糖尿病肾病药物治疗策略新进展  

Recent advances in the emerging therapeutic strategies for diabetic kidney diseases

作　　者：郭凯 成玮 朱玉琴 叶娜 朱文锦 周尊海 GUO Kai;CHENG Wei;ZHU Yuqin(Department of Endocrinology,Shanghai Yangpu District Central Hospital(Yangpu Hospital,Tongji University),Shanghai 200090,China;不详)

机构地区：[1]上海市杨浦区中心医院(同济大学附属杨浦医院)内分泌科,上海市200090 [2]上海市杨浦区中心医院(同济大学附属杨浦医院)急诊内科,上海市200090

出　　处：《河北医药》2025年第2期302-306,312,共6页Hebei Medical Journal

基　　金：国家自然科学基金面上项目(编号:32271226)。

摘　　要：糖尿病肾病(diabetic kidney disease,DKD)是糖尿病的主要并发症之一,也是引致终末期肾病的主要原因。DKD治疗与糖尿病患者临床预后密切相关。传统的治疗策略侧重于改善患者生活方式和控制患者的风险因素,如血糖、血脂和血压。过去肾素-血管紧张素系统抑制剂一直是治疗DKD的主要药物,但由于DKD发病机制复杂,其治疗尚未取得突破性进展。近年来,钠-葡萄糖协同转运蛋白2抑制剂、胰高血糖素样肽-1抑制剂和二肽基肽酶-4抑制剂等新型降糖药以及盐皮质激素受体拮抗剂的出现为DKD的治疗提供了更多选择。此外,一些新开发的药物,包括蛋白激酶C抑制剂、晚糖基化终产物抑制剂、内皮素受体抑制剂、磷酸二酯酶抑制剂等,在动物实验或临床试验中均显示出积极的效果。本文综述了近年来DKD的治疗进展,一些新兴药物的研究现状,以及未来治疗DKD的潜在药物,希望能为临床治疗DKD提供一些指导。Diabetic kidney disease(DKD)is not only one of the main complications of diabetes,but also the leading cause of the end-stage renal disease.The DKD treatment is strongly associated with clinical outcomes in patients with diabetes mellitus.Traditional therapeutic strategies focus on improving patients'lifestyle and controlling the major risk factors,such as blood glucose,blood lipids,and blood pressure.Renin-angiotensin system inhibitors have been the main therapeutic measures for DKD in the past,but the complex pathophysiology of DKD poses a challenge in the development of effective medical treatments for the disease.In recent years,the emergences of new hypoglycemic drugs,such as sodium-glucose cotransporter 2 inhibitors(SGLT2i),glucagon-like peptide-1 receptor(GLP-1R)agonists,dipeptidyl peptidase-4 inhibitors(DP4i),and mineralocorticoid receptor antagonist(MRA)have provided more options for the management of DKD.Besides,there are some newly developed drugs,including protein kinase C(PKC)inhibitors,advanced glycation end product(AGEs)inhibitors,endothelin receptor antagonists(ERAs),phosphodiesterase(PDE)inhibitor and so on,which show positive effects in animal or clinical trials.In this review,we sort out the progress in the treatment of DKD in recent years,the research status of some emerging drugs,and the potential drugs for the treatment of DKD in the future,hoping to provide some directions for clinical treatment of DKD.

关 键 词：糖尿病肾病 肾素-血管紧张素系统抑制剂 盐皮质激素受体拮抗剂 钠-葡萄糖共转运蛋白2抑制剂 胰高血糖素样肽-1受体激动剂 二肽基肽酶-4抑制剂 

分 类 号：R587.24[医药卫生—内分泌]