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| “成血管-成骨耦联”机制及骨质疏松症治疗 |
| Discussion on the mechanism of “angiogenic-osteogenic coupling” and osteoporosis treatment |
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| DOI：10.3969/j.issn.1006-7108.2026.10.011 |
| 中文关键词: 骨质疏松症 成血管-成骨耦联 中医药 理论探讨 心肾相交 |
| 英文关键词:osteoporosis angiogenesis-osteogenesis coupling traditional Chinese medicine theoretical discussion heart-kidney interaction |
| 基金项目:深圳市“医疗卫生三名工程”（SZZYSM202311020）；深圳市中老年群体骨健康状况流行病学研究项目（2022110）；湖南省卫生健康高层次人才重大科研专项（20230479） |
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| 中文摘要: |
| 骨质疏松症（osteoporosis，OP）是一种以骨量丢失、骨结构退化和骨强度下降为特征的全身性骨骼疾病。本文基于中医“心肾相交”理论，系统探讨“成血管-成骨耦联（angiogenic-osteogenic coupling）”机制在OP发病中的作用及OP的中西医结合防治策略。“心肾相交”理论强调心肾两脏在经络互通、气机相合、精血互生和精神互用的协同作用。而“心肾失交”被视为OP的重要病机，具体可表现为骨络不濡，因虚致痿和骨络不畅，因瘀致痿。现代研究表明，骨组织血管微循环与骨形成存在精密耦联，血管通过信号通路及细胞因子调控骨形成，相反血管状态也受骨细胞调节，这一双向耦联机制在骨稳态维持中至关重要，其失调可导致骨代谢失衡。针对上述中西医机制，提出在“补肾活血壮骨”的基础上结合“交通心肾法”以调节下丘脑-垂体-肾上腺轴（HPA轴）、调控相关信号通路及细胞因子表达，恢复CD31hiEmcnhi血管功能，改善骨微循环，从而促进“成血管-成骨耦联”过程以防治OP。在未来研究中，需整合多组学技术，深入挖掘“心肾-血管-骨”轴的分子网络，并通过临床模型量化“心肾失交”的现代生物学指标，对其病理状态的诊断及临床疗效评估提供依据，为OP防治提供循证支持。 |
| 英文摘要: |
| Osteoporosis is a systemic bone disease characterized by loss of bone mass, deterioration of bone structure and loss of bone strength. Based on the theory of “heart-kidney intersection” in traditional Chinese medicine, this paper systematically discusses the role of “angiogenic-osteogenic coupling” mechanism in the pathogenesis of OP and the prevention and treatment strategy of OP by combining Chinese and Western medicine. The theory of “heart-kidney interaction” emphasizes the synergistic effects of the heart and kidney in the intercommunication of meridians and channels, the coordination of qi, the mutual production of essence and blood, and the reciprocal use of spirit, and the “heart-kidney mismatch” is regarded as an important pathogenetic mechanism of OP, which can be manifested in the following ways: the bone and channel are not moistened, which leads to impotence due to deficiency, and the bone and channel are not smooth, which leads to impotence due to blood stasis. impotence. Modern studies have shown that the vascular microcirculation of bone tissue is precisely coupled with bone formation, and the vasculature regulates bone formation through signaling pathways and cytokines; on the contrary, the vasculature is also regulated by osteoblasts, which is a bi-directional coupling mechanism that is crucial in the maintenance of bone homeostasis, and whose dysfunction can lead to an imbalance in bone metabolism. In view of the above mentioned Chinese and Western medical mechanisms, it is proposed that on the basis of “tonifying the kidney, activating blood and strengthening the bone”, combined with the “transportation of the heart and kidney method”, in order to regulate the hypothalamus-pituitary-adrenal axis (HPA axis), regulate the relevant signaling pathways and cytokine expression, and to recover the CD31hiEmcnhi vascular function, improve bone microcirculation, and thus promote the process of “angiogenesis-osteogenesis coupling” to prevent and treat OP. In future research, we need to integrate multi-omics technology to deeply explore the molecular network of the “heart-kidney-vessel-bone” axis and quantify the “heart-kidney-vessel-bone” by clinical modeling. In the future, we need to integrate multi-omics technology to deeply explore the molecular network of the “heart-kidney-vessel-bone” axis, and quantify the modern biological indexes of “heart-kidney dysfunction” through clinical modeling, so as to provide a basis for the diagnosis of the pathological state and assessment of clinical efficacy, and provide evidence-based support for the prevention and treatment of OP. |
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