的提升效果归纳为“相使”关系。(4)一些中药与材料搭配使用能减少对方的毒副反应,文章将这种减毒关系归纳为“相畏相杀”。(5)文章得出了一个由七情配伍关系启发、基于作用关系分类的关于中药复合支架的全新视角,将中药传统观念引入组织工程领域,为后续复合支架的研究者提供新的研究思路,并在选材搭配方面提供一定的便利。

中药调控线粒体质量控制防治骨质疏松研究进展

骨质疏松症是一种慢性代谢性骨病,主要由成骨细胞和破骨细胞之间的失衡引起。发生骨质疏松后若不及时治疗,则会引发反复骨折的恶性循环,最终导致患者残疾和过早死亡。目前治疗骨质疏松症的方法以抑制骨吸收和促进骨形成药物为主,缺少较好的治疗手段。既往国内外学者研究发现,线粒体质量控制可以通过调节成骨细胞和破骨细胞活性之间的平衡来维持骨稳态。中医通过辨证论治依据患者个人的体质进行综合调理,起到了延缓和治疗骨质疏松进展的作用。同时,研究表明中药通过靶向线粒体质量控制可以调控成骨细胞和破骨细胞以及骨髓间充质干细胞的活性,进而防止骨质疏松的发生,但相关研究缺乏系统阐述。因此,笔者将从中药调控线粒体质量控制防治骨质疏松展开研究,旨在为中药治疗骨质疏松症的新药研发和治疗方式提供新的思路和方法。

化脓性骨髓炎病因病机的古代中医文献溯源

化脓性骨髓炎属于中医学“附骨疽”“附骨痈”等范畴,文章通过系统梳理中国古代文献典籍,总结探析从先秦至明清历代医家对于化脓性骨髓炎病因病机的认识,秦汉时期多以“内虚”立论,外感热邪而致病;晋唐时期,认为患者体质素热,风寒外袭未愈,复感湿邪而致病。宋元时期认为,由于脾肾亏虚、外感风、寒、湿、火等邪气,最终导致以痰积、瘀血为病理表现。明清时期,认为病因主要由于肾、脾、肝亏虚,导致风、寒、暑、湿、火侵入,而致此病。最终为现代临床治疗化脓性骨髓炎提供中医辨治思路。

消增强骨片联合西医常规治疗肝肾亏虚兼气滞血瘀型骨质疏松症的临床观察

目的 观察消增强骨片结合西医常规治疗肝肾亏虚兼气滞血瘀型骨质疏松症的临床疗效。方法 选取2019年5月至2020年5月间四川省骨科医院骨质疏松专科门诊收治的肝肾亏虚兼气滞血瘀型骨质疏松症患者60例,按照随机数字表法分为2组,每组30例。对照组予西医常规治疗,治疗组在对照组的基础上联合消增强骨片治疗。比较较2组治疗前后骨密度(BMD)、骨代谢标志物[包括β-胶原降解产物(β-CROSSL)、总1型胶原氨基酸端延长链(t-P1NP)及25羟基维生素D(25-OH-D)]及中医证候(包括腰膝酸痛、腰膝酸软、下肢抽筋、步履艰难、持重困难)评分变化情况。结果 治疗后2组BMD水平均较治疗前增加(P<0.05),且治疗组治疗后BMD水平高于对照组(P<0.05)。治疗后2组25-OH-D水平均较前显著增加(P<0.05),t-PINP、β-CROSSL水平均降低(P<0.05),其中治疗组治疗后对25-OH-D、β-CROSSL水平改善均优于对照组(P<0.05),2组t-PINP水平治疗后组间比较差异无统计学意义(P<0.05)。治疗后治疗组中医证候分腰膝酸痛、腰膝酸软、下肢抽筋评分及总分较治疗前降低(P<0.05),对照组中医证候腰膝酸痛、腰膝酸软评分及总分较治疗前降低(P<0.05),其中治疗组治疗后腰膝酸痛、腰膝酸软、下肢抽筋评分及总分均低于对照组(P<0.05)。结论 消增强骨片联合西医常规治疗肝肾亏虚兼气滞血瘀型骨质疏松症疗效确切,可提高患者BMD水平,改善骨代谢,改善中医证候表现,可为临床骨质疏松症治疗用药起到重要的补充作用。

滇南正骨名医苏采臣正骨学术思想及其特色正骨手法

滇南苏氏正骨流派为中医骨伤科流派之一,滇南正骨名医苏采臣为滇南苏氏正骨流派承上启下的关键人物。该文系统总结了苏采臣的“顺”“合”“归”的正骨学术思想及其“原始创腔”“治血先治脉,复脉先复骨;整骨兼顺筋,瘀去骨自生”的正骨核心理念,并详述了5种治疗常见上肢骨折的正骨手法,即摇推法治疗桡骨远端骨折、漂浮法治疗尺桡骨双骨折、五步法治疗肱骨髁上骨折、分时段法治疗肱骨干骨折、脱套法治疗肱骨近端骨折合并肩关节脱位。苏采臣的正骨学术思想、正骨核心理念及其特色中医正骨手法,构建了滇南苏氏正骨学术思想及理论体系,可为中医治疗骨伤疾病提供治疗思路,将对中医骨伤的特色流派传承发展起到促进作用。

益肾强骨化瘀汤联合PVP治疗骨质疏松性脊椎压缩性骨折临床观察

目的探讨骨质疏松性脊椎压缩性骨折(OVCF)患者应用益肾强骨化瘀汤联合经皮椎体成形术(PVP)治疗的效果。方法采用随机数字表法将2020年8月—2022年2月于江西省婺源县人民医院就诊的OVCF患者60例分为观察组、对照组,各30例。两组均行PVP治疗,对照组术后予阿法骨化醇胶囊+碳酸钙片治疗,观察组加用自拟益肾强骨化瘀汤治疗,均连续治疗6周。对比两组临床疗效、疼痛程度、胸腰背部功能、椎体前缘高度、骨密度、骨代谢指标及不良反应发生情况。结果观察组临床总有效率为96.67%(29/30),高于对照组的73.33%(22/30)(P<0.05)。治疗后,观察组椎体前缘高度、骨密度高于对照组,视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评分及骨碱性磷酸酶(BALP)、骨钙素(BGP)水平低于对照组(P<0.05)。两组均未见明显不良反应。结论益肾强骨化瘀汤联合PVP治疗OVCF,效果确切,有利于改善患者骨密度及骨代谢,缓解痛苦,加速胸腰部功能恢复进程,且安全性好,值得推广。

慢性肾脏病-矿物质和骨异常的中西医治疗进展

慢性肾脏病(CKD)是威胁人体健康的一类重大疾病,已经成为全球性公共健康问题。CKD-矿物质和骨异常(MBD)是CKD患者常见的并发症之一,主要影响患者内环境及骨代谢,进而导致严重的骨质疏松。其临床治疗以调节钙磷紊乱、抑制甲状旁腺激素释放或者手术为主要方案。目前国内对于CKD-MBD的管理并没有达到理想水平,而结合中医药不仅能有效调节患者骨代谢水平,还能改善患者全身疼痛、乏力、瘙痒的症状,减慢整体病情的进展并促进肾功能恢复。因此,未来进一步规范西医治疗并结合个体化中医治疗有助于提高CKD-MBD患者的临床疗效。

Chinese topical herbal medicine gives additive effect on pharmaceutical agent on fracture healing

OBJECTIVE:To investigate the efficacy on the combination of oral strontium ranelate(Sr R)with a topical Chinese herbal paste on facilitation of fracture healing.METHODS:An open fracture was created at the mid-shaft of the right tibia of rat.A herbal pastecalled CDR containing Honghua(Flos Carthami),Chuanxuduan(Radix Dipsaci Asperoidis)and Dahuang(Radix Et Rhizoma Rhei Palmati)was prepared.The rats were treated with either CDR topically on the fracture site,or Sr R orally,or their combinations.Bone turnover biochemical markers in serum were measured.Microarchitecture of the fracture was analyzed using micro-CT after 14 and 28 d,followed by histomorphometrical analysis.RESULTS:Micro-computed tomography analysis revealed that the combined treatment of CDR with600 mg/g Sr R significantly increased the total callus density,mineralized callus volume fraction,mineralized callus mineral content and mineralized callus density of the callus after 28 d of treatment.This result was consistent with the histomorphometrical analysis on the osteoid volume.Analysis of biochemical markers showed that the combined treatments reduced the bone resorption that occurs temporarily after fracture.CONCLUSION:This study demonstrated that the combined treatment of oral Sr R and topical CDR is effective to promote fracture healing by their additive effect on promoting bone formation and retarding bone resorption.

益肾固疏方干预老年性骨质疏松症患者骨代谢标志物的变化及临床疗效

背景:随着疾病治疗模式的改变及近年来对老年性骨质疏松症研究的深入,越来越多的研究证实中医药在防治老年性骨质疏松症方面的效果显著。目的:探讨益肾固疏方对肾虚血瘀型老年性骨质疏松症患者骨代谢标志物的影响。方法:选择2020年7月至2022年3月广西中医药大学附属瑞康医院收治的肾虚血瘀型老年性骨质疏松症患者102例,其中男32例,女70例,年龄71-93岁。采用随机数字表法将102例患者分为试验组及对照组,每组51例,对照组给予碳酸钙D3颗粒+阿仑磷酸钠片治疗,治疗组给予碳酸钙D3颗粒+阿仑磷酸钠片+益肾固疏方治疗,连续治疗3个月。治疗前及治疗3个月后,检测两组患者L_(1-4)椎体与左侧股骨颈骨密度,评估目测类比评分,检测血清骨钙素、骨桥素、Ⅰ型胶原交联C-末端肽及抗酒石酸酸性磷酸酶水平,评估中医证候积分与治疗有效率。结果与结论:①两组治疗3个月后的L1-4椎体与左侧股骨颈骨密度均高于治疗前(P<0.05),试验组治疗3个月后的L1-4椎体与左侧股骨颈骨密度均高于对照组(P<0.05);②两组治疗3个月后的目测类比评分均低于治疗前(P<0.05),试验组治疗3个月后的目测类比评分低于对照组(P<0.05);③两组治疗3个月后的血清骨钙素、骨桥素、Ⅰ型胶原交联C-末端肽及抗酒石酸酸性磷酸酶水平均较治疗前明显改善(P<0.05),试验组治疗3个月后的血清骨钙素、骨桥素水平高于对照组(P<0.05),Ⅰ型胶原交联C-末端肽及抗酒石酸酸性磷酸酶水平低于对照组(P<0.05);④两组治疗3个月后的中医证候总评分均低于治疗前,试验组治疗3个月后的中医证候总评分低于对照组;治疗3个月后,两组均未发生明显不良反应,试验组于对照组治疗总有效率分别为88.2%,70.6%,组间比较差异有显著性意义(P<0.05);⑤结果显示,益肾固疏方联合抗骨质疏松药物可通过调节骨代谢、提高骨密度、减轻患者病痛来显著改善肾虚血瘀型老年性骨质疏松症患者的临床症状,阻止疾病的进一步发展。

基于筋骨理论对青少年颈痛的临床新思考

青少年颈痛症状类似于成人颈椎病,但其病理改变并不完全符合颈椎椎间盘退变。因此,应积极探索更符合其临床特点的病因学和病理学理论,实现临床对青少年颈痛的有效诊断与治疗。在石氏伤科百年治伤临床经验和最新科学研究认识的基础上,探讨青少年颈痛的诊断名称和基于“筋骨合和”理论的病因病机,并针对颈部“筋出槽、骨错缝”核心病机建立“四以相和”的诊治策略。

基于骨免疫学论中医药抑制类风湿关节炎骨破坏的研究进展

类风湿关节炎(RA)是一种以滑膜炎、软骨与骨破坏为主要病理表现的自身免疫性疾病,致残率较高。RA免疫及炎症反应与骨细胞代谢互为影响,其核心环节为破坏机体核因子κB受体活化因子配体/核因子κB受体活化因子/骨保护素(RANKL/RANK/OPG)信号通路的平衡,导致成骨细胞减少,以及破骨细胞凋亡减退及异常活化。西药目前以抑制炎症反应及相关细胞因子分泌,减缓疾病进展,但长期使用其不良反应难以忽视。中医药在防治骨破坏中研究逐步深入,但在基础及临床研究方面仍存在一定局限性。

基于“筋、节、骨、髓”分型探讨神经根型颈椎病的手法治疗

神经根型颈椎病(CSR)是一种由于颈椎间盘和椎间关节退变引起的疾病,主要表现为颈部、肩部及上肢神经支配区域的疼痛、感觉异常和运动障碍。传统中医的筋骨辨证在治疗该病时存在概念不清、辨证分型不一等问题。岐黄学者林定坤教授在筋骨辨证的基础上,结合现代解剖学提出了颈椎“筋”“节”“骨”“髓”4大分型。该文通过总结林定坤教授对CSR筋骨辨证学术思想,总结手法治疗该病的作用靶点,提出基于筋劳、节错、骨变和髓损等4种病损分型,采用理筋、调节、护髓和治骨4种手法治疗,以期完善骨伤科手法治疗CSR的辨证施治体系,为临床提供参考。