摘要
糖尿病肾病(DKD)是糖尿病的主要微血管并发症,也是世界范围内终末期肾病的最常见原因。DKD的进程与高糖激活的肾组织氧化应激、炎症反应、细胞凋亡、纤维化密切相关。众多的研究表明,p38丝裂原活化蛋白激酶(p38 MAPK)信号通路的转导参与DKD肾组织的病理进程,激活了氧化、炎症、凋亡、纤维化等多种病理机制。因此阻断p38 MAPK信号通路的传导有利于缓解DKD。目前西医治疗的主要原则是降糖、降脂、降压等,以及新型药物钠-葡萄糖协同转运蛋白-2、盐皮质激素受体、内皮素受体等,但是仍不能阻止DKD的进程,中医药对DKD的治疗有具有标本兼治及简、廉、便的优势,近年来中药干预DKD的基础研究已经取得许多进展,p38 MAPK是中药发挥干预DKD的关键因子,该文通过对近十年来国内外关于中药干预p38 MAPK信号通路治疗DKD的文献进行检索和总结,p38 MAPK与转化生长因子-β_(1)(TGF-β_(1))、胱天蛋白酶-3(Caspase-3)、核转录因子-κB(NF-κB)等因子相互作用和影响从而激活了纤维化、炎症、氧化应激、凋亡等病理机制,中药作用于p38 MAPK因子及其上下游因子对DKD的病理进程进行阻断,抑制了DKD肾脏的病理损伤和肾功能的恶化。以期为中药防治DKD提供新的思路和方向。
Diabetic kidney disease(DKD),a major microvascular complication of diabetes mellitus,serves as the most common cause of end-stage renal disease worldwide.The progression of DKD is closely related to oxidative stress,inflammatory response,apoptosis,and fibrosis in renal tissues activated by high glucose.Numerous studies have shown that the transduction of the p38 mitogen-activated protein kinase(p38 MAPK)signaling pathway is involved in the pathological process of DKD in renal tissues,activating various pathological mechanisms,such as oxidation,inflammation,apoptosis,and fibrosis.Therefore,blocking the transduction of the p38 MAPK signaling pathway is beneficial to alleviating DKD.At present,the main treatment principles of western medicine are glucose lowering,lipid lowering,and blood pressure lowering,as well as medications with new drugs renal sodium-glucose co-transporter 2(SGLT2),mineralocorticoid receptor,and endothelin receptor,but the progression of DKD still cannot be stopped.The treatment of DKD by traditional Chinese medicine(TCM)has the advantages of simplicity,low cost,and convenience,and the symptoms and root causes can be both treated.In recent years,the basic research on Chinese medicine intervention in DKD has greatly advanced,and p38 MAPK is the key factor of Chinese medicine intervention in DKD.The present study searched and reviewed the literature on the Chinese medicine intervention in the p38 MAPK signaling pathway in DKD treatment in the past decade.The results showed that p38 MAPK interacted with transforming growth factor-β_(1)(TGF-β_(1)),cysteinyl aspartate-specific protease-3(Caspase-3),nuclear factor-κB(NF-κB),and other factors to activate fibrosis,inflammation,oxidative stress,and apoptosis.By acting on p38 MAPK and its upstream and downstream factors,Chinese medicine blocked the pathological processes of DKD and inhibited the pathological injury of DKD and the deterioration of renal function.This study is expected to provide new ideas and directions for the prevention and treatment of DKD with Chinese medicine.
作者
杨鹏
刘铜华
吴丽丽
秦灵灵
张程斐
彭川
张秋娥
YANG Peng;LIU Tonghua;WU Lili;QIN Lingling;ZHANG Chengfei;PENG Chuan;ZHANG Qiue(First Clinical School of Medicine,Shaanxi University of Chinese Medicine,Xianyang 712046,China;Key Laboratory of Chinese Medicine and Health Sciences,Ministry of Education,Beijing University of Chinese Medicine,Beijing 100029,China;Chengdu University of Traditional Chinese Medicine,Chengdu 610075,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2023年第11期212-223,共12页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家级国际联合研究中心项目(2015B01022)
北京市中医药防治糖尿病国际科技合作基地项目
教育部中医药防治糖尿病及其并发症创新引智基地项目(B20055)。
