血管紧张素受体拮抗剂治疗糖尿病肾病机制研究进展

Advances in the treatment of diabetic nephropathy with angiotensin receptor antagonists

糖尿病肾病(DN)是引起终末期肾病(ESRD)的主要原因,几乎占ESRD的40%以上,也是糖尿病患者的主要死亡原因。DN发病确切的机制尚未完全清楚,以高糖为基础的病理生理改变是DN发生发展的基础,主要涉及遗传因素、糖代谢紊乱、血流动力学改变、炎性递质、细胞因子、免疫等多种因素。过氧化物酶体增殖物激活受体(PPAR)是核受体超家族中配体激活的转录因子之一,其亚型PPARγ在脂质代谢、胰岛素敏感性、炎性反应和血压调控等方面具有重要作用。Toll样受体(TLRs)是介导免疫和炎性反应的主体。血管紧张素受体拮抗剂(ARBs)是一类作用于肾素-血管紧张素系统(RAS)的降压药物,不仅可以从血流动力学上治疗DN的发生发展,还在调节代谢紊乱、抑制炎症及免疫中起到重要作用。本文对血管紧张素受体拮抗剂治疗DN机制研究进展进行综述。

Diabetic nephropathy is the leading cause of ESRD,accounting for more than 40%of ESRD,and is the leading cause of death in patients with diabetes.The exact mechanism of DN is not completely clear.The pathophysiological changes based on High Glucose are the basis of the development of DN,it mainly involves genetic factors,glucose metabolism disorder,Hemodynamics changes,inflammatory mediators,cytokines,immunity and other factors.Peroxisome receptor PPAR is one of the ligand activated transcription factors in nuclear receptor superfamily,and its subtype,Ppar,plays an important role in Lipid metabolism,insulin sensitivity,inflammatory response and blood pressure regulation.Tlrs are the host of immune and inflammatory responses mediated by Toll-like receptors.Angiotensinogen receptor antagonist is a class of antihypertensive drugs that act on Renin–Angiotensin system and can not only treat the development of DN from Hemodynamics,it also plays an important role in regulating metabolic disorder,inhibiting inflammation and immunity.This article reviews the progress in the mechanism of Angiotensin receptor antagonists in the treatment of DN.