非创伤性股骨头缺血性坏死(nontraumatic avascular necrosis of femoral head，NANFH)是一种因血供中断导致骨死亡的一种常见的难治性股骨头疾病。其早期临床症状不典型，可见髋关节疼痛、关节功能活动受限等，晚期常见疼痛剧烈、患肢缩短、跛行等严重症状，严重影响了患者生活质量。故积极改善NANFH临床症状对提高NANFH患者生活质量的意义重大。NANFH发病机制复杂，如创伤性血管循环障碍、使用激素或其他药物、酗酒、糖尿病等。这些因素直接或间接地导致了股骨头血管损伤、血栓形成和凝血系统紊乱，从而减少了髋臼、股骨头的血液供养，进而引起股骨头缺血死亡，甚至股骨头塌陷。NANFH主要归属于中医学"骨痿""骨痹"范畴。中医药治疗NANFH具有历史源远、疗效稳靠、不良反应少、患者耐受性好、接受度高的特点和优势。既往研究表明，促进血管新生是防治NANFH关键举措，中医药可通过干预血管生成相关因子表达来促进股骨头血管新生，进而帮助股骨头血供恢复，达到改善NANFH临床症状、防治NANFH的作用。该文阐述了血供中断、血管新生在NANFH中的作用及中医学对NANFH的认识及经验积累，总结了血管生成因子在NANFH中的作用及中药干预研究进展，旨在为后续相关研究的深入提供思路、为NANFH治疗中药的临床应用提供新依据。
Research progress on mechanism of traditional Chinese medicine intervention in angiogenesis in prevention and treatment of nontraumatic avascular necrosis of femoral head
Nontraumatic avascular necrosis of the femoral head(NANFH)is a common and refractory femoral head disease that causes bone death due to interruption of blood supply.Early clinical symptoms are atypical,such as hip pain and limited joint func-tion.In the late stage,severe pain,shortening of the affected limb,claudication,and other serious symptoms are common,which se-riously affects the quality of life of patients.Therefore,it is of great significance to actively improve the clinical symptoms of NANFH to enhance the quality of life of patients.The pathogenesis of NANFH is complex,such as traumatic vascular circulatory disorders,the use of hormones or other drugs,alcoholism,and diabetes mellitus.These factors directly or indirectly lead to femoral head vascular damage,thrombosis,and coagulation system disorders,which reduce the blood supply to the acetabulum and femoral head,thus cau-sing ischaemic death of the femoral head or even femoral head collapse.NANFH is mainly categorized as"bone impotence"and"bone paralysis"in traditional Chinese medicine(TCM).The treatment of NANFH with TCM has the characteristics and advantages of a long history,stable and reliable therapeutic effect,fewer adverse reactions,good patient tolerance,and high acceptance.Previous studies have shown that the promotion of angiogenesis is a key initiative in the prevention and treatment of NANFH,and TCM can promote fe-moral head angiogenesis by interfering with the expression of angiogenesis-related factors,which in turn can help to restore the blood supply of the femoral head and thus improve clinical symptoms of NANFH and prevent and treat NANFH.This article described the roles of blood supply interruption and angiogenesis in NANFH and the accumulated knowledge and experience of TCM in NANFH and summarized the role of angiogenesis-related factors in NANFH and the research progress on TCM intervention,so as to provide an idea for the subsequent research and a new basis for the clinical application of TCM in the treatment of NANFH.
necrosis of femoral headavascular necrosisangiogenesistraditional Chinese medicinemechanism
NETL
NSTL
万方数据
