从“虚”论治激素性股骨头坏死与OPG/RANK/RANKL系统相关性研究进展

曹林忠 张晓刚 赵希云 宋敏 张宏伟 秦大平 汪小敏

摘要：近年研究表明，中医药治疗骨代谢疾病如激素性股骨头坏死疗效确切，受到广泛关注，但由于缺乏药效机制的分子生物学依据，尚未达到科学标准化治疗水平。OPG/RANK/RANKL系统的发现成为骨代谢疾病防治及研究的新切入点，激素性股骨头坏死“脾肾亏虚-由痰致瘀-因瘀致痹”的病机演变与该系统密切相关，从“虚”论治的效应最终可通过该系统轴向调控的微观信息来表达。本文初步探讨激素性股骨头坏死的中医辨治，并结合OPG/RANK/RANKL系统对骨代谢的调控机制阐述其相关性，为该病的防治及后续研究提供依据。

关键词：激素性股骨头坏死；OPG/RANK/RANKL系统；脾肾亏虚；综述

DOI：10.3969/j.issn.1005-5304.2017.04.034

中图分类号：R274.94 文献标识码：A 文章编号：1005-5304（2017）04-0123-04

Research Progress in Relationship Between Treating Steroid-induced Osteonecrosis of Femoral Head by Deficiency and OPG/RANK/RANKL CAO Lin-zhong1，2， ZHANG Xiao-gang1，2， ZHAO Xi-yun2， SONG Min1， ZHANG Hong-wei1， QIN Da-ping1， WANG Xiao-ming1 （1. Gansu University of Chinese Medicine， Lanzhou 730000， China； 2. Affiliated Hospital of Gansu University of Chinese Medicine， Lanzhou 730020， China）

Abstract： Recent studies have shown that TCM treatment for bone metabolic diseases， such as steroid-induced avascular necrosis of the femoral head， has definite efficacy and has received extensive attention. However， due to lack of molecular biological basis of pharmacodynamics mechanism， it has not yet reached the standard of scientific treatment. The discovery of OPG/RANK/RANKL system has become a new breakthrough point in the prevention and treatment of bone metabolic diseases. The pathogenesis of “deficiency of spleen and kidney - blood stasis - caused by phlegm arthralgia caused by blood stasis” is closely related to the system. The effect of the final control of the system from the “deficiency” theory can be expressed through the axial micro-information. This article discussed the TCM syndrome differentiation of steroid-induced osteonecrosis of the femoral head and the relation of regulation of bone metabolism combined with the OPG/RANK/RANKL system， and provided the basis for prevention and treatment of this disease.

Key words： steroid-induced osteonecrosis of femoral head； OPG/RANK/RANKL system； spleen and kidney deficiency； review

激素性股骨头坏死（steroid-induced osteonecrosis of femoral head，SONFH）是由于糖皮質激素（glucocorticoid，GC）的滥用导致机体微环境紊乱，骨组织代谢失衡，股骨头血供中断，引起局部缺血坏死，关节面塌陷，甚至引发骨折的骨代谢性疾病[1]。GC是一把双刃剑，临床滥用导致SONFH的发病率呈逐年上升趋势，占非创伤性股骨头坏死的50%以上，致残率极高，甚至发生瘫痪，增加死亡率[2-3]。GC问题已然成为影响患者生活质量的重大公共课题，也是中医药防治SONFH的难点和热点。

中医理论认为，肾为先天之本，以主骨生髓为核心，肾精为基础，至虚则精亏，骨枯髓减；脾为后天之本，化生气血之源，主湿，脾虚失健运，聚湿为痰，阻塞脉络，四肢百骸及筋骨失养，骨枯而髓削，足不任身，发为骨痹[4-5]。因此，“脾肾亏虚，由痰致瘀，因瘀致痹，乃至骨枯髓空，骨肉不相亲”成为骨痹的病机关键，治疗应以补虚为主，活血祛痰为辅，三者兼顾，后天以养先天。……