盐皮质激素受体拮抗剂在糖尿病肾病治疗中的应用进展

Research progress in the application of mineralocorticoid receptor antagonists in the treatment of diabetic kidney disease

盐皮质激素受体(mineralocorticoid receptor,MR)的过度激活与糖尿病肾病(diabetic kidney disease,DKD)的发生和进展密切相关。盐皮质激素受体拮抗剂(mineralocorticoid receptor antagonists,MRAs)通过阻断MR以发挥抑制炎症和抗纤维化作用,改善靶器官损伤,为DKD患者提供保护。甾体类MRAs作用明确但其应用受限于高钾血症、性激素相关不良反应等。近年来,非甾体类MRAs在DKD治疗中取得了明显疗效,且具备更高的选择性和良好的安全性,被视为延缓DKD进展的新兴治疗选择。本文就MRAs治疗DKD的机制及各类MRAs的临床进展进行综述,以期为临床实践提供参考。

The excessive activation of the mineralocorticoid receptor(MR)is closely linked to the development and progression of diabetic kidney disease(DKD).Mineralocorticoid receptor antagonists(MRAs)play a protective role in DKD by inhibiting MR,which lead to anti-inflammatory and anti-fibrotic effects,ultimately improving organ damage.Steroidal MRAs have a well-established mode of action,but their use is limited due to adverse effects such as hyperkalemia and hormonal disturbances.In recent years,nonsteroidal MRAs have emerged as a promising option for DKD treatment,demonstrating significant efficacy along with greater selectivity and improved safety profiles.They are considered a novel therapeutic approach to slow down the progression of DKD.This paper offers a comprehensive review of the mechanisms and clinical research advancements related to MRAs in the treatment of DKD,aiming to provide valuable insights for clinical practice.