慢性肾脏病(CKD)是由多种肾脏疾病长期发展而来的慢性进展性疾病,肾性骨病(renal osteopathy)是慢性肾脏病晚期与血液透析患者的重要并发症。通常由肾小球滤过功能下降引起钙磷代谢紊乱和继发性甲状旁腺功能亢进,进而引发骨形成与吸收的异常,以骨骼畸形、骨质疏松、骨痛、软组织和血管钙化以及皮肤瘙痒等为主要表现。该文论述了肾性骨病的相关分子通路及治疗肾性骨病方面应用较为广泛的中药单体和复方的作用机制,旨在为中药防治肾性骨病的临床应用及新药研发提供思路。Chronic kidney disease (CKD) is a progressive long-term condition that evolves from various renal disorders. Renal osteopathy, a significant complication in advanced CKD and hemodialysis patients, is typically caused by the decline in glomerular filtration rate, leading to calcium-phosphorus metabolism disorders and secondary hyperparathyroidism. This, in turn, triggers abnormalities in bone formation and resorption, characterized by skeletal deformities, osteoporosis, bone pain, soft tissue and vascular calcification, and skin itching. The article discusses the molecular pathways associated with renal osteopathy and the mechanisms of action of widely used monomers and compound formulations of traditional Chinese medicine in treating this condition. The aim is to provide insights for the clinical application and development of new drugs for the prevention and treatment of renal osteopathy using traditional Chinese medicine.
激素性股骨头坏死(steroid-induced osteonecrosis of the femoral head,SIONFH)是由于糖皮质激素使用不当或过度而引起的髋关节疾病,发病机制尚未统一,临床疗效亦不佳。当前,没有效果明确的药物可以延缓疾病进程,而中医药治疗SIONFH在临床上取得一定疗效。即便如此,仍未能完整的从分子生物及细胞生物学角度阐明中药治疗SIONFH的作用机制。转化生长因子-β(TGF-β)/骨形态发生蛋白(BMP)/Smad信号通路的转导是防治SIONFH的研究热点之一,故该文阐明了该信号通路的转导机制以及与SIONFH的联系,检索了基于该通路治疗SIONFH的全部中药及复方并阐述其影响机制。基于中医对SIONFH的认识,现临床上使用补肝肾强筋骨以及活血祛瘀通络类的方药治疗SIONFH,且具有良好的疗效。中药通过调控该通路,可刺激骨髓间充质干细胞成骨分化,降低破骨细胞含量,减少脂肪生成,改善微循环,抗氧化损伤,促进股骨头内血管新生,从而促进股骨头损伤的修复。现基于TGF-β/BMP/Smad信号通路对中医药治疗SIONFH的研究进展做一综述,期许为中医药治疗SIONFH提供理论依据及参考。
