2026 年第 2 期 第 21 卷

乳酸及乳酸化修饰调控巨噬细胞极化影响骨愈合的研究进展

Research progress on the impact on bone healing of the regulation of macrophage polarization by lactic acid and lactylation modification

作者：陆辰旸1孙孝先1俞云飞2张炎1吴毛2

英文作者：Lu Chenyang1 Sun Xiaoxian1 Yu Yunfei2 Zhang Yan1 Wu Mao2

单位：1南京中医药大学附属无锡医院江苏省无锡市中医医院，无锡214071；2南京中医药大学附属无锡医院江苏省无锡市中医医院创伤正骨科，无锡214071

英文单位：1Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine Wuxi Traditional Chinese Medicine Hospital Jiangsu Province Wuxi 214071 China; 2Department of Trauma and Orthopedics Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine Wuxi Traditional Chinese Medicine Hospital Jiangsu Province Wuxi 214071 China

关键词：骨愈合；乳酸；乳酸化修饰；巨噬细胞极化；代谢重编程；炎症反应

英文关键词：Bonehealing;Lacticacid;Lactylationmodification;Macrophagepolarization;Metabolicreprogramming;Inflammatoryresponse

• 摘要：

• 本文探讨了乳酸及其衍生的乳酸化修饰在巨噬细胞极化和骨愈合中的作用。文章详细阐述了乳酸如何通过代谢重编程和信号通路调控巨噬细胞从M1向M2表型的转变，并进一步讨论了该过程在骨折愈合的炎症期、修复期和重塑期中的重要意义。此外，文章针对骨折微环境缺氧及骨质疏松等病理状态下巨噬细胞极化的特殊表现进行了阐述。在机制层面，不仅总结了组蛋白乳酸化修饰，更揭示了非组蛋白乳酸化修饰（如丙酮酸激酶M2）如何直接调控骨愈合相关基因表达，包括调节破骨细胞吸收与成骨细胞分化。本文强调乳酸及乳酸化修饰作为骨愈合治疗靶点的潜力，并提出通过调控巨噬细胞极化来改善骨修复效果的未来研究方向，为治疗不愈合骨折提供了创新策略。

• This paper explores the roles of lactic acid and its derived lactylation modification in macrophage polarization and bone healing. It elaborates on how lactic acid regulates the transformation of macrophages from the M1 to M2 phenotype through metabolic reprogramming and signaling pathways, and further discusses the important significance of this process in the inflammatory, reparative and remodeling phases of fracture healing. In addition, the paper describes the special manifestations of macrophage polarization under pathological conditions such as hypoxia in the fracture microenvironment and osteoporosis. At the mechanistic level, it not only summarizes histone lactylation modification, but also reveals how non-histone lactylation modification (e.g., pyruvate kinase M2) directly regulates the expression of bone healing-related genes, including the regulation of osteoclast resorption and osteoblast differentiation. This paper emphasizes the potential of lactic acid and lactylation modification as therapeutic targets for bone healing, and proposes future research directions for improving bone repair efficacy by regulating macrophage polarization, providing an innovative strategy for the treatment of non-union fractures.