糖尿病肾病及其危险因素的研究进展

Advances in the Study of Diabetic Kidney Disease and Its Risk Factors

糖尿病肾病(DKD)是糖尿病最常见的微血管并发症之一,其已经成为需要肾脏替代治疗的终末期肾脏病的首要原因,严重影响患者的生活质量并增加社会医疗负担。多种危险因素可通过不同机制参与DKD的发生和发展,如血糖、血压、血脂、尿酸可增加氧化应激、激活肾素血管紧张素醛固酮系统、损害肾小球滤过屏障,内脏脂肪增多引起异位脂肪沉积、加重胰岛素抵抗,吸烟增加促纤维化细胞因子的表达,贫血引起组织缺氧加重肾纤维化等。这些危险因素大多可以通过积极治疗及改变生活方式得到改善。因此,早期识别DKD的危险因素并综合管理对降低其发病率和死亡率起决定性作用。这篇综述总结了DKD的定义、分期、危险因素及对可改变危险因素的管理,可为临床提供指导。

Diabetic kidney disease (DKD) is one of the most common microvascular complications of diabetes mellitus, and it has become the leading cause of end-stage renal disease requiring renal replace-ment therapy, which seriously affects the quality of life of patients and increases the medical bur-den of the society. Multiple risk factors can be involved in the development and progression of DKD through various mechanisms, such as blood glucose, blood pressure, lipids, and uric acid can in-crease oxidative stress, activate the renin angiotensin aldosterone system, damage the glomerular filtration barrier, increased visceral fat causes ectopic fat deposition, aggravate insulin resistance;smoking increases the expression of profibrotic cytokines, anemia causes tissue hypoxia aggravates renal fibrosis, etc. Most of these risk factors can be improved by active treatment and lifestyle changes. Therefore, the early identification of risk factors for DKD and their integrated management can play a decisive role in reducing its morbidity and mortality. This review summarizes the defini-tion, staging, risk factors and management of modifiable risk factors for DKD to provide clinical guidance.