中医利湿化瘀通络法治疗2型糖尿病肾病临床蛋白尿和肾脏损伤的研究进展

Role of “Removing Dampness, Dispersing stagnation and Dredging Collateral” of Traditional Chinese Medicine in Treatment of Clinical Proteinuria and Renal Injury in Type 2 Diabetic Kidney Disease

目的2型糖尿病肾病(T2DKD)是2型糖尿病最常见的微血管并发症之一,该文旨在探讨中医利湿化瘀通络治法对T2DKD中期(G3A2期)临床蛋白尿和肾脏损伤的治疗作用。方法通过文献回顾近年来中医理论对T2DKD"湿瘀阻络"重要病机的认识,分析总结相关临床和基础研究,探讨中医利湿化瘀通络法对T2DKD中期患者和DKD小鼠模型蛋白尿和肾脏损伤的治疗作用。结果蛋白尿和肾脏损伤不仅是T2DKD中期主要的诊断指标和临床表现,也是关键的治疗靶点,目前西医缺乏理想治疗方法。中医药治疗T2DKD中期患者体现了良好疗效和独特优势,积累了丰富经验,近年来多项临床研究表明利湿化瘀通络治法和方药对T2DKD中期患者蛋白尿和肾脏损伤有显著疗效,实验研究也证实该治法对DKD小鼠蛋白尿和肾脏损伤也具有保护作用。结论中医利湿化瘀通络法在防治T2DKD中期临床蛋白尿和肾功能减退的临床实践中具有重要意义和广泛应用价值,对今后T2DKD患者的分期治疗有临床指导意义。

Objective Type 2 diabetic kidney disease(T2 DKD)is one of the major micro-vascular complications in type 2 diabetic patients.The present review aimed to explore the role of“removing dampness,dispersing stagnation and dredging collateral”therapy in treating clinical proteinuria and renal injury in the advanced stage of T2 DKD(stage G3 A2).Methods Based on the theory of traditional Chinese medicine,it is regarded that“collaterals blockage by dampness and stagnation”plays an important role in pathogenesis of proteinuria in advanced stage of T2 DKD.The study systemically reviewed the clinical and basic studies about the therapeutic effect of“removing dampness,dispersing stagnation and dredging collateral”therapy on T2 DKD.Results Proteinuria and renal damages are not only the diagnostic criteria and clinical manifestation,but also the major of therapeutic target of T2 DKD.There is no ideal therapeutic method of Western medicine for treatment of proteinuria and renal damages of T2 DKD till now.In recent years,traditional Chinese medicine displays effective and unique in treating T2 DKD with accumulating experience.Multiple clinical studies have indicated that“removing dampness,dispersing stagnation and dredging collateral”therapy and prescription have significant therapeutic effect in treatment of proteinuria and renal injury in advanced stage of T2 DKD patients.In addition,some experimental studies have suggested that“removing dampness,dispersing stagnation and dredging collateral”therapy and prescription also had a protective effect on proteinuria and renal damages in DKD mice.Conclusion The recent research showed that“removing dampness,dispersing stagnation and dredging collateral”therapy of traditional Chinese medicine might be an essential and promising strategy for treatment of T2 DKD(stage G3 A2),which will be insightful to the future T2 DKD clinical practice based on stages.