关节退行性变－德国重要研究发现

　　老人面对关节退行性变引起的疼痛很普遍，轻则行动不便，重者撑拐杖坐轮椅，生活素质大受影响;近年来，随着手机的刷屏习惯，大量的年轻男女都成了低头族，颈椎退行性变问题(包括富贵包)越来越普及，甚至手指的关节也出现不同程度的劳损退行性变。

　　关节退行性变导致

　　一、关节软骨进行性劳损和破坏;二、软骨下骨增厚;三、骨刺形成滑膜炎;四、膝关节韧带和半月板变性;五、关节囊肥大(7,8,9,10,11,12)

　　主要临床症状

　　一、慢性疼痛;二、关节不稳;三、关节僵硬;四、关节间隙狭窄(18,19)

　　成因：

　　炎症： 炎症介质通过MMPs和ADAMTS活性的增加导致软骨ECM降解(13,14,15,16,17)

　　老化： 老化细胞表现出氧化应激增加，从而促进细胞衰老并改变线粒体功能(20,21,22,23)

　　肥胖： 除了增加膝关节的生物力学负荷外，肥胖还被认为通过分泌脂肪组织来源的细胞因子(称为脂肪因子)而导致低级别的全身炎症。(24,25,26)

　　运动劳动损伤、机械性磨损：

　　创伤相关的运动损伤可引起骨、软骨、韧带和半月板损伤，所有这些都会对关稳定产生负面影响(26,27,28);软骨组织撕裂、关节脱位、韧带拉伤和撕裂是临床上最常见的可能导致关节炎的损伤(29,30)。

　　遗传倾向性：

　　主要通过诱导软骨细胞分解反应来促进关节炎的发展和进展(6);成纤维细胞生长因子(FGF)通路的改变主要通过诱导软骨细胞分解反应来促进关节炎的发展和进展(31,32,33,34,35,36)

　　当我们面对关节退行性变导致的疼痛，目前在药物上面的治疗，广泛使用的是氨基葡萄糖，但治疗效果差强人意。关于氨基葡萄糖的问题，国际上也有了更新的研究，这个研究成果我们以后再专门介绍。我们现在有更安全更理想的修补方案可选择。

　　今天就跟大家探讨一下德国最新的一些与关节退行性变有关的新临床研究。先探讨关节退行性变导致的疼痛或者行动不便，甚至坐轮椅撑拐杖;以后还会与大家探讨别的关节问题，包括痛的要命的痛风、还有类风湿性关节炎、强直性脊椎炎等等。希望大家多加留意或者关注我们。

　　早于2000年时,克利夫兰大学医院的Moskowitz RW博士等人已进行了胶原水解物在骨关节疾病中的作用(2,37);2016和2017 M Schunck 及S Oesser两位学者在德国的研究发现，用新鲜牛皮提炼的<水解骨胶原蛋白>可以修复关节软组织，促进软骨的再生。水解骨胶原蛋白是胶原蛋白的水解产物，与关节软骨中主要成分2型的胶原蛋白相似(3)。与大分子的胶原相比，水解产物更容易被人体吸收，用来修补因关节退行性变而导致的关节软骨的流失，同时减少关节的疼痛(1,5)。

　　此外，德国弗赖堡大学施瓦兹沃德斯特尔分校的Daniel KönigSteffen Oesser, Stephan Scharla, Denise Zdzieblik及 Albert Gollhofer 等学者在2018年的另一项研究，发现每天口服5克的水解骨胶原蛋白，可以增加停经后妇女腰椎和股骨颈的密度，大大缓解因矿物元素流失而引起的骨质疏松症的风险(4)。

　　水解骨胶原蛋白也可以刺激韧带细胞外基质的生物合成，在2013年的研究发现，水解骨胶原蛋白可以增加50%弹性蛋白生物的合成，同时增加了2.4倍的胶原蛋白的合成，在预防韧带和肌腱病理性的病变起到了积极的作用(3)。

　　除了针对软组织的修补外，医学界同时还要面对其它关节退行性变的挑战；怎样解决关节内粘连(Intraarticular adhesion)(38)、纤维化(fibrosis)(39)、软骨钙化(cartilage calcification) (40)（骨刺－骨质增生）问题。因要解决骨关节整体退行性变问题，修补软组织只完成小部份任务;发炎、粘连、纤维化、软骨钙化也需要别的研究突破来处理的，所以我们必须从生物医学、营养医学等各方面，全面去研究。 希望国内相关大学、医学院、科研机构也能投入更多资源、精力在相关领域的临床研究，能够超越欧美成就，带领医学进入新阶段! 下次再跟大家分享更多国际上的新研究;如痛风、强直性脊椎炎、类风湿性关节炎等等。有兴趣了解更多关节研究话题的，欢迎关注我们。

　　身边如果有任何人正在面对关节疼痛的问题，欢迎大家把这一篇内容转发给他们。希望这些学术研究成果能为他们带来新的希望，为他们带来更理想的治疗方案。

　　本文章属於拜塞复康中心团队原创，如要转载请联同作者机构一并转发，否则需取得作者书面同意方能节录引用。

　　医学文章需要专业、认真、严谨的态度，您的转发和点赞会成为我们的重大动力，谢谢。

　　原创：拜塞复康中心

　　张阳生(顾问医生)、高建伟(顾问医生)

　　欧阳宏基(香港脊骨神经科医生)、

　　马圆(英国注册营养师)、施丹虹(香港营养学家)

　　郑志雄(加拿大放射影像物理学家)

　　了解更多

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　　37.From the Case Western Reserve University; Division of Rheumatic Diseases, University Hospitals of Cleveland, OH.　Roland W. Moskowitz, MD: Professor of Medicine, Case　Western Reserve University; Director, Division of Rheumatic Diseases, University Hospitals of Cleveland　Dr. Moskowitz was the Principal Investigator and Con-sultant for a study on pharmaceutical collagen hydrolysate for DGF Stoess. doi:10.1053/sarh.2000.9622

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