摘要
适度自噬可通过多种信号通路干预慢性肾脏病的形成与发展,而自噬不足则会引起衰老细胞器、异常蛋白等病理垃圾累积,造成细胞损伤甚至凋亡,故细胞自噬有望成为调控慢性肾脏病进展的新靶点。“肾虚湿热”是中医对慢性肾脏病病因病机的总概括,细胞自噬异常或可看作肾虚湿热病机的微观体现。临床利用“益肾清利”法治疗慢性肾脏病具有良好的疗效,益肾清利中药具有减轻细胞损伤、改善蛋白尿、延缓肾脏纤维化等作用。现有研究存在如下问题:①起效机制研究主要集中于mTOR相关信号通路,缺乏对非mTOR信号通路的研究;②益肾清利中药对自噬水平的调控是否具有双向性,这一特性是否与药物剂量或单一中药的不同成分相关,尚未明确;③中药复方作用靶点研究难度较大,机制研究尚不充分。今后需进一步明确益肾清利法治疗慢性肾脏病的起效机制,加强对中药干预细胞自噬过程具体环节的研究,进一步探讨其是否具有双向调节作用,同时加强中药复方各有效成分发挥协同拮抗作用的现代药理学证据支持。
Moderate autophagy can interfere with the formation and development of chronic kidney disease through a variety of signal pathways.Insufficient autophagy will cause the accumulation of pathological waste such as aging organelles and abnormal proteins,resulting in cell damage and even apoptosis.Therefor,autophagy is expected to become a new target for regulating the progression of chronic kidney disease."Damp-heat caused by kidney deficiency"is the refinement and generalization of the etiology and pathogenesis of chronic kidney disease in Chinese medicine.Abnormal autophagy may be regarded as the micro mechanism of the pathogenesis.Clinically,the regulation of autophagy level by"invigorating kidney to clear heat-damp"method has a good effect in the treatment of chronic kidney disease.Chinese materia medica with the function of invigorating kidney to clear heat-damp can reduce cell damage,improve proteinuria and delay renal fibrosis.However,the existing studies have the following problems:(1)The research on the mechanism of action mainly focuses on mTOR related signal pathway,and there is a lack of research on non mTOR signal pathway;(2)whether the regulation of Chinese materia medica with the function of invigorating kidney to clear heat-damp on autophagy level is bidirectional and whether this characteristic is related to medicine dose or different components of a single Chinese materia medica is not clear;(3)it is difficult to study the target of Chinese materia medica compound,and the mechanism is not enough.In the future,it is necessary to further clarify the effective mechanism of invigorating kidney to clear heat-damp method in the treatment of chronic kidney disease,strengthen the research on the specific links of Chinese materia medica in the process of cell autophagy,further explore whether it has a two-way regulatory effect,and strengthen the modern pharmacological evidence support of the synergistic antagonistic effect of various effective components of Chinese materia medica.
作者
吴静怡
蒋春波
WU Jingyi;JIANG Chunbo(Nanjing University of Chinese Medicine,Nanjing Jiangsu China 210023;Suzhou Chinese Medicine Hospital Affliated to Nanjing University of Chinese Medicine,Suzhou Jiangsu China 215000)
出处
《中医学报》
CAS
2021年第11期2346-2350,共5页
Acta Chinese Medicine
基金
国家自然科学基金青年项目(81704005)
江苏省自然科学基金青年项目(BK20170384)
江苏省青年医学重点人才项目(QNRC2016254)
姑苏卫生青年拔尖人才项目(GSWS2019063)。
关键词
肾虚湿热
细胞自噬
慢性肾脏病
damp-heat caused by kidney deficiency
autophagy
chronic kidney disease
