清热药知母及其配伍防治糖尿病肾病的效应机制分析  

Mechanism of Hear-Clearing Drug Zhimu(Anemarrhenae Rhizoma)and Its Compatibility in Preventing and Treating Diabetic Nephropathy

作　　者：宋楠楠 刘超[1,2] 姚锐[2] 张晓菊[2] 姜睿斌 董晓静 李锋[2] SONG Nannan;LIU Chao;YAO Rui;ZHANG Xiaoju;JIANG Ruibin;DONG Xiaojing;LI Feng(Shaanxi University of Chinese Medicine,Xianyang 712046,Shaanxi,China;Xijing Hospital of Air Force Military Medical University,Xi'an 710032,Shaanxi,China)

机构地区：[1]陕西中医药大学,陕西咸阳712046 [2]空军(第四)军医大学第一附属西京医院,陕西西安710032

出　　处：《中华中医药学刊》2023年第1期69-73,共5页Chinese Archives of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81273622);第四军医大学科研基金项目(2019-29)。

摘　　要：糖尿病肾病(diabetic nephropathy,DN)发病机制较为复杂,与炎症反应、氧化应激损伤、肾脏血流异常、糖脂代谢紊乱等因素有关,且各机制间相互影响。现代医学多采用控制糖脂及血压等方式治疗DN,患者需长期服药、经济负担重且不良反应大,但无法从根本上避免DN进展。而中医药防治DN具有多层次、多环节、多途径的复合效应,可标本兼顾,呈现出降脂、降黏、抗炎及抗氧化等药理作用,能延缓DN进展,减轻患者经济负担并提高其生活质量。DN病始阴虚燥热,中期热耗精津,后期瘀水并见,热邪贯穿疾病始终,中医多采用清热养阴兼活血的治法防治DN进展,疗效确切。知母性寒、味甘苦,擅于清热泻火、滋阴润燥,临床用于防治DN及糖尿病(diabetes mellitus,DM),含有芒果苷、知母皂苷和知母多糖等多种化学成分,常与石膏、黄柏及葛根相须配伍,也用于白虎汤、知柏地黄丸等经典复方,可显著降低DN患者糖脂及尿蛋白、减轻其临床症状。知母的单体-芒果苷,能有效减轻炎症反应及氧化应激损伤,临床常与石膏相须配伍,但此药对防治DN的文献较少。因此,还需研究更多中药单体、药对及复方防治DN的机制。基于清法学说及DN病因病机,从分子生物学角度对知母及其配伍防治DN的机制作一综述,以期为中医药防治DN提供理论支撑。The pathogenesis of diabetic nephropathy(DN)is more complicated and is related to factors such as inflammation,oxidative stress damage,abnormal renal blood flow,abnormal glucose and lipid metabolism,and the various mechanisms influence each other.Modern medicine often uses methods such as controlling glycolipid and blood pressure to treat DN.Patients need to take medicine for a long time,with a heavy economic burden and large toxic and side effects,but it is impossible to fundamentally avoid the progression of DN.Traditional Chinese medicine has a multi-level,multi-link and multi-path compound effect in the prevention and treatment of DN,taking into account both the root causes and pathological products.It exhibits pharmacological effects such as lipid-lowering,viscosity-lowering,anti-inflammatory and antioxidant effects,which can delay the progression of DN,reduce the economic burden of patients and improve the quality of life.DN disease starts with Yin deficiency and dryness,and consumes essence and fluid in the middle stage.In the later stage,there is blood stasis and heat evil runs through the disease all the time.Traditional Chinese medicine usually adopts the treatment of clearing heat and nourishing Yin and promoting blood circulation to prevent and treat the progress of DN,and the curative effect is definite.Zhimu(Anemarrhenae Rhizoma)is cold in nature and tastes sweet and bitter.It is good at clearing heat and purging fire,nourishing Yin and moisturizing dryness.It is clinically used to prevent and treat DN and diabetes mellitus(DM).It contains mangiferin,anemarrhena saponins,anemarrhena polysaccharides and other chemical components.It is often compatible with Shigao(Gypsum Fibrosum),Huangbai(Phellodendri Chinensis Cortex)and Gegen(Puerariae Lobatae Radix)and is also used in classic compound prescriptions such as Baihu Decoction(白虎汤)and Zhibai Dihuang Pills(知柏地黄丸),which can significantly reduce glycolipid and urine protein in patients with DN,and relieve their clinical symptoms.The monome

关 键 词：糖尿病肾病 知母 清法 机制 

分 类 号：R259.871[医药卫生—中西医结合]