高渗葡萄糖增生疗法诱导新细胞增殖修复软组织缓解疼痛:现状与问题
|
摘要
背景:高渗葡萄糖增生疗法是一种在肌腱和韧带附着于骨组织的部位注入增殖剂来诱导新细胞的增殖来修复软组织的疼痛管理方法,因其价格低廉、安全性高,临床应用逐渐增多。目的:就高渗葡萄糖增生疗法的概念、目前机制研究、临床研究、注意事项、禁忌证及不良反应等方面进行综述。方法:结合英文检索词(hypertonic glucose、Dextrose Prolotherapy、proliferation therapy)和中文检索词(高渗葡萄糖、增生疗法),检索PubMed、Embase、The Cochrane Library、CNKI(中国知网)、cqVIP(维普资讯网)、万方全文数据库,搜索关于高渗葡萄糖增生疗法的特点、产生及发展相关领域的文章,并进行总结和综述。结果与结论:相关细胞研究及动物实验研究了高渗葡萄糖在促进软骨修复、促纤维化以及神经血管效应方面的作用。临床研究也表明高渗葡萄糖增生疗法可以治疗多种类型的软组织损伤与疼痛类疾病,但目前实验研究机制较单一,临床试验异质性较大,随访时间较短,因此仍需开展大量的科学严谨的实验机制研究来阐明其具体机制,以及开展高质量、高同质性、长期随访的随机对照试验来验证高渗葡萄糖增生疗法的临床疗效。
BACKGROUND: Dextrose prolotherapy is a pain management method that injects a proliferation agent to induce the proliferation of new cells to repair soft tissue at the site where the tendon and ligament are attached to the bone tissue. Due to its low price and high safety, clinical applications are gradually increasing.OBJECTIVE: To summarize the concept of hyperosmotic glucose hyperplasia therapy, current mechanism research, clinical research,matters needing attention, contraindications, side effects and adverse reactions.METHODS: Keywords of "hypertonic glucose, dextrose prolotherapy and proliferation therapy" in English and Chinese were used in PubMed,Embase, The Cochrane Library, CNKI, VIP and WanFang databases. The articles related to the characteristics, generation and development of hypertonic glucose hyperplasia therapy were retrieved and summarized.RESULTS AND CONCLUSION: Related cell studies and animal experiments have investigated the role of hypertonic glucose in promoting cartilage repair, profibrosis, and neurovascular effects. Clinical studies have shown that dextrose prolotherapy can treat many types of soft tissue injury and pain-like diseases, but the current experimental research mechanism is relatively simple, clinical trials are heterogeneous,and the follow-up time is short, so a lot of scientific studies on experimental mechanism still need to be carried out to clarify its specific mechanisms. High-quality, high homogeneity, long-term follow-up randomized controlled trials should be conducted to verify the clinical efficacy of dextrose prolotherapy.
BACKGROUND: Dextrose prolotherapy is a pain management method that injects a proliferation agent to induce the proliferation of new cells to repair soft tissue at the site where the tendon and ligament are attached to the bone tissue. Due to its low price and high safety, clinical applications are gradually increasing.OBJECTIVE: To summarize the concept of hyperosmotic glucose hyperplasia therapy, current mechanism research, clinical research,matters needing attention, contraindications, side effects and adverse reactions.METHODS: Keywords of "hypertonic glucose, dextrose prolotherapy and proliferation therapy" in English and Chinese were used in PubMed,Embase, The Cochrane Library, CNKI, VIP and WanFang databases. The articles related to the characteristics, generation and development of hypertonic glucose hyperplasia therapy were retrieved and summarized.RESULTS AND CONCLUSION: Related cell studies and animal experiments have investigated the role of hypertonic glucose in promoting cartilage repair, profibrosis, and neurovascular effects. Clinical studies have shown that dextrose prolotherapy can treat many types of soft tissue injury and pain-like diseases, but the current experimental research mechanism is relatively simple, clinical trials are heterogeneous,and the follow-up time is short, so a lot of scientific studies on experimental mechanism still need to be carried out to clarify its specific mechanisms. High-quality, high homogeneity, long-term follow-up randomized controlled trials should be conducted to verify the clinical efficacy of dextrose prolotherapy.
引文
[1]Fullerton BD.Prolotherapy for the Thoracolumbar Myofascial System. Phys Med RehabilClin N Am.2018, 29(1):125-138.
[2]Rabago D,Nourani B.Prolotherapy for Osteoarthritis and Tendinopathy:a Descriptive Review. Curr Rheumatol Rep. 2017;19(6):34.
[3]Sanderson LM, Bryant A. Effectiveness and safety of prolotherapy injections for management of lower limb tendinopathy and fasciopathy:a systematic review. J Foot Ankle Res. 2015;8:57.
[4]Nourani B,Rabago D. Prolotherapy for Knee Osteoarthritis:A Descriptive Review. Curr Phys Med Rehabil Rep.2016; 4(1):42-49.
[5]Derakhshan P. What is the role of erythropoietin prolotherapy on pain relief of knee osteoarthritis?. J Res Med Sci. 2018 6;23:50.
[6]Ryu K, Ko D, Lim G,et al.Ultrasound-Guided Prolotherapy with Polydeoxyribonucleotide for Painful Rotator Cuff Tendinopathy. Pain Res Manag. 2018;2018:8286190..
[7]Refai H.Long-term therapeutic effects of dextrose prolotherapy in patients with hypermobility of the temporomandibular joint:a single-arm study with 1-4 years’ follow up. Br J Oral Maxillofac Surg.2017;55(5):465-470.
[8]Rabago D, Slattengren A, Zgierska A. Prolotherapy in Primary Care Practice. Prim Care. 2010;37(1):65-80.
[9]Rahimzadeh P, Imani F, Faiz SH, et al. Investigation the efficacy of intra-articular prolotherapy with erythropoietin and dextrose and intra-articular pulsed radiofrequency on pain level reduction and range of motion improvement in primary osteoarthritis of knee. J Res Med Sci. 2014;19(8):696-702.
[10] Park YS, Lim SW, Lee IH, et al. Intra-articular injection of a nutritive mixture solution protects articular cartilage from osteoarthritic progression induced by anterior cruciate ligament transection in mature rabbits:a randomized controlled trial. Arthritis Res Ther.2007;9(1):R8.
[11] Jensen KT, Rabago DP, Best TM, et al. Early inflammatory response of knee ligaments to prolotherapy in a rat model. J Orthop Res. 2008;26(6):816-823.
[12] Chan O, Havard B, Morton S, et al. Outcomes of prolotherapy for intra-tendinous Achilles tears:a case series. Muscles Ligaments Tendons J. 2017;7(1):78-87.
[13] Wu TJ,Fong YC,Lin CY,et al.Glucose enhances aggrecan expression in chondrocytes via the PKCα/p38-miR141-3p signaling pathway. J Cell Physiol. 2018;233(9):6878-6887.
[14] Derby B M,Reichensperger J, Chambers C, et al. Early Growth Response Factor-1:Expression in a Rabbit Flexor Tendon Scar Model. Plast Reconstr Surg. 2012;129(3):435e-442e.
[15] Hoksrud A,Ohberg L,Alfredson H,et al.Ultrasound-guided sclerosis of neovessels in painful chronic patellar tendinopathy:a randomized controlled trial. Am J Sports Med. 2006;34(11):1738-1746.
[16] Burdakov D, Jensen L T, Alexopoulos H, et al. Tandem-Pore K+,Channels Mediate Inhibition of Orexin Neurons by Glucose. Neuron.2006;50(5):711-722.
[17] Ryan M, Wong A. Ultrasound-guided injections of hyperosmolar dextrose for overuse patellar tendinopathy:a pilot study.Br J Sports Med.2011;45(12):972-977.
[18] Lyftogt J. Subcutaneous prolotherapy treatment of refractory knee,shoulder, and lateral elbow pain. Australasian Musculoskeletal Medicine. 2007; 12(2):202-210.
[19] Veronesi B,Oortgiesen M.Neurogenic Inflammation and Particulate Matter(PM)Air Pollutants. Neurotoxicology, 2001; 22(6):795-810.
[20] Tsai CH, Chiang YC, Chen HT, et al. High glucose induces vascular endothelial growth factor production in human synovial fibroblasts through reactive oxygen species generation. Biochim Biophys Acta.2013;1830(3):2649-2658.
[21] Ashraf S, Walsh DA. Angiogenesis in osteoarthritis. Curr Opin Rheumatol. 2008;20(5):573-580.
[22] Ismail HM, Yamamoto K, Vincent TL, et al. Interleukin-1 Acts via the JNK-2 Signaling Pathway to Induce Aggrecan Degradation by Human Chondrocytes. Arthritis Rheumatol. 2015;67(7):1826-1836.
[23] Dagenais S,Ogunseitan O,Haldeman S, et al. Side Effects and Adverse Events Related to Intraligamentous Injection of Sclerosing Solutions(Prolotherapy)for Back and Neck Pain:A Survey of Practitioners. Arch Phys Med Rehabil. 2006;87(7):909-913.
[24] Vora A,Borg-Stein J, Nguyen R T. Regenerative injection therapy for osteoarthritis:fundamental concepts and evidence-based review.PM R. 2012;4(5 Suppl):S104-S109.
[25] Rabago D,Kijowski R, Woods M, et al. Association between disease-specific quality-of-life and magnetic resonance imaging outcomes in a clinical trial of prolotherapy for knee osteoarthritis.Arch Phys Med Rehabil. 2013;94(11):2075-2082.
[26] Eslamian F, Amouzandeh B. Therapeutic effects of prolotherapy with intra-articular dextrose injection in patients with moderate knee osteoarthritis:a single-arm study with 6 months follow up. Ther Adv Musculoskelet Dis. 2015;7(2):35-44.
[27] Jean-Paul Ouellette,Jeffrey J.Patterson,George Yu,许涛.增生疗法[J].实用疼痛学杂志,2006,2(1):3-9.
[28] Lyftogt J. Prolotherapy and Achilles tendinopathy:a prospective pilot study of an old treatment. Australasian Musculoskeletal Medicine. 2005;10(1):12-16.
[29] Maxwell NJ, Ryan MB, Taunton JE, et al. Sonographically Guided Intratendinous Injection of Hyperosmolar Dextrose to Treat Chronic Tendinosis of the Achilles Tendon:A Pilot Study. Ajr Am J Roentgenol. 2007; 189(4):215-220.
[30] Ryan M,Wong A,Taunton J.Favorable Outcomes After Sonographically Guided Intratendinous Injection of Hyperosmolar Dextrose for Chronic Insertional and Midportion Achilles Tendinosis.AJR Am J Roentgenol. 2010;194(4):1047-1053.
[31] Schultz LW. A Treatment for subluxation of the Temporomandibular Joint. JAMA.1937; 109(12):1947-1950.
[32] Nagori SA, Jose A, Gopalakrishnan V, et al. Roy ID The efficacy of dextrose prolotherapy over placebo for temporomandibular joint hypermobility:a systematic review and meta-analysis. J Oral Rehabil. 2018;45(12):998-1006.
[33] Refai H,Altahhan O,Elsharkawy R.The efficacy of dextrose prolotherapy for temporomandibular joint hypermobility:a preliminary prospective, randomized, double-blind, placebocontrolled clinical trial.J Oral Maxillofac Surg. 2011;69(12):2962-2970.
[34] KilicSC, GungormusM. Is dextrose prolotherapy superior to placebo for the treatment of temporomandibular joint hypermobility?A randomized clinical trial. Int J Oral Maxillofac Surg. 2016;45(7):813-819.
[35] Mustafa R,GungormusM,Mollaoglu N.Evaluation of the Efficacy of Different Concentrations of Dextrose Prolotherapy in Temporomandibular Joint Hypermobility Treatment. J Craniofac Surg. 2018;29(5):e461-e465.
[36] Umlauf D,Frank S,Pap T,et al.Cartilage biology, pathology, and repair. Cell Mol Life Sci. 2010;67(24):4197-4211.
[37] Clifton T,Selby M.Epidural abscess from prolotherapy:a cautionary tale. ANZ J Surg. 2018;88(3):E216-E217..
[38]刘伟,陈世荣.不同支架材料与间充质干细胞构建组织工程韧带在前交叉韧带损伤中的应用[J].中国组织工程研究, 2011,15(38):7181-7184.
[39]侯存强,周宪华,孙磊.骨骼肌对前交叉韧带重建腱性移植物关节内愈合效果的影响[J].中国骨科临床与基础研究杂志, 2012,4(2):133-137.
[40] Sahr M, Sturnick DR, Nwawka OK. Quantitative Ultrasound Assessment of the Achilles Tendon Under Varied Loads. J Ultrasound Med. 2018;(3):13-23.
[2]Rabago D,Nourani B.Prolotherapy for Osteoarthritis and Tendinopathy:a Descriptive Review. Curr Rheumatol Rep. 2017;19(6):34.
[3]Sanderson LM, Bryant A. Effectiveness and safety of prolotherapy injections for management of lower limb tendinopathy and fasciopathy:a systematic review. J Foot Ankle Res. 2015;8:57.
[4]Nourani B,Rabago D. Prolotherapy for Knee Osteoarthritis:A Descriptive Review. Curr Phys Med Rehabil Rep.2016; 4(1):42-49.
[5]Derakhshan P. What is the role of erythropoietin prolotherapy on pain relief of knee osteoarthritis?. J Res Med Sci. 2018 6;23:50.
[6]Ryu K, Ko D, Lim G,et al.Ultrasound-Guided Prolotherapy with Polydeoxyribonucleotide for Painful Rotator Cuff Tendinopathy. Pain Res Manag. 2018;2018:8286190..
[7]Refai H.Long-term therapeutic effects of dextrose prolotherapy in patients with hypermobility of the temporomandibular joint:a single-arm study with 1-4 years’ follow up. Br J Oral Maxillofac Surg.2017;55(5):465-470.
[8]Rabago D, Slattengren A, Zgierska A. Prolotherapy in Primary Care Practice. Prim Care. 2010;37(1):65-80.
[9]Rahimzadeh P, Imani F, Faiz SH, et al. Investigation the efficacy of intra-articular prolotherapy with erythropoietin and dextrose and intra-articular pulsed radiofrequency on pain level reduction and range of motion improvement in primary osteoarthritis of knee. J Res Med Sci. 2014;19(8):696-702.
[10] Park YS, Lim SW, Lee IH, et al. Intra-articular injection of a nutritive mixture solution protects articular cartilage from osteoarthritic progression induced by anterior cruciate ligament transection in mature rabbits:a randomized controlled trial. Arthritis Res Ther.2007;9(1):R8.
[11] Jensen KT, Rabago DP, Best TM, et al. Early inflammatory response of knee ligaments to prolotherapy in a rat model. J Orthop Res. 2008;26(6):816-823.
[12] Chan O, Havard B, Morton S, et al. Outcomes of prolotherapy for intra-tendinous Achilles tears:a case series. Muscles Ligaments Tendons J. 2017;7(1):78-87.
[13] Wu TJ,Fong YC,Lin CY,et al.Glucose enhances aggrecan expression in chondrocytes via the PKCα/p38-miR141-3p signaling pathway. J Cell Physiol. 2018;233(9):6878-6887.
[14] Derby B M,Reichensperger J, Chambers C, et al. Early Growth Response Factor-1:Expression in a Rabbit Flexor Tendon Scar Model. Plast Reconstr Surg. 2012;129(3):435e-442e.
[15] Hoksrud A,Ohberg L,Alfredson H,et al.Ultrasound-guided sclerosis of neovessels in painful chronic patellar tendinopathy:a randomized controlled trial. Am J Sports Med. 2006;34(11):1738-1746.
[16] Burdakov D, Jensen L T, Alexopoulos H, et al. Tandem-Pore K+,Channels Mediate Inhibition of Orexin Neurons by Glucose. Neuron.2006;50(5):711-722.
[17] Ryan M, Wong A. Ultrasound-guided injections of hyperosmolar dextrose for overuse patellar tendinopathy:a pilot study.Br J Sports Med.2011;45(12):972-977.
[18] Lyftogt J. Subcutaneous prolotherapy treatment of refractory knee,shoulder, and lateral elbow pain. Australasian Musculoskeletal Medicine. 2007; 12(2):202-210.
[19] Veronesi B,Oortgiesen M.Neurogenic Inflammation and Particulate Matter(PM)Air Pollutants. Neurotoxicology, 2001; 22(6):795-810.
[20] Tsai CH, Chiang YC, Chen HT, et al. High glucose induces vascular endothelial growth factor production in human synovial fibroblasts through reactive oxygen species generation. Biochim Biophys Acta.2013;1830(3):2649-2658.
[21] Ashraf S, Walsh DA. Angiogenesis in osteoarthritis. Curr Opin Rheumatol. 2008;20(5):573-580.
[22] Ismail HM, Yamamoto K, Vincent TL, et al. Interleukin-1 Acts via the JNK-2 Signaling Pathway to Induce Aggrecan Degradation by Human Chondrocytes. Arthritis Rheumatol. 2015;67(7):1826-1836.
[23] Dagenais S,Ogunseitan O,Haldeman S, et al. Side Effects and Adverse Events Related to Intraligamentous Injection of Sclerosing Solutions(Prolotherapy)for Back and Neck Pain:A Survey of Practitioners. Arch Phys Med Rehabil. 2006;87(7):909-913.
[24] Vora A,Borg-Stein J, Nguyen R T. Regenerative injection therapy for osteoarthritis:fundamental concepts and evidence-based review.PM R. 2012;4(5 Suppl):S104-S109.
[25] Rabago D,Kijowski R, Woods M, et al. Association between disease-specific quality-of-life and magnetic resonance imaging outcomes in a clinical trial of prolotherapy for knee osteoarthritis.Arch Phys Med Rehabil. 2013;94(11):2075-2082.
[26] Eslamian F, Amouzandeh B. Therapeutic effects of prolotherapy with intra-articular dextrose injection in patients with moderate knee osteoarthritis:a single-arm study with 6 months follow up. Ther Adv Musculoskelet Dis. 2015;7(2):35-44.
[27] Jean-Paul Ouellette,Jeffrey J.Patterson,George Yu,许涛.增生疗法[J].实用疼痛学杂志,2006,2(1):3-9.
[28] Lyftogt J. Prolotherapy and Achilles tendinopathy:a prospective pilot study of an old treatment. Australasian Musculoskeletal Medicine. 2005;10(1):12-16.
[29] Maxwell NJ, Ryan MB, Taunton JE, et al. Sonographically Guided Intratendinous Injection of Hyperosmolar Dextrose to Treat Chronic Tendinosis of the Achilles Tendon:A Pilot Study. Ajr Am J Roentgenol. 2007; 189(4):215-220.
[30] Ryan M,Wong A,Taunton J.Favorable Outcomes After Sonographically Guided Intratendinous Injection of Hyperosmolar Dextrose for Chronic Insertional and Midportion Achilles Tendinosis.AJR Am J Roentgenol. 2010;194(4):1047-1053.
[31] Schultz LW. A Treatment for subluxation of the Temporomandibular Joint. JAMA.1937; 109(12):1947-1950.
[32] Nagori SA, Jose A, Gopalakrishnan V, et al. Roy ID The efficacy of dextrose prolotherapy over placebo for temporomandibular joint hypermobility:a systematic review and meta-analysis. J Oral Rehabil. 2018;45(12):998-1006.
[33] Refai H,Altahhan O,Elsharkawy R.The efficacy of dextrose prolotherapy for temporomandibular joint hypermobility:a preliminary prospective, randomized, double-blind, placebocontrolled clinical trial.J Oral Maxillofac Surg. 2011;69(12):2962-2970.
[34] KilicSC, GungormusM. Is dextrose prolotherapy superior to placebo for the treatment of temporomandibular joint hypermobility?A randomized clinical trial. Int J Oral Maxillofac Surg. 2016;45(7):813-819.
[35] Mustafa R,GungormusM,Mollaoglu N.Evaluation of the Efficacy of Different Concentrations of Dextrose Prolotherapy in Temporomandibular Joint Hypermobility Treatment. J Craniofac Surg. 2018;29(5):e461-e465.
[36] Umlauf D,Frank S,Pap T,et al.Cartilage biology, pathology, and repair. Cell Mol Life Sci. 2010;67(24):4197-4211.
[37] Clifton T,Selby M.Epidural abscess from prolotherapy:a cautionary tale. ANZ J Surg. 2018;88(3):E216-E217..
[38]刘伟,陈世荣.不同支架材料与间充质干细胞构建组织工程韧带在前交叉韧带损伤中的应用[J].中国组织工程研究, 2011,15(38):7181-7184.
[39]侯存强,周宪华,孙磊.骨骼肌对前交叉韧带重建腱性移植物关节内愈合效果的影响[J].中国骨科临床与基础研究杂志, 2012,4(2):133-137.
[40] Sahr M, Sturnick DR, Nwawka OK. Quantitative Ultrasound Assessment of the Achilles Tendon Under Varied Loads. J Ultrasound Med. 2018;(3):13-23.