中医药治疗糖尿病肾病合并高脂血症的研究进展

Research progress of traditional Chinese medicine in the treatment of diabetic nephropathy complicated with hyperlipidemia

随着生活方式的改变和人口老龄化进程加速,糖尿病肾病已成为糖尿病常见的并发症之一,也是造成肾功能衰竭的常见原因之一。糖尿病肾病病位在肾,主要累及脾、肺、肝、胃等脏腑,在疾病不同阶段,其病机侧重点不同。糖尿病肾病不是单独某一个脏腑病变,而是多脏器功能失调,且夹杂湿邪、血瘀、痰浊等,特点是本虚标实。高脂血症属于慢行代谢性疾病,临床表现为三酰甘油、总胆固醇、高密度脂蛋白胆固醇水平升高,其与糖尿病肾病的疾病进展存在共同的作用因子及机制,并且能够引发糖尿病肾小球硬化及尿蛋白改变,介导糖尿病肾病的发生发展。糖尿病肾病合并高脂血症可归属于中医学“消渴”“痰证”“瘀证”等范畴,二者属于中医“异病同治”范围。中医药治疗糖尿病肾病合并高脂血症的效果确切,可通过调控视黄醇结合蛋白4(Retinol-Binding Protein 4,RBP4)、肝型脂肪酸结合蛋白(Liver Type Fatty Acid Binding Protein,L-FABP)和晚期糖基化终末产物(Advanced Glycation End Products,AGEs)等标志物的表达及相关作用机制,达到治疗目的。中医药治疗糖尿病肾病合并高脂血症从抑制炎症因子分泌、拮抗氧化应激、改善线粒体功能等方面入手,具有多靶点、多途径等优势。研究对近年来中医药治疗糖尿病肾病合并高脂血症的研究进展做一综述,以期为临床治疗及研究方向提供参考。

With the acceleration of lifestyle changes and population aging,diabetic nephropathy(DN)has become one of the common complications of diabetes and one of the common causes of kidney failure.Hyperlipidemia is a slow-moving metabolic disease,and there are co-acting factors and mechanisms between it and the disease progression of DN,which belongs to the scope of“Homotherapy for heteropathy”in traditional Chinese medicine.The effect of traditional Chinese medicine in the treatment of DN complicated with hyperlipidemia is certain,and it can achieve the therapeutic purpose by regulating the expression of markers such as retinol-binding protein 4,hepatic fatty acid-binding protein,and advanced glycation end products,as well as related mechanisms of action,which has the advantages of multiple targets and multiple pathways.This article reviews the research progress of traditional Chinese medicine in the treatment of DN complicated with hyperlipidemia in recent years,in order to provide reference for clinical treatment and research directions.