通络药水蛭及配伍防治糖尿病肾病的机制探析

Mechanism of dredging collaterals medicine leech and its compatibility in the prevention and treatment of diabetic nephropathy

糖尿病肾病(Diabetic Nephropathy,DN)是一种病因及致病机制复杂、需长期持续治疗的慢性疾病,其机制与免疫、炎症、氧化应激、血流变异常及糖脂代谢紊乱等相关。中医药在治疗该病方面显示出不良反应小、低成本等优势,可减轻患者经济负担。中医认为DN病机以气血亏虚为本,痰浊血瘀为标,病理产物日久盘踞肾络,导致肾络瘀阻,影响肾气发挥功能,久之肾络受损。近年来通络法的应用对于DN的治疗显示出较好的疗效。通络法是针对气血运行不畅、脉络瘀阻疾病的一种治疗方法。多数医家常用水蛭联合活血化瘀药、补气药及辛温药等治疗DN。水蛭作为通络药之代表,《神农本草经》记载:“主逐恶血,破血瘕积聚”,功长破血通经,逐瘀消癥,临床广泛用于治疗DN。其单体、对药及其他制品可从微观层面调节炎症反应、氧化应激、血流动力学、血管内皮功能及糖脂代谢等,还可从宏观层面稳定足细胞骨架、减缓肾小管间质纤维化、抑制内皮细胞迁移及血管新生等,显著改善DN状态下肾功能及蛋白尿。基于通络法及DN中医病因病机,本研究试从分子生物学角度对水蛭及其配伍防治DN的机制做一综述,以期为中医药防治DN提供理论支撑。

Diabetic nephropathy(DN)is a chronic disease with complex etiology and pathogenesis,which requires long-term and continuous treatment.The mechanism is related to immunity,inflammation,oxidative stress,abnormal blood rheology and disorders of glucose and lipid metabolism.Traditional Chinese medicine has shown advantages in the treatment of the disease such as small side effects and low cost,which can reduce the economic burden of patients.TCM believes that the pathogenesis of DN is based on Qi(气)and blood deficiency,phlegm turbidness and blood stasis,and the pathological products occupy the kidney collaterals for a long time,resulting in kidney collaterals stasis,affecting the function of kidney Qi,and the kidney collaterals are damaged for a long time.In recent years,the application of dredging collaterals method has shown a good effect on the treatment of diabetic nephropathy.Dredging collaterals method is a kind of treatment method for the diseases of poor movement of Qi and blood stasis.Most doctors often use leech combined with blood-activating and stasis-resolving drugs,Qi-tonifying drugs and pungent-warm drugs to treat diabetic nephropathy.As a representative of collateral-dredging drugs,leech has been widely used in the treatment of DN in clinic.Shennong’s Classic of Materia Medica says that leech expels evil blood and relieves blood conglomeration and is good at removing blood stasis and dredging the meridians,relieving mass and eliminating symptoms.The application of its monomer,pairs of drugs and other products can play a role in regulating inflammatory response,oxidative stress,hemodynamics,vascular endothelial function,glucose and lipid metabolism and other mechanisms at the the microscopic level.It can also stabilize podocyte cytoskeleton,slow down renal tubular interstitial fibrosis,inhibit endothelial cell migration and angiogenesis at the macroscopic level,and significantly improve renal function and proteinuria in diabetic nephropathy.Based on the method of dredging collaterals and the etiology and pathogenesis of DN in traditional Chinese medicine,this paper tries to review the mechanism of leech and its compatibility in the prevention and treatment of DN from the perspective of molecular biology,in order to provide theoretical support for the prevention and treatment of DN in traditional Chinese medicine.