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1.河北中医学院,石家庄 050200
2.河北省中医院,石家庄 050011
Received:14 September 2021,
Published Online:30 November 2021,
Published:05 February 2022
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靳贺超,顾悦,张圆圆等.细胞焦亡与坏死性凋亡在糖尿病肾病中的作用及中医药干预研究进展[J].中国实验方剂学杂志,2022,28(03):58-67.
JIN He-chao,GU Yue,ZHANG Yuan-yuan,et al.Roles of Pyroptosis and Necroptosis in Diabetic Kidney Disease and Its Regulation with Traditional Chinese Medicine: A Review[J].Chinese Journal of Experimental Traditional Medical Formulae,2022,28(03):58-67.
靳贺超,顾悦,张圆圆等.细胞焦亡与坏死性凋亡在糖尿病肾病中的作用及中医药干预研究进展[J].中国实验方剂学杂志,2022,28(03):58-67. DOI: 10.13422/j.cnki.syfjx.20220336.
JIN He-chao,GU Yue,ZHANG Yuan-yuan,et al.Roles of Pyroptosis and Necroptosis in Diabetic Kidney Disease and Its Regulation with Traditional Chinese Medicine: A Review[J].Chinese Journal of Experimental Traditional Medical Formulae,2022,28(03):58-67. DOI: 10.13422/j.cnki.syfjx.20220336.
肥胖和糖尿病发病率的增加已使糖尿病肾病(DKD)成为慢性肾病和终末期肾病的主要原因。尽管目前有优化血糖控制和肾素-血管紧张素系统抑制等药物干预,但肾脏疾病进展和并发症的风险仍然很高。目前DKD发病机制尚未完全明确,包括慢性炎症反应、氧化应激、糖脂代谢紊乱、血流动力学异常等,近年研究发现肾脏固有细胞的程序性死亡(PCD)如细胞焦亡及坏死性凋亡对DKD发生发展有关键作用。细胞焦亡和坏死性凋亡是新近发现的细胞程序性死亡的两种途径,虽然这些细胞死亡程序可以保护宿主免受病原微生物的侵害,但他们的失调与多种自身免疫和自身炎症反应有关。细胞焦亡和坏死性凋亡紧密联系且相互交叉调节,这两种不同于凋亡的细胞自杀机制通过各自的执行蛋白消皮素D(GSDMD)和混合系激酶区域样蛋白(MLKL)导致膜破裂并使胞内容物释放,包括损伤相关分子模式(DAMPs)和炎症细胞因子如白细胞介素-1
β
(IL-1
β
)来触发炎症,而慢性炎症反应是导致DKD进展的关键因素。中医药防治DKD由来已久且临床疗效显著,研究表明中药可通过影响核苷酸寡聚化结构域样受体蛋白3(NLRP3)炎症小体,受体相互作用蛋白激酶3(RIPK3),MLKL的表达发挥糖尿病肾保护作用,本文就细胞焦亡、坏死性凋亡与DKD之间关系及中医药的干预作用进行综述。
The increasing incidence of obesity and diabetes has made diabetic kidney disease (DKD) the main cause of chronic kidney disease and end-stage renal disease. Despite current pharmacological interventions for blood glucose control and renin-angiotensin system inhibition, the risk of kidney disease progression and complications remains high. At present, the pathogenesis of DKD has been clarified to be related to chronic inflammatory response, oxidative stress, glucose and lipid metabolism disorders, and hemodynamic abnormalities. According to recent studies, the programmed cell deaths (PCD) of renal intrinsic cells such as pyroptosis and necroptosis play a key role in the occurrence and development of DKD. Pyroptosis and necroptosis, the two newly discovered routes of PCD, can protect the hosts from being invaded by microbial pathogens, but their dysregulation is associated with multiple autoimmunity and autoinflammatory responses. Pyroptosis and necroptosis are closely interlinked and cross-regulated. Different from apoptosis, these two cellular suicide mechanisms cause membrane rupture and release of cell contents through their respective gasdermin D (GSDMD) and mixed lineage kinase domain-like protein (MLKL), with damage-associated molecular patterns (DAMPs) and inflammatory cytokines like interleukin-1
β
(IL-1
β
) involved to trigger inflammation, and chronic inflammatory responses are key factors leading to the progression of DKD. Traditional Chinese medicine (TCM) has long been employed for the prevention and treatment of DKD and the resulting clinical outcomes are remarkable. TCM has been proved to exert a protective effect against DKD by affecting the expression of nucleotide oligomerization domain-like receptor protein 3 (NLRP3) inflammasome, receptor-interacting protein kinase 3 (RIPK3), and MLKL. This paper reviewed the relationship of pyroptosis and necroptosis with DKD and its intervention with TCM.
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