中药治疗绝经后骨质疏松症及其作用机制的研究进展
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摘要
绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)是一种全身性骨代谢疾病,好发于绝经后女性,体内雌激素水平下降是其主要病因,故而补充雌激素是最直接、有效的方法,然而长期服用雌激素将会带来诸如增加妇科肿瘤发病风险等副作用。近年来,从植物中提取的活性成分——植物雌激素引起了人们的广泛关注,其与天然雌激素拥有相似的结构,所以同样能够作用于雌激素在骨组织上的靶点——雌激素受体。临床实践证实,多种中药对PMOP疗效显著,其作用机制也随着研究的深入而逐渐被揭示,无论是提高雌激素水平,还是增加雌激素受体的表达,抑或通过雌激素调节骨代谢相关因子,中药都有着卓越表现,因而对其的进一步研究显得尤为重要。
Postmenopausal osteoporosis( PMOP) is a systemic metabolic bone disease which frequently occurs among postmenopausal women. Decrease in the level of internal estrogen is the main cause of PMOP. Therefore supplementing estrogen is the most direct and effective method of PMOP treatment. However,long-term intake of PMOP causes side-effects including an increased risk of gynecologic tumors. In recent years,phytoestrogen( PE),an active constituent extracted from plants has attracted much attention.Due to its similar structure to natural estrogen,PE can also affect estrogen receptors,the target on the bones for estrogen. Many traditional Chinese medicines prove to be highly effective at PMOP treatment through clinical practice,and their mechanisms of action are progressively uncovered as more research is conducted. TCM produce significant results in raising the level of estrogen receptors,increasing the expression of estrogen receptors and regulating the related factors of bone metabolism. Therefore it is extremely important to carry out further research in this field.
Postmenopausal osteoporosis( PMOP) is a systemic metabolic bone disease which frequently occurs among postmenopausal women. Decrease in the level of internal estrogen is the main cause of PMOP. Therefore supplementing estrogen is the most direct and effective method of PMOP treatment. However,long-term intake of PMOP causes side-effects including an increased risk of gynecologic tumors. In recent years,phytoestrogen( PE),an active constituent extracted from plants has attracted much attention.Due to its similar structure to natural estrogen,PE can also affect estrogen receptors,the target on the bones for estrogen. Many traditional Chinese medicines prove to be highly effective at PMOP treatment through clinical practice,and their mechanisms of action are progressively uncovered as more research is conducted. TCM produce significant results in raising the level of estrogen receptors,increasing the expression of estrogen receptors and regulating the related factors of bone metabolism. Therefore it is extremely important to carry out further research in this field.
引文
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[3]An K C.Selective Estrogen Receptor Modulators[J].Asian Spine J,2016,10(4):787-791.
[4]Wend K,Wend P,Krum S A.Tissue-Specific Effects of Loss of Estrogen during Menopause and Aging[J].Front Endocrinol(Lausanne),2012,3:19.
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[10]陈醒,周应芳,白文佩.绝经期激素替代治疗的相关肿瘤风险研究进展[J].国际妇产科学杂志,2016,43(5):489-492,496.
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[12]Rietjens I M,Louisse J,Beekmann K.The potential health effects of dietary phytoestrogens[J].Br J Pharmacol,2016,174(11):1263-1280.
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[15]刘颖,陈中沛,邓武权,等.黑升麻提取物治疗围绝经期骨质疏松患者的疗效[J].中国老年学杂志,2013,33(6):1241-1242.
[16]徐秀玲,马娴,孙津津.加味二仙汤治疗绝经后骨质疏松症的疗效观察及其对患者E-2、ALP水平的影响[J].中国中医药科技,2016,23(1):68,74.
[17]高卫辉,吴芬芬,段小青,等.杜仲-牛膝药对干预去卵巢骨质疏松大鼠雌二醇和骨密度的影响实验研究[J].中南药学,2016,14(8):820-823.
[18]王建华,郭敏,郑丽,等.补骨脂素干预大鼠成骨细胞骨保护素/核因子κB受体激活因子配体m RNA的表达[J].中国组织工程研究与临床康复,2010,14(37):6927-6930.
[19]陈鑫,朱雄白,林文军,等.仙灵骨葆胶囊治疗绝经后骨质疏松的疗效及其机制研究[J].中国临床药理学杂志,2015,31(10):827-829,854.
[20]方晔,邹斌,赵劲民,等.α-玉米赤霉醇在雌激素缺乏所致骨质疏松症中的研究进展[J].广西医科大学学报,2014,31(5):870-872.
[21]郭辉,苟丽,熊鑫鑫,等.洋葱干预后对去势大鼠骨质疏松的影响[J].中国骨质疏松杂志,2016,22(4):406-409,449.
[22]黄思敏.绝经后骨质疏松症中药用药规律及仙茅苷促成骨机制探讨[D].广州:广州中医药大学,2016.
[23]刘珊,李劲平,杨琳,等.淫羊藿苷对去势大鼠ERβ基因表达及血清E-2水平的影响[J].湖南中医杂志,2016,32(1):150-152.
[24]Pacifici R.T cells:critical bone regulators in health and disease[J].Bone,2010,47(3):461-471.
[25]周胜虎,刘兴炎,王湘辉,等.葛根素对卵巢切除大鼠血清E-2、腰椎BMD及骨髓细胞IL-6 m RNA表达的影响[J].中国骨质疏松杂志,2010,16(12):946-948.
[26]刘景科,沈霖,杨艳萍,等.青娥方对绝经后骨质疏松伴有骨痛患者血清IGF-1、IL-6以及TNF-α水平的影响[J].中国中医骨伤科杂志,2014,22(4):12-13.
[27]潘亚磊,翟远坤,牛银波,等.杜仲防治骨质疏松症的研究进展[J].化学与生物工程,2013,30(7):6-9.
[28]李翠娟,巩振东,崔馨文,等.Wnt信号通路与骨质疏松症发病关系及中医药治疗研究进展[J].现代中医药,2016,36(2):97-100.
[29]何帮剑,朱胤晟,应建伟,等.益骨汤含药血清通过经典Wnt信号通路促进成骨细胞增殖分化的研究[J].新中医,2017,49(3):10-13.
[30]陶智,郑小利,薛莎,等.不同补肾方对卵巢摘除术后骨质疏松大鼠Wnt信号表达的影响[J].世界科学技术-中医药现代化,2016,18(5):839-845.
[2]Tella SH,Gallagher JC.Prevention and treatment of postmenopausal osteoporosis[J].J Steroid Biochem Mol Biol,2014,142:155-170.
[3]An K C.Selective Estrogen Receptor Modulators[J].Asian Spine J,2016,10(4):787-791.
[4]Wend K,Wend P,Krum S A.Tissue-Specific Effects of Loss of Estrogen during Menopause and Aging[J].Front Endocrinol(Lausanne),2012,3:19.
[5]Jia M,Dahlman-Wright K,Gustafsson J A.Estrogen receptor alpha and beta in health and disease[J].Best Pract Res Clin Endocrinol Metab,2015,29(4):557-568.
[6]Almeida M,Iyer S,Martin-Millan M,et al.Estrogen receptor-alpha signaling in osteoblast progenitors stimulates cortical bone accrual[J].J Clin Invest,2013,123(1):394-404.
[7]Castillo A B,Triplett J W,Pavalko F M,et al.Estrogen receptor-beta regulates mechanical signaling in primary osteoblasts[J].Am J Physiol Endocrinol Metab,2014,306(8):937-944.
[8]Brown J P,Dempster D W,Ding B,et al.Bone remodeling in postmenopausal women who discontinued denosumab treatment:off-treatment biopsy study[J].J Bone Miner Res,2011,26(11):2737-2744.
[9]Shi L F,Wu Y,Li C Y.Hormone therapy and risk of ovarian cancer in postmenopausal women:a systematic review and meta-analysis[J].Menopause,2016,23(4):417-424.
[10]陈醒,周应芳,白文佩.绝经期激素替代治疗的相关肿瘤风险研究进展[J].国际妇产科学杂志,2016,43(5):489-492,496.
[11]Sirotkin A V,Harrath A H.Phytoestrogens and their effects[J].Eur J Pharmacol,2014,741:230-236.
[12]Rietjens I M,Louisse J,Beekmann K.The potential health effects of dietary phytoestrogens[J].Br J Pharmacol,2016,174(11):1263-1280.
[13]Maeda S S,Lazaretti-Castro M.An overview on the treatment of postmenopausal osteoporosis[J].Arq Bras Endocrinol Metabol,2014,58(2):162-171.
[14]Wolski H,Drews K,Bogacz A,et al.The RANKL/RANK/OPGsignal trail:significance of genetic polymorphisms in the etiology of postmenopausal osteoporosis[J].Ginekol Pol,2016,87(5):347-352.
[15]刘颖,陈中沛,邓武权,等.黑升麻提取物治疗围绝经期骨质疏松患者的疗效[J].中国老年学杂志,2013,33(6):1241-1242.
[16]徐秀玲,马娴,孙津津.加味二仙汤治疗绝经后骨质疏松症的疗效观察及其对患者E-2、ALP水平的影响[J].中国中医药科技,2016,23(1):68,74.
[17]高卫辉,吴芬芬,段小青,等.杜仲-牛膝药对干预去卵巢骨质疏松大鼠雌二醇和骨密度的影响实验研究[J].中南药学,2016,14(8):820-823.
[18]王建华,郭敏,郑丽,等.补骨脂素干预大鼠成骨细胞骨保护素/核因子κB受体激活因子配体m RNA的表达[J].中国组织工程研究与临床康复,2010,14(37):6927-6930.
[19]陈鑫,朱雄白,林文军,等.仙灵骨葆胶囊治疗绝经后骨质疏松的疗效及其机制研究[J].中国临床药理学杂志,2015,31(10):827-829,854.
[20]方晔,邹斌,赵劲民,等.α-玉米赤霉醇在雌激素缺乏所致骨质疏松症中的研究进展[J].广西医科大学学报,2014,31(5):870-872.
[21]郭辉,苟丽,熊鑫鑫,等.洋葱干预后对去势大鼠骨质疏松的影响[J].中国骨质疏松杂志,2016,22(4):406-409,449.
[22]黄思敏.绝经后骨质疏松症中药用药规律及仙茅苷促成骨机制探讨[D].广州:广州中医药大学,2016.
[23]刘珊,李劲平,杨琳,等.淫羊藿苷对去势大鼠ERβ基因表达及血清E-2水平的影响[J].湖南中医杂志,2016,32(1):150-152.
[24]Pacifici R.T cells:critical bone regulators in health and disease[J].Bone,2010,47(3):461-471.
[25]周胜虎,刘兴炎,王湘辉,等.葛根素对卵巢切除大鼠血清E-2、腰椎BMD及骨髓细胞IL-6 m RNA表达的影响[J].中国骨质疏松杂志,2010,16(12):946-948.
[26]刘景科,沈霖,杨艳萍,等.青娥方对绝经后骨质疏松伴有骨痛患者血清IGF-1、IL-6以及TNF-α水平的影响[J].中国中医骨伤科杂志,2014,22(4):12-13.
[27]潘亚磊,翟远坤,牛银波,等.杜仲防治骨质疏松症的研究进展[J].化学与生物工程,2013,30(7):6-9.
[28]李翠娟,巩振东,崔馨文,等.Wnt信号通路与骨质疏松症发病关系及中医药治疗研究进展[J].现代中医药,2016,36(2):97-100.
[29]何帮剑,朱胤晟,应建伟,等.益骨汤含药血清通过经典Wnt信号通路促进成骨细胞增殖分化的研究[J].新中医,2017,49(3):10-13.
[30]陶智,郑小利,薛莎,等.不同补肾方对卵巢摘除术后骨质疏松大鼠Wnt信号表达的影响[J].世界科学技术-中医药现代化,2016,18(5):839-845.