p38 MAPK信号通路在膝关节骨性关节炎中医药诊疗中的作用

骨性关节炎(knee osteoarthritis,KOA)是以关节软骨进行性退变、滑膜炎症和疼痛为主要特征的关节类疾病。其发病机制目前尚未完全明确,一般认为是年龄、性别、肥胖、创伤、炎症、遗传易感性等力学及生物学因素共同作用导致软骨细胞、细胞外基质以及软骨下骨3者降解和合成偶联失衡的结果。近年来,信号通路在KOA软骨细胞增殖、凋亡的研究中成为了热点,且信号通路在KOA发病机制和靶向治疗的研究也逐渐起步,通常会涉及KOA软骨细胞中细胞因子、相关基因和蛋白的表达等。这些关于信号通路与KOA的研究主要集中在软骨细胞的增殖和凋亡、细胞外基质的合成和降解以及软骨下骨的硬化等方面,其中研究比较多的是p38丝裂原活化蛋白激酶(p38 mitogen activated protein kinase,p38 MAPK)信号通路。文献研究表明,p38 MAPK信号通路可调控软骨细胞增殖、凋亡,维持细胞外基质代谢平衡,调节基质金属蛋白酶、促炎症因子的产生,参与胶原蛋白和蛋白多糖降解,在KOA病理进程中起重要的调控作用。而以整体观念和辨证施治理论为指导的中医药疗法治疗该病针对性强,疗效显著,可以从根本上控制病情的发展,为治本之道。本文从p38 MAPK与KOA发病机制的关系入手,对p38 MAPK信号通路在KOA中医药诊疗中的研究进展作一综述,为KOA的临床诊疗提供新的分子靶点。

Effect of p38 MAPK Signaling Pathway in Diagnosis and Treatment of Knee Ksteoarthritis by Traditional Chinese Medicine

Knee osteoarthritis (KOA) is a kind of joint disease characterized by progressive degeneration of articular cartilage, synovitis and pain. Its pathogenesis is not yet completely clear. Generally, it is believed that age, sex, obesity, trauma, inflammation, genetic susceptibility and other mechanical and biological factors together lead to the degradation and synthetic coupling imbalance of cartilage cells, extracellular matrix and subchondral bone. In recent years, signaling pathway has become a hot spot in the research of KOA chondrocyte proliferation and apoptosis, and the research of signal pathway in the pathogenesis and targeted therapy of KOA also began. It usually involves the expressions of cytokines, relevant genes and proteins in KOA chondrocyte. These researches mainly focus on the proliferation and apoptosis of chondrocytes, the synthesis and degradation of extracellular matrix, and the sclerosis of subchondral bone. More studies focus on p38 mitogen-activated protein kinase (p38 MAPK) signaling pathway. Literatures show that p38 MAPK signaling pathway can regulate the proliferation and apoptosis of chondrocytes, maintain the balance of extracellular matrix metabolism, regulate the production of matrix metalloproteinases and pro-inflammatory factors, participate in the degradation of collagen and proteoglycan, and play an important regulatory role in the pathological process of KOA. Traditional Chinese medicine(TCM) therapy under the guidance of holistic concept and dialectical treatment theory has a strong pertinence and remarkable curative effect, and can control the development of the disease fundamentally. Starting with the relationship between p38 MAPK and the pathogenesis of KOA, this paper summarizes the research progress of p38 MAPK signaling pathway in the diagnosis and treatment of KOA by TCM, and provides new targets for the clinical diagnosis and treatment of KOA.