nav emailalert searchbtn searchbox tablepage yinyongbenwen piczone journalimg searchdiv qikanlogo popupnotification paper
2025 11 v.66 1089-1093
基于微观病理表型的膝骨关节炎中医学病名再认识
基金项目(Foundation): 国家中医药管理局中医药国际合作专项中心类项目(0610-2040NF020931); 中国中医科学院眼科医院高水平中医医院课题(GSP5-81);中国中医科学院科技创新工程(CI2021A02012)
邮箱(Email): gaoyun70@126.com;
DOI: 10.13288/j.11-2166/r.2025.11.001
中文作者单位:

中国中医科学院眼科医院;中国中医科学院针灸研究所;中国中医科学院中医药数据中心;中国中医科学院望京医院;

摘要(Abstract):

从膝骨关节炎微观病理表型分型角度,对中医古籍中“痹证”相关病名进行阐释。通过系统梳理中医古籍中所载着痹、骨痹、筋痹不同病名的病机及临床表现特征,结合现代膝骨关节炎滑膜炎型、软骨-半月板型、软骨下骨型病理分型研究进展,探讨中医传统病名与现代微观病理表型的对应关系。提出基于滑膜炎症病理特征的“着痹”分型、对应软骨下骨重塑异常的“骨痹”分型、表征软骨-半月板退变的“筋痹”分型,不仅为传统中医辨证提供了微观生物学解释,更为推动中西医结合诊疗创新提供思路。

关键词(KeyWords): 膝骨性关节炎;痹证;中医病名;病理表型
参考文献

[1]全国中医标准化技术委员会.中医临床名词术语第5部分:骨伤科学[S].北京:中国标准出版社,2023:12.

[2]LV Z, YANG YX, LI J, et al. Molecular classification of knee osteoarthritis[J]. Front Cell Dev Biol,2021,27(9):725568.

[3]葛伟韬,高云,刘珍珠,等.膝骨关节炎中医病名辨识[J].中医杂志,2016,57(23):1989-1992.

[4]张怡瑾,李辉,陈子颖,等.基于“筋出槽,骨错缝”病机探析推拿治疗颈椎病的调衡作用[J].中医杂志,2023,64(14):1436-1439.

[5]中华医学会骨科学分会关节外科学组.中国骨关节炎诊疗指南(2021年版)[J].中华骨科杂志,2021,41(18):1291-1314.

[6]SHARMA L. Osteoarthritis of the knee[J]. N Engl J Med, 2021,384(1):51-59.

[7]SUNG WH, TSAO YT, SHEN CJ, et al. Small-volume detection:platform developments for clinically-relevant applications[J]. J Nanobiotechnology,2021,19(1):114.

[8]ATTUR M, KRASNOKUTSKY S, ZHOU H, et al. The combination of an inflammatory peripheral blood gene expression and imaging biomarkers enhance prediction of radiographic progression in knee osteoarthritis[J]. Arthritis Res Ther,2020,22(1):208.

[9]KAPOOR M, MARTEL-PELLETIER J, LAJEUNESSE D, et al. Role of proinflammatory cytokines in the pathophysiology of osteoarthritis[J]. Nat Rev Rheumatol,2011,7(1):33-42.

[10]HU W, CHEN Y, DOU C, et al. Microenvironment in subchondral bone:predominant regulator for the treatment of osteoarthritis[J]. Ann Rheum Dis, 2021,80(4):413-422.

[11]FAULKNER B, ASTLEFORD K, MANSKY KC. Regulation of osteoclast differentiation and skeletal maintenance by histone deacetylases[J]. Molecules,2019,24(7):1355.

[12]KRAUS VB, HARGROVE DE, HUNTER DJ, et al.Establishment of reference intervals for osteoarthritisrelated soluble biomarkers:the FNIH/OARSI OA biomarkers consortium[J]. Ann Rheum Dis, 2017,76(1):179-185.

[13]EASTELL R, SZULC P. Use of bone turnover markers in postmenopausal osteoporosis[J]. Lancet Diabetes Endocrinol,2017,5(11):908-923.

[14]STEIN GS, LIAN JB. Molecular mechanisms mediating proliferation/differentiation interrelationships during progressive development of the osteoblast phenotype[J].Endocr Rev, 1993,14(4):424-442.

[15]PARK HM, LEE JH, LEE YJ. Positive association of serum alkaline phosphatase level with severe knee osteoarthritis:a nationwide population-based study[J].Diagnostics(Basel), 2020,10(12):1016.

[16]PARK EH, FRITZ J. The role of imaging in osteoarthritis[J]. Best Pract Res Clin Rheumatol, 2023,37(2):101866.

[17]HUNTER DJ, BIERMA-ZEINSTRA S. Osteoarthritis[J].Lancet,2019,393(10182):1745-1759.

[18]MARTEL-PELLETIER J, BARR AJ, CICUTTINI FM,et al. Osteoarthritis[J]. Nat Rev Dis Primers,2016,13:16072. doi:10. 1038/nrdp. 2016. 72.

[19]BERENBAUM F. Osteoarthritis as an inflammatory disease(osteoarthritis is not osteoarthrosis!)[J]. Osteoarthritis Cartilage,2013,21(1):16-21.

[20]FLEISCHMANN RM, BLIDDAL H, BLANCO FJ, et al.A phase II trial of Lutikizumab, an anti-interleukin-1α/βdual variable domain immunoglobulin, in knee osteoarthritis patients with synovitis[J]. Arthritis Rheumatol,2019,71(7):1056-1069.

[21]ROBINSON WH, LEPUS CM, WANG Q, et al. Lowgrade inflammation as a key mediator of the pathogenesis of osteoarthritis[J]. Nat Rev Rheumatol,2016,12(10):580-592.

[22]杨玉鑫,马笃军,彭力平,等.中医药防治膝骨关节炎肿胀作用机制[J].辽宁中医药大学学报,2024,26(5):71-77.

[23]LOSE-JENSEN R, HARTLEV LB, BOEL LWT, et al.Subchondral bone turnover, but not bone volume, is increased in early stage osteoarthritic lesions in the human hip joint[J]. Osteoarthritis Cartilage,2015,23(12):2167-2173.

[24]BURR DB, GALLANT MA. Bone remodelling in osteoarthritis[J]. Nat Rev Rheumatol,2012,8(11):665-673.

[25]ZHU S, ZHU J, ZHEN G, et al. Subchondral bone osteoclasts induce sensory innervation and osteoarthritis pain[J]. J Clin Invest,2019,129(3):1076-1093.

[26]ZHEN G, WEN C, JIA X, et al. Inhibition of TGF-β signaling in mesenchymal stem cells of subchondral bone attenuates osteoarthritis[J]. Nat Med, 2013,19(6):704-712.

[27]茆敏,朱在师,易周萍,等.基于“肾主骨生髓通于脑”理论探析膝骨关节炎疼痛的神经调控[J].风湿病与关节炎,2024,13(1):47-49.

[28]BOYDE A. The bone cartilage interface and osteoarthritis[J]. Calcif Tissue Int, 2021,109(3):303-328.

[29]胡永召,阮志华,韩柄秋,等.膝骨关节炎的软骨下骨改变[J].风湿病与关节炎,2022,11(8):42-46.

[30]崔玉石,吴红飞,高云,等.基于“痿痹一体”探析骨质疏松症、膝骨性关节炎共病辨治[J].中医杂志,2024,65(15):1565-1570.

[31]肖方骏,邱俊鹏,敖耀鑫,等.基于五体三候态靶辨治体系探讨膝骨关节炎的辨治思路与养护方法[J].中医正骨,2025,37(1):69-72.

[32]黄桂成,王拥军.中医骨伤科学[M].北京:中国中医药出版社,2021:266.

[33]乔连生,李军,谢兰,等.基于靶向转录组、专家经验和人工智能研发守正创新中药的路径探索:以治疗慢性心力衰竭的中药新药研发为例[J].中医杂志,2023,64(3):217-224.

基本信息:

DOI:10.13288/j.11-2166/r.2025.11.001

中图分类号:R274.9

引用信息:

[1]吴红飞,崔玉石,高云等.基于微观病理表型的膝骨关节炎中医学病名再认识[J].中医杂志,2025,66(11):1089-1093.DOI:10.13288/j.11-2166/r.2025.11.001.

基金信息:

国家中医药管理局中医药国际合作专项中心类项目(0610-2040NF020931); 中国中医科学院眼科医院高水平中医医院课题(GSP5-81);中国中医科学院科技创新工程(CI2021A02012)

检 索 高级检索

引用

GB/T 7714-2015 格式引文
MLA格式引文
APA格式引文