膝关节骨性关节炎（KOA）为常见的肌肉骨骼疾病，铁死亡为铁离子参与的一种新型程序性细胞死亡方式。 该文概述 了铁死亡机制与KOA发病的关系，并探讨了基于铁死亡机制的KOA中医药干预进展。铁死亡的发生机制主要与氨基酸抗氧 化系统失衡、铁代谢紊乱、脂质过氧化物集聚有关。胱氨酸/谷氨酸反向转运体（System XC-）、谷胱甘肽（GSH）、谷胱甘肽 过氧化物酶4（GPX4）为调节铁死亡的核心靶点，涉及中药干预铁死亡治疗KOA的主要信号通路。 单味中药如骨碎补、半枝 莲、淫羊藿、黄芪、女贞子、牛膝等，以及复方如独活寄生汤、右归丸等均可通过多靶点、多通路抑制软骨细胞的铁死亡， 从而治疗KOA。通过研究中医药干预软骨细胞的铁死亡及与其相关联的信号通路，可为拓展KOA的中医药疗法提供思路。

Knee osteoarthritis （KOA） is a common musculoskeletal disease， and ferroptosis is a new type of programmed cell death involving iron ions. This paper summarized the relationship between the pathological changes of ferroptosis and the onset of KOA，and reviewed the progress of traditional Chinese medicine （TCM） intervention in KOA based on the pathological changes of ferroptosis. The pathological changes of ferroptosis are mainly related to the imbalance of amino acid antioxidant system， iron metabolism disorder and lipid peroxide accumulation. The cystine/glutamate antiporter （System XC-），glutathione （GSH） and glutathione peroxidase 4 （GPX4） are the core targets for regulating ferroptosis，involving the main signaling pathways for studying the TCM intervention of KOA via ferroptosis. Single herbs such as Drynariae Rhizoma， Scutellariae Barbatae Herba， Epimedii Folium，Astragali Radix，Ligustri Lucidi Fructus，and Achyranthis Bidentatae Radix，and multi-herb formulae such as Duhuo Jisheng Decoction and Yougui Pills，can inhibit the ferroptosis of chondrocytes through multiple targets and multiple pathways，thus treating KOA. The research of the TCM intervention on the ferroptosis of chondrocytes and its associated signaling pathways can provides a novel approach for expanding the TCM therapy of KOA.

R274.9

河南省中医药管理局科学研究专项课题（编号：2023ZY1008，2024ZYZD06）