摘要
氧化应激是糖尿病肾病(DKD)发生发展的关键因素,也是防治DKD的重要环节。“膏浊”病机认为DKD以膏浊侵袭、肾络受损为标,以脾气不足、膏浊内生为本,对氧化应激具有一定的指导意义。脾气不足、膏浊内生是一个动态演变的过程,膏浊侵袭肾络,损伤肾气,逐渐进展为浊瘀凝滞,并最终形成脾肾衰败之象。膏浊损伤肾络和肾气的过程类同于过量活性氧诱导氧化应激造成的肾脏器质性和功能性损伤。肾络受损描述了肾小球、肾小管和肾间质等器质性损伤,而肾气耗伤描述了肾小球滤过和肾小管重吸收作用的损伤。浊瘀凝滞肾络类同于氧化应激诱发肾基底膜增厚和纤维化。脾肾气虚与浊瘀凝滞互为因果,相互加重,形成恶性循环,并最终演变为脾肾衰败。脾肾衰败类同于肾功能衰竭,而脾肾衰败之极即是终末期肾病与尿毒症。中医药治疗DKD氧化应激以健脾补肾、化浊祛瘀为原则,根据证型分别采用健脾益气、燥湿化浊,健脾补肾、燥湿化浊,健脾补肾、化浊祛瘀,固摄脾肾、清化浊瘀。
Oxidative stress is a pivotal factor in the onset and progression of diabetic kidney disease(DKD),and it plays an essential role in the prevention and treatment of DKD.The"Gaozhuo"pathogenesis posits that DKD is characterized by the invasion of Gaozhuo and damage to the kidney collaterals,with the underlying cause being the insufficiency of spleen Qi and the internal formation of Gaozhuo,which provides valuable guidance on oxidative stress.The insufficiency of spleen Qi and the internal formation of Gaozhuo represent a dynamic,evolving process.Gaozhuo invades the kidney collaterals,impairs kidney Qi,and progressively leads to the congealing and stagnation of Gaozhuo and blood,ultimately resulting in the failure of both the spleen and kidneys.The damage caused by Gaozhuo to the kidney collaterals and kidney Qi is analogous to the organ and functional damage of the kidneys induced by excessive reactive oxygen species and oxidative stress.Damage to the kidney collaterals means organic injuries to the glomeruli,renal tubules,and renal interstitium,and the depletion of kidney Qi refers to damage to glomerular filtration and renal tubular reabsorption.The congealing and stagnation of Gaozhuo and blood in the kidney collaterals is similar to oxidative stress-induced thickening of the glomerular basement membrane and fibrosis.The interaction between spleen and kidney Qi deficiency and the congealing and stagnation of Gaozhuo and blood creates a vicious cycle that exacerbates the condition,ultimately evolving into the failure of both the spleen and kidneys.The failure of the spleen and kidneys is analogous to renal failure,and its extreme manifestation is end-stage renal disease and uremia.The treatment of oxidative stress in DKD with traditional Chinese medicine(TCM)is based on the principles of strengthening the spleen and tonifying the kidneys,and dispelling turbidity and removing blood stasis.According to the syndrome type,it is recommended to use methods such as strengthening the spleen and tonifying Qi while dispelling dampness and removing turbidity,strengthening the spleen and tonifying the kidneys while dispelling dampness and removing turbidity,strengthening the spleen and tonifying the kidneys while dispelling turbidity and removing blood stasis,or consolidating the spleen and kidneys while clearing away turbidity and blood stasis.
作者
殷语蔓
俞赟丰
黄湘宁
黄家望
胡港
黄娟
喻嵘
YIN Yuman;YU Yunfeng;HUANG Xiangning;HUANG Jiawang;HU Gang;HUANG Juan;YU Rong(School of Traditional Chinese Medicine,Hunan University of Chinese Medicine,Changsha 410208,China)
出处
《中国实验方剂学杂志》
北大核心
2026年第2期226-234,共9页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家自然科学基金联合基金项目(U21A20411)
湖南省自然科学基金创新研究群体项目(2024JJ1007)
湖南省自然科学基金医卫联合项目(2024JJ9436)
湖南省教育厅重点项目(24A0263,24A0272)
湖南省教育厅优秀青年项目(22B0389)
湖南中医药大学学科建设“揭榜挂帅”项目(22JBZ002)
湖南中医药大学研究生科研创新项目(2025CX058)。
关键词
糖尿病肾病
氧化应激
膏浊
中医药
diabetic kidney disease
oxidative stress
Gaozhuo
traditional Chinese medicine
