生长因子在椎间盘退变中的作用及中医药干预研究进展

Research progress on the role of growth factors in intervertebral disc degeneration and intervention of traditional Chinese medicine

摘要:

椎间盘退变为当今世界范围内患病率最高的疾病之一，逐渐呈现低龄化的趋势。椎间盘退变的有效防治日益成为全球关注的焦点及临床研究的热点。椎间盘退变受营养状况、生物力学、免疫机制等因素的影响，其中细胞凋亡及细胞外基质紊乱是目前公认影响椎间盘退变发展的主要病理机制。现代医学对椎间盘退变的研究已经深入分子免疫水平。研究发现相关生长因子在椎间盘退变的病理机制中扮演着重要角色，其通过调控椎间盘细胞的凋亡及基质降解，是调控椎间盘退变发生、发展的重要传导因子。转化生长因子-β及胰岛素类生长因子的表达可抑制髓核细胞凋亡，减少基质降解；血管内皮生长因子促进新生血管的形成及椎间盘的重吸收；碱性成纤维细胞生长因子保护椎间盘终板软骨细胞不受破坏，延缓椎间盘退变进程。目前治疗椎间盘退变临床多使用非甾体抗炎药或阿片类等药物进行治疗，但长期服用会导致胃肠道不良反应。中医药治疗椎间盘退变有不良反应小、价廉效优等优势。不断深入的现代网络药理学及分子生物学等研究发现，中医药可干预多种生长因子的表达，进而调节椎间盘细胞外基质的稳定，发挥治疗椎间盘退变的作用。该文阐述相关生长因子在椎间盘退变中的作用，以及中医药调控相关生长因子的研究成果，以期为中医药防治椎间盘退变提供参考和依据。

Abstract:

As one of the most prevalent diseases in the world, intervertebral disc degeneration (IVDD) is gradually showing a trend of younger age, and the effective prevention and treatment of intervertebral disc degeneration is increasingly becoming the focus of global attention and clinical research. Intervertebral disc degeneration can be affected by nutritional status, biomechanics, immune mechanism and other factors, among which apoptosis and disorder of extracellular matrix are currently recognized as the main pathological mechanisms affecting the development of IVDD. Along with the research on IVDD in modern medicine, it has been found that the related growth factors play an important role in the pathological mechanism of IVDD, and they play an important role in regulating the occurrence and development of IVDD by regulating the apoptosis of intervertebral disc cells and matrix degradation. The expression of transforming growth factor -β and insulin-like growth factor -1 could inhibit the apoptosis of nucleus pulposus cells and reduce matrix degradation. Vascular endothelial growth factor promotes neovascularization and disc reabsorption. Basic fibroblast growth factor protects the cartilage cells of the disc endplate from damage. Connective tissue growth factor can also inhibit the expression of pro-inflammatory factors and delay IVDD process. At present, non-steroidal anti-inflammatory drugs or opioids are commonly used in the clinical treatment of IVDD, but long-term use will lead to gastrointestinal adverse reactions. Traditional Chinese medicine plays an important role in the treatment of IVDD due to its advantages of small adverse reactions, low cost and excellent effect. With the continuous development of modern network pharmacology and molecular biology, it is found that traditional Chinese medicine can interfere with the expression of a variety of growth factors, thus regulating the stability of extracellular matrix of intervertebral disc and playing a role in the treatment of IVDD. This paper will elaborate on the role of related growth factors in IVDD and the research results of TCM regulation of related growth factors, in order to provide reference and basis for TCM prevention and treatment of IVDD.