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从脑神失养探讨膝骨关节炎患者中枢敏化发生机制

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膝骨关节炎(Knee Osteoarthritis,KOA)发病与肾虚髓减密切相关.肾虚髓减导致KOA发病时,又会使脑髓失充,从而导致脑神失养.所以,肾虚髓减是KOA患者发病及脑神失养的根本病因病机.KOA好发于中老年人群,在其发展进程中,肾虚髓减更甚,则脑神失养,脑主神明功能异常,继而发生中枢敏化(Central sensitization,CS).CS是KOA疼痛发展和维持重要机制之一,CS诱发的痛觉异常、情绪障碍、认知障碍以及睡眠障碍等,实际是脑神失养后,中医学"脑"对于人体精神活动、意识思维的异常调控.通过改善脑神失养,抑制CS可缓解KOA患者异常疼痛、痛觉过敏,改善认知障碍、焦虑、抑郁等其他伴随症状.骨痹是KOA主要表现形式,脑神失养所导致的CS是KOA发展过程的延伸,这为中医药通过抑制CS干预KOA,从而改善膝关节疼痛和功能障碍提供了一定的理论基础,有利于从整体观认识CS的发病机制,继而辨证识别CS的潜在靶点,为抑制CS改善KOA患者膝关节疼痛和功能障碍提供新的思路与策略.
Study on the Mechanism of Central Sensitization in Patients with Knee Osteoarthritis Based on Dysfunction of the Brain Spirit
The occurrence of knee osteoarthritis(KOA)is closely related to kidney deficiency and marrow decrease.When kidney defi-ciency and marrow decrease leads to the onset of KOA,it will cause the lack of cerebral nourishment,leading to the dysfunction of the brain spirit.So kidney deficiency and marrow decrease is the fundamental etiology and pathogenesis for the occurrence of KOA and dys-function of the brain spirit.KOA tends to occur in middle-aged and elderly people.In the course of its development,the kidney deficien-cy and marrow decrease are more severe,which leads to the dysfunction of the brain spirit,and then Central sensitization(CS)occurs.CS is one of the important mechanisms for the development and maintenance of pain in KOA.The pain abnormalities,emotional disor-ders,cognitive disorders,and sleep disorders induced by CS are actually the abnormal regulation of human mental activity and conscious thinking by the brain in TCM after dysfunction of the brain spirit.Improving dysfunction of the brain spirit,and inhibiting CS can allevi-ate abnormal pain and hyperalgesia in KOA patients,and improve other accompanying symptoms such as cognitive impairment,anxiety,and depression,etc.Bone stiffness is the main manifestation of KO A,and CS caused by dysfunction of the brain spirit is an extension of the development process of KOA.This provides a theoretical basis for TCM to intervene KOA by inhibiting CS,thereby improving knee joint pain and dysfunction.It is conducive to understanding the pathogenesis of CS from a holistic perspective,identifying potential tar-gets of CS through syndrome differentiation,and providing new ideas and strategies for inhibiting CS to improve knee joint pain and dys-function in KOA patients.

knee osteoarthritis(KOA)dysfunction of the brain spiritbraincentral sensitizationkidney deficiency and marrow de-crease

张建强、周运峰、许辉、赵翅

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郑州市第三人民医院,河南郑州 450000

河南中医药大学第三附属医院,河南郑州 450008

河南中医药大学,河南郑州 450046

膝骨关节炎 脑神失养 脑 中枢敏化 肾虚髓减

2022年度中原英才计划(育才系列)——中原青年拔尖人才项目河南省科技攻关项目2022年河南省中医药科学研究专项项目2023年度河南省中医学"双一流"创建科学研究专项项目河南省特色骨干学科中医学学科建设项目河南省高等教育教学改革研究与实践项目2024年度河南省中医药科学研究专项课题项目

豫人才办[2022]5号2221023102142022ZY1108NHSRP-DFCTCM-2023-7-09STG-ZYX04-2021312021JX372024ZY3060

2024

10.16367/j.issn.1003-5028.2024.02.0032

河南中医
河南省中医药学会 河南中医学院

河南中医

影响因子：0.968
ISSN：1003-5028
年,卷(期)：2024.44(2)
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