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Gut-derived Uremic Toxins in Chronic Kidney Disease Based on Gut-kidney Axis： A Review
- Chinese Journal of Experimental Traditional Medical Formulae Vol. 29, Issue 7, Pages: 274-282(2023)
- 作者机构：
辽宁中医药大学，沈阳 110032
- 作者简介：
- 基金信息：
DOI：10.13422/j.cnki.syfjx.20230791
CLC： R2-0;R22;R2-031;R692;R256.5Published：05 April 2023，
Published Online：23 May 2022，
Received：06 April 2022，
- 稿件说明：
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相学梅,李宜航,牟曾熠等.基于“肠-肾轴”探讨肠源性尿毒症毒素在慢性肾脏病的研究进展[J].中国实验方剂学杂志,2023,29(07):274-282.
XIANG Xuemei,LI Yihang,MOU Zengyi,et al.Gut-derived Uremic Toxins in Chronic Kidney Disease Based on Gut-kidney Axis： A Review[J].Chinese Journal of Experimental Traditional Medical Formulae,2023,29(07):274-282.
相学梅,李宜航,牟曾熠等.基于“肠-肾轴”探讨肠源性尿毒症毒素在慢性肾脏病的研究进展[J].中国实验方剂学杂志,2023,29(07):274-282. DOI： 10.13422/j.cnki.syfjx.20230791.
XIANG Xuemei,LI Yihang,MOU Zengyi,et al.Gut-derived Uremic Toxins in Chronic Kidney Disease Based on Gut-kidney Axis： A Review[J].Chinese Journal of Experimental Traditional Medical Formulae,2023,29(07):274-282. DOI： 10.13422/j.cnki.syfjx.20230791.
摘要
慢性肾脏病（CKD）是一个全球性健康问题，其发病率逐年增加，研究表明CKD进展为终末期肾脏疾病（ESRD）与其肾功能降低不能有效清除毒素有关，同时肠道微生物群在蛋白质发酵过程中也会产生大量的肠源性尿毒症毒素（GDUTs）；“肠-肾轴”理论认为肠肾互相作用，CKD降低了清除尿毒素（UTs）的能力，导致UTs在血液中积聚。同时，UTs的积累会加速肾功能的恶化，导致恶性循环。该文着重从GDUTs中硫酸吲哚酚、对甲酚硫酸来源及其对CKD的作用机制（如诱导肾小管细胞死亡、氧化应激、内皮损伤，促进肾纤维化及下调肾保护性蛋白）和氧化三甲胺来源及其对CKD的作用机制（如促肾纤维化、促炎）来阐述；从肠-肾轴角度出发，总结饮食营养调节、毒素吸附、强化透析增加清除率、抑制肠源性毒素来源、中医疗法（中药制剂、中药活性成分）方式来调节肠道微生态及减少GDUTs的产生以期延缓CKD的进展提供新的治疗思路。
Abstract
Chronic kidney disease （CKD） is a global health problem， and its incidence increases year by year. Studies have revealed that the progression of CKD into end-stage renal disease （ESRD） is related to its inability to effectively eliminate toxins due to decreased renal function. Additionally， intestinal microflora produces a large amount of gut-derived uremic toxins （GDUTs） during protein fermentation. The theory of gut-kidney axis holds that gut and kidney interact with each other， and CKD reduces the ability to remove uremic toxins （UTs）， resulting in the accumulation of UTs in the blood. The accumulation of UTs also accelerates the deterioration of renal function， leading to a vicious circle. This paper focused on the sources of indoxyl sulfate and p-cresol sulfate in GDUTs and their mechanisms against CKD （such as inducing renal tubular cell death， oxidative stress and endothelial injury， promoting renal fibrosis and down-regulating renal protective protein） as well as the sources of trimethylamine oxide and its mechanisms against CKD （such as promoting renal fibrosis and inflammation）. Moreover， starting from gut-kidney axis， this paper summarized the ways of diet and nutrition regulation， toxin adsorption， enhanced dialysis to increase the clearance， inhibiting the sources of gut-derived toxins and traditional Chinese medicine （TCM） therapy （TCM preparations and TCM active ingredients） to regulate intestinal microecology and reduce the generation of GDUTs， aiming to provide new therapeutic ideas for delaying the progression of CKD.
关键词
慢性肾脏病肠-肾轴肠源性尿毒症毒素研究进展中医药
Keywords
chronic kidney diseasegut-kidney axisgut-derived uremic toxinsresearch progresstraditional Chinese medicine
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