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放射性骨损伤是人体全身或局部受到一次或短时间内受到分次大剂量外照射,或长期多次受到超过剂量当量限值的外照射而导致骨的一系列代谢和临床病理变化[1]。放疗是目前公认的高效利用射线进行肿瘤治疗的方法之一。但低剂量的局部照射也会导致照射部位邻近器官、组织和血管的并发症,其中,骨因含钙量高,射线吸收率可比周围组织高30%~40%以上[2] ,这表明骨对于任何给定剂量的照射的吸收率均比周围组织高很多。因此,骨是放射损伤的常见部位,其并发症在接受放疗的患者中较为常见[3] 。我们主要就放疗导致的骨损伤展开综述。
放射性骨损伤的研究进展
Research progress on radiation-induced bone injury
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摘要: 射线照射是现代医疗中常用的方法之一,尤其在恶性肿瘤的治疗中应用广泛。但在放疗过程中,射线可对骨相关细胞、骨微观结构产生直接影响,或对骨髓、脉管系统等产生间接影响,从而造成骨损伤。尽管目前的研究成果对放射性骨损伤的认识并不透彻,但因其具有普遍性,故近年来逐渐受到医疗工作者的重视。笔者对射线引起的骨骼系统损伤及其预防和治疗进行综述。Abstract: Radiation is one of the commonly used methods in modern medical treatment, especially in the treatment of malignant tumors. However, in the process of radiotherapy, radiation directly affect bone-related cells and bone microstructure, or indirectly affect bone marrow and vascular system, resulting in bone injury. Although the current research results do not have a thorough understanding of radiation-induced bone injury, it has gradually recevied attention from medical workers in recent years because of its universality. The bone system injury caused by radiation and its prevention and treatment are reviewed in this paper.
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Key words:
- Radiotherapy /
- Radiation injuries /
- Osteoradionecrosis /
- Fractures /
- Bone injury /
- Bone losses /
- Bone biomechanics
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[1] 中华人民共和国卫生部. GBZ 100-2010 放射性骨损伤诊断[S]. 北京: 中国标准出版社, 2011.
Ministry of Health of the People's Republic of China. GBZ 100-2010 Diagnostic criteria for external radiation bone injury[S]. Beijing: Standards Press of China, 2011.[2] Costa S, Reagan MR. Therapeutic irradiation: consequences for bone and bone marrow adipose tissue[J/OL]. Front Endocrinol, 2019, 10: 587[2020-07-28]. https://www.frontiersin.org/articles/10.3389/fendo.2019.00587/full. DOI: 10.3389/fendo.2019.00587. [3] Higham CE, Faithfull S. Bone health and pelvic radiotherapy[J]. Clin Oncol, 2015, 27(11): 668−678. DOI: 10.1016/j.clon.2015.07.006. [4] 林调. 激活经典Wnt/β-catenin信号通路促进成骨细胞DNA修复和存活: 放射性骨损伤的机制和治疗[D]. 杭州: 浙江大学, 2015.
Lin T. Activating canonical Wnt/β-catenin pathway enhances DNA repair and promotes cell survival in osteoblasts: a novel anabolic treatment for radiotherapy associated bone damage[D]. Hangzhou: Zhejiang University, 2015.[5] Zhang J, Qiu XY, Xi KD, et al. Therapeutic ionizing radiation induced bone loss: a review of in vivo and in vitro findings[J]. Connect Tissue Res, 2018, 59(6): 509−522. DOI: 10.1080/03008207.2018.1439482. [6] Celii FG, Beckmann NM. Radiation-induced insufficiency fracture of the femur 18 years after radiation therapy[J]. Radiol Case Rep, 2019, 14(2): 179−183. DOI: 10.1016/j.radcr.2018.10.025. [7] He FL, Bai JT, Wang JP, et al. Irradiation-induced osteocyte damage promotes HMGB1-mediated osteoclastogenesis in vitro[J]. J Cell Physiol, 2019, 234(10): 17314−17325. DOI: 10.1002/jcp.28351. [8] Omolehinwa TT, Akintoye SO. Chemical and radiation-associated jaw lesions[J]. Dent Clin North Am, 2016, 60(1): 265−277. DOI: 10.1016/j.cden.2015.08.009. [9] 胡丽萍. 妊娠期骨密度检测对孕期的指导作用[J]. 中国卫生标准管理, 2016, 7(2): 168−169.
Hu LP. Guiding significance of bone mineral density testing during pregnancy for pregnant women[J]. Chin Health Stand Manage, 2016, 7(2): 168−169.[10] Wei RL, Jung BC, Manzano W, et al. Bone mineral density loss in thoracic and lumbar vertebrae following radiation for abdominal cancers[J]. Radiother Oncol, 2016, 118(3): 430−436. DOI: 10.1016/j.radonc.2016.03.002. [11] Wright LE, Buijs JT, Kim HS, et al. Single-limb irradiation induces local and systemic bone loss in a murine model[J]. J Bone Miner Res, 2015, 30(7): 1268−1279. DOI: 10.1002/jbmr.2458. [12] Zou Q, Hong W, Zhou Y, et al. Bone marrow stem cell dysfunction in radiation-induced abscopal bone loss[J]. J Orthop Surg Res, 2016, 11: 3. DOI: 10.1186/s13018-015-0339-9. [13] Rocha FS, Dias PC, Limirio PHJO, et al. High doses of ionizing radiation on bone repair: is there effect outside the irradiated site?[J]. Injury, 2017, 48(3): 671−673. DOI: 10.1016/j.injury.2016.11.033. [14] Imbert L, Gourion-Arsiquaud S, Villarreal-Ramirez E, et al. Dynamic structure and composition of bone investigated by nanoscale infrared spectroscopy[J/OL]. PLoS One, 2018, 13(9): e0202833[2020-07-28]. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202833. DOI: 10.1371/journal.pone.0202833. [15] Gong B, Oest ME, Mann KA, et al. Raman spectroscopy demonstrates prolonged alteration of bone chemical composition following extremity localized irradiation[J]. Bone, 2013, 57(1): 252−258. DOI: 10.1016/j.bone.2013.08.014. [16] Limirio PHJO, Soares PBF, Emi ETP, et al. Ionizing radiation and bone quality: time-dependent effects[J]. Radiat Oncol, 2019, 14(1): 15. DOI: 10.1186/s13014-019-1219-y. [17] 谢涛江, 蓝勇波, 张彤, 等. 闭合复位空心螺钉固定联合自体红骨髓移植治疗股骨颈骨折的疗效观察[J]. 临床和实验医学杂志, 2018, 17(13): 1419−1421. DOI: 10.3969/j.issn.1671-4695.2018.13.023.
Xie TJ, Lan YB, Zhang T, et al. Effect of closed reduction and hollow screw fixation combined with autologous red bone marrow transplantation with medullary decompression on femoral neck fracture[J]. J Clin Exp Med, 2018, 17(13): 1419−1421. DOI: 10.3969/j.issn.1671-4695.2018.13.023.[18] Chandra A, Lin T, Young T, et al. Suppression of sclerostin alleviates radiation-induced bone loss by protecting bone-forming cells and their progenitors through distinct mechanisms[J]. J Bone Miner Res, 2017, 32(2): 360−372. DOI: 10.1002/jbmr.2996. [19] Liu XL, Li Q, Niu X, et al. Exosomes secreted from human-induced pluripotent stem cell-derived mesenchymal stem cells prevent osteonecrosis of the femoral head by promoting angiogenesis[J]. Int J Biol Sci, 2017, 13(2): 232−244. DOI: 10.7150/ijbs.16951. [20] Zuo R, Liu MH, Wang YQ, et al. BM-MSC-derived exosomes alleviate radiation-induced bone loss by restoring the function of recipient BM-MSCs and activating Wnt/β-catenin signaling[J]. Stem Cell Res Ther, 2019, 10(1): 30. DOI: 10.1186/s13287-018-1121-9. [21] Lee SW, Yeo SG, Oh IH, et al. Bone mineral density in women treated for various types of gynecological cancer[J]. Asia Pac J Clin Oncol, 2016, 12(4): e398−e404. DOI: 10.1111/ajco.12584. [22] Hopewell JW. Radiation-therapy effects on bone density[J]. Med Pediatr Oncol, 2003, 41(3): 208−211. DOI: 10.1002/mpo.10338. [23] 曹善峰. 放射性损伤的分子基础及治疗策略[D]. 郑州: 郑州大学, 2017.
Cao SF. Molecular basis and treatment strategy of acute radiation injury[D]. Zhengzhou: Zhengzhou University, 2017.[24] de Freitas DQ, de Moraes Ramos-Perez FM, Neves EG, et al. Radioprotective effect of sodium selenite on bone repair in the tibia of ovariectomized rats[J]. Braz Dent J, 2012, 23(6): 723−728. DOI: 10.1590/s0103-64402012000600017. [25] Donneys A, Tchanque-Fossuo CN, Blough JT, et al. Amifostine preserves osteocyte number and osteoid formation in fracture healing following radiotherapy[J]. J Oral Maxillofac Surg, 2014, 72(3): 559−566. DOI: 10.1016/j.joms.2013.09.006. [26] Rogers MJ, Crockett JC, Coxon FP, et al. Biochemical and molecular mechanisms of action of bisphosphonates[J]. Bone, 2011, 49(1): 34−41. DOI: 10.1016/j.bone.2010.11.008. [27] Shirazi-Fard Y, Alwood JS, Schreurs AS, et al. Mechanical loading causes site-specific anabolic effects on bone following exposure to ionizing radiation[J]. Bone, 2015, 81: 260−269. DOI: 10.1016/j.bone.2015.07.019. [28] Song XX, Xie YC, Kang R, et al. FANCD2 protects against bone marrow injury from ferroptosis[J]. Biochem Biophys Res Commun, 2016, 480(3): 443−449. DOI: 10.1016/j.bbrc.2016.10.068. [29] Liu YG, Chen JK, Zhang ZT, et al. NLRP3 inflammasome activation mediates radiation-induced pyroptosis in bone marrow-derived macrophages[J]. Cell Death Dis, 2017, 8(2): e2579. DOI: 10.1038/cddis.2016.460. [30] Purbey PK, Scumpia PO, Kim PJ, et al. Defined sensing mechanisms and signaling pathways contribute to the global inflammatory gene expression output elicited by ionizing radiation[J]. Immunity, 2017, 47(3): 421−434.E3. DOI: 10.1016/j.immuni.2017.08.017.
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