糖尿病肾病的中医药干预机制及辨证论治思考

Discussion on traditional Chinese medicine intervention mechanism and syndrome differentiation of diabetickidney disease

糖尿病肾病(DKD)是糖尿病的一种慢性并发症,临床表现为肾小球肥大、蛋白尿、肾小球滤过功能下降和肾纤维化导致肾功能丧失。虽然DKD的确切发病原因尚不清楚,但已经推测了几种机制,如高血糖诱导的肾脏高滤过和肾损伤,糖基化终末产物诱导的氧化应激增加,激活的蛋白激酶C(PKC)诱导的细胞因子、趋化因子的产生增加,以及不同炎症和凋亡信号。在各种因素中,氧化应激已被认为在DKD的发病中起主要作用,它触发了PKC级联反应、Janus激酶/信号转导和转录激活因子(JAK/STAT)、丝裂素活化蛋白激酶(MAPK)、哺乳动物雷帕霉素靶蛋白(mTOR)等参与糖尿病的多种信号通路。但无论是中药单药还是中药复方辨证治疗DKD均有较好的疗效,因此,如何更好地运用中医药治疗DKD给我们带来了更多的思考。

Diabetic kidney disease (DKD) is a chronic complication of diabetes mellitus. The clinicalmanifestations are glomerular hypertrophy, proteinuria, decreased glomerular filtration and renal fibrosis leadingto loss of renal function. Although the exact cause of DKD is unclear, several mechanisms have been hypothesized,such as hyperglycemia-induced hyper-filtration of the kidney and kidney damage, increased oxidative stress inducedby advanced glycation end products, activated protein kinase C (PKC) induced cytokines, increased production ofchemokines, as well as different signals of inflammation and apoptosis. Among various factors, oxidative stress has beenconsidered to play a major role in the pathogenesis and proliferation of DKD. It triggers several signaling pathwaysinvolved in DM, such as PKC cascade, Janus kinase/signal transduction and activating transcription factor (JAK/STAT)signaling, mitogen-activated protein kinase (MAPK), mammalian target of rapamycin (mTOR), etc. Clinical practiceshowed no matter it is Chinese single herbal medicine or compound Chinese medicine it has a good therapeutic effect.Therefore, how to use Chinese medicine more properly to treat DKD requires us to think over more seriously.