活血化瘀类中药治疗糖尿病肾病机制的研究进展

糖尿病肾病(diabetic nephropathy,DN)是糖尿病最主要的微血管并发症之一,终末期造成的肾功能衰竭所引起的死亡率很高。目前研究发现影响DN发生发展的因素较多,发病机制复杂,其中由高血糖所引起的氧化应激、细胞因子表达异常,肾组织炎症反应增加、肾脏血流动力学变化以及糖脂代谢紊乱是引起DN的主要原因。临床所用西药对于DN的治疗有一定的效果,但是其主要治疗机制在于降低糖脂,无法从根本上防治DN的发生发展,加之DN的治疗是漫长的过程,需要长时间服药,造成西药使用中对患者的毒副作用和经济负担很大。以上原因使得中医药在多因素诱发的DN的治疗中显示出较大的优势,很多中药具有多种药理学特性,例如抗氧化、调节免疫、营养心血管、降脂降糖的作用,这种药理学特性与DN的发病原因相合。针对中药的优势,如今出现了很多对中药治疗DN的研究,并且发掘出了很多有良好效果的药物。临床研究表明活血化瘀类中药可明显降低尿蛋白,改善患者临床症状,延缓DN的发生、发展,提高患者生活质量。为此,本文对活血化瘀类中药治疗DN的机制进行综述,从分子生物学角度为活血化瘀类中药治疗DN提供科学的理论依据。

Mechanism of Traditional Chinese Medicine for Promoting Blood Circulation and Removing Blood Stasis in Treating Diabetic Nephropathy

Diabetic nephropathy (DN) is one of the most important microvascular complications of diabetes, and the mortality caused by end-stage renal failure is very high. Current studies have discovered many factors affecting the development of DN, and the pathogenesis is complicated. Among them, oxidative stress caused by hyperglycemia, abnormal expression of cytokines, increased renal inflammatory reaction, renal hemodynamic changes and disorders of glycolipid metabolism are the main causes for DN. Western medicine used in clinical practice has a certain effect on the treatment of DN. Its main therapeutic mechanism is to reduce glycolipid, which however cannot fundamentally prevent the occurrence and development of DN. In addition, the treatment of DN is a long process, which requires long-term use of western medicine, and cause toxic side effects and economic burden on patients. In this case, traditional Chinese medicines(TCM) show great advantages in the treatment of multi-factor-induced DN. Many TCM have a variety of pharmacological properties, such as anti-oxidation, immune regulation, cardiovascular nutrition, lipid-lowering and hypoglycemic effects. With respect to the advantages of TCM, there have been many studies on the treatment of DN with TCM, and many drugs with good effects have been discovered. Clinical studies have shown that TCM for promoting blood circulation and removing phlegm can significantly reduce urinary protein, improve clinical symptoms, delay the occurrence and development of DN, and improve the quality of life of patients. To this end, this paper reviews the mechanisms of TCM for promoting blood circulation and removing blood stasis in the treatment of DN, and provides a scientific theoretical basis for the treatment of DN with TCM for promoting blood circulation and removing blood stasis from the perspective of molecular biology.