中医药调控痛风性肾病尿酸转运蛋白的肾保护机制研究

Renal Protective Mechanism of Traditional Chinese Medicine Regulating Uric Acid Transporters in Gouty Nephropathy

痛风性肾病是痛风及高尿酸血症常见的并发症之一,最终可发展至肾衰竭,危及生命。高血尿酸水平是痛风性肾病发病的基础,在尿酸的生理代谢过程中,尿酸转运蛋白(GLUT9、URAT1、OAT4、OAT10、GLUT12、NPT1、NPT4、OAT1、OAT2及OAT3等)在促进尿酸排泄方面发挥了重要作用,同时也是目前研究降尿酸药物的关键靶点之一。笔者查阅整理近3年中医药治疗痛风性肾病的相关文献,发现中药有效成分(猫须草水提物、菊苣酸、牛膝茎叶总皂苷、木犀草素、枸杞多糖、芍药花总苷、茯苓提取物及穿心莲提取物等)及中药复方(苓泽合剂、痛风宁、健脾清热利浊汤、复方芪苓配方颗粒及排酸护肾汤)在通过调节尿酸转运蛋白降低血尿酸水平方面有其独特优势,多个中药单体及复方可显著调节GLUT9、OAT1、OAT3、URAT1、ABCG2转运蛋白,降低血尿酸水平,改善高血尿酸所引起的肾组织炎症及损伤,保护肾脏。

Gouty nephropathy is one of the common complications of gout and hyperuricemia,which can eventually progress to kidney failure and threaten life.High blood uric acid level is the basis of gouty nephropathy.In the physiological process of uric acid metabolism,uric acid transporters(GLUT9,URAT1,OAT4,OAT10,GLUT12,NPT1,NPT4,OAT1,OAT2,OAT3,etc.)play an important role in promoting uric acid excretion,and are also some key targets of uric-lowering drugs.The authors reviewed and collated the relevant literature on the treatment of gouty nephropathy by traditional Chinese medicine(TCM)in recent 3 years.It was found that some effective components of Chinese herbal medicinals and Chinese herbal medicinal formulae have their unique advantages in reducing blood uric acid level by regulating uric acid transporters.The former includes water extract of Herb of Spicate Clerodendranthus,cichory acid,total saponins of Achyranthus rhizome,luteolin,Lycium barbarum polysaccharide,total glycosides of Paeoniflorin,Poria extract and andrographis extract;while the latter includes Lingze mixture,Tongfeng Ning,Jianpi Qingre Lizhuo decoction,compound Qiling Formula granules,and Paisuan Hushen decoction.Many TCM monomers and compounds can significantly regulate GLUT9,OAT1,OAT3,URAT1,ABCG2 transporters,reduce blood uric acid level,improve renal tissue inflammation and injury caused by high blood uric acid,and protect kidneys.