"肌少-骨质疏松症"的共同发病机制

"肌少-骨质疏松症"(sarco-osteopenia)的提出是基于两者共同的病理生理学基础,其中涉及八类主要影响因素.简要概括为机械因素作用于骨细胞构成的机械支架和肌管;肌肉-骨骼系统相互影响彼此化学因子的释放;甲基转移酶样蛋白21C(METTL21C)和肌肉生长抑制素(myostatin,MSTN,简称肌抑素)以及硬骨抑素(sclerostin,SOST)作为共同的遗传因素调控肌肉-骨骼系统;肌肉和骨骼在旁分泌和内分泌水平上的串扰、脂肪浸润因素导致肌力的下降和骨折发生率增加;炎性反应、糖尿病和糖皮质激素过量影响肌肉的丢失以及骨丢失;营养缺乏加速骨丢失和肌肉蛋白质合成减少;个体运动量的减少和神经-肌肉功能减弱间接影响肌肉和骨骼的合成代谢.深入研究"肌少-骨质疏松症"共同的致病机制,以推动生物检测特异性指标的确定、临床疾病的评估和诊断以及有效治疗药物和设备开发工作,最终目标是有效地治疗和预防"肌少-骨质疏松症".本文对"肌少-骨质疏松症"共同病理生理学机制研究现状与进展进行系统综述.

Common pathogenesis of"sarco-osteopenia"

Sarco-osteopenia was proposed on the basis of the common pathophysiological basis,involving eight major influencing factors.Briefly summarized as mechanical factors acting on the mechanical scaffolds and myotubes com-posed of bone cells;musculoskeletal systems interact with each other to influence the release of chemical factors,methyl-transferase-like protein 21C(METTL21C)and myostatin(MSTN,referred to as“myostatin”)and sclerostin(SOST)act as a common genetic factor to regulate the musculoskeletal system;crosstalk and fat infiltration factors in muscle and bone at paracrine and endocrine levels lead to decreased muscle strength and increased incidence of fractures;inflammation,diabe-tes,and excessive glucocorticoids affect muscle loss and bone loss;nutritional deficiency accelerates bone loss and reduces muscle protein synthesis;decreased individual exercise and decreased neuro-muscular function indirectly affect muscle and bone anabolism.In-depth study of the common pathogenesis of sarco-osteopenia to promote the identification of specific indi-cators for bioassays,the assessment and diagnosis of clinical diseases,and the development of effective therapeutic drugs and equipment,the ultimate goal is to effectively treat and prevent“sarco-osteopenia”.This article systematically reviews the current progress of the common pathophysiological mechanisms of sarco-osteopenia.