糖尿病肾病相关药物的研究进展.docVIP

糖尿病肾病相关药物的研究进展 　　【摘要】 糖尿病肾病(DN)是糖尿病重要微血管并发症，其病理特征性表现为肾小球周边部位出现嗜酸性K-W结节，是糖尿病性肾病具有诊断意义的改变。但仅出现于约10%~20%的糖尿病性肾病患者。糖尿病性肾病其他病理改变特点包括肾小球基膜增厚，肾小球上皮细胞足突融合以及由于细胞外系膜基质增多所致肾小球增大。疾病晚期可出现肾小管萎缩肾内纤维化。糖尿病病程10年以上者约50%并发糖尿病肾病，每年新增终末期肾病中，糖尿病导致者所占比例逐年增高。近年关于血管紧张素转换酶抑制剂(ACEI)治疗糖尿病肾病的研究较多。其外内皮素拮抗剂等，被认为有一定的肾脏保护作用，基因治疗亦给糖尿病肾病带来新希望。现就有关内容综述如下。? 　　【关键词】 　　糖尿病肾病；血管紧张素转换抑制剂；基本治疗；综述 　　? 　　【Abstract】 Objective Diabetic nephropathy (DN) is an important microvascular complications of diabetes, the pathological features of the performance of the peripheral parts of the glomerular eosinophilic KW nodule appears, is the diagnosis of diabetic nephropathy has changed. But only appeared in about 10% to 20% of patients with diabetic nephropathy. Other pathological changes of diabetic nephropathy include glomerular basement membrane thickening characteristics of the glomerular epithelial cell foot process fusion as a Results of increased extracellular caused by glomerular mesangial matrix increase. Advanced disease, renal fibrosis and tubular atrophy may occur. More than 10 years duration of diabetes of approximately 50% of the complicated diabetic nephropathy, an annual increase of end-stage renal disease, diabetes caused by increasing the proportion of each year. In recent years, on the angiotensin-converting enzyme inhibitor (ACEI) treatment of diabetic nephropathy more. Its external endothelin antagonist, is said to have some protective effect of kidney, gene therapy has brought new hope to diabetic nephropathy. Now the contents are summarized below.? 　　【Key words】 　　Diabetic；Nephropathy 　　 　　1 ACEI及血管紧张素Ⅱ受体1拮抗剂(AT1拮抗剂)? 　　血管紧张素Ⅱ(AngⅡ)是活性最强的内源性缩血管物质之一。近年AngⅡ引起的非血流动力学因素在DN发病机制中的作用也越来越受到重视。较为突出的是AngⅡ能促进多种细胞因子的生成和细胞增殖基质积聚。其中转化生长因子(TGF-β1)是重要因子。糖尿病时，血糖糖化产物AngⅡ，低密度脂蛋白，二酰甘油等含量增加，以及血流动力学改变均可使用PKC(蛋白激酶C)活化进而引起TGF-β和MAPK(丝裂原激活蛋白激酶)含量及活性增高［1］。对于糖尿病的临床蛋白尿期，ACEI也可以延缓其肾功能的进一步恶化。近年来的研究表明，氯沙坦、缬沙坦等AT1拮抗剂也能通过以上机制发挥肾脏保护作用。单独使用ACEI或ARB，并比较二者的疗效差异无显著性［2］。联合应用ACEI和ARB可以有效地减少蛋白，效果比增加单一药物的更好［2］。AngⅡ在肾脏损害中扮演着重要的角色