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糖尿病肾脏病"内热致癥"病机内涵

WU Qiaoru,WANG Yaoxian,YANG Hanwen, ZHANG Chao,ZHANG Jiale,SUN Weiwei

China Journal of Chinese Medicine（2023）

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Abstract
线粒体功能障碍是糖尿病肾脏病(diabetic kidney disease,DKD)的重要发病机制.持续高血糖状态可能通过抑制AMPK-ULK1通路,抑制线粒体自噬,导致受损线粒体未能被及时清除,线粒体功能受损,从而加快DKD的进展.另外,基于"内热致癥"理论,DKD基本病机为伤阴耗气,痰郁热瘀互相胶结于络脉,形成微型癥瘕,"内热"是肾络癥瘕形成的初始病机,并贯穿于病程始终.随着DKD进程内热证表现形式不同,兼夹证候亦不同:早期内热主要表现为燥热、郁热,常并见阴虚证、气虚证;中期主要表现为结热、湿热,常并见气虚证,逐渐形成肾络微型癥瘕;晚期主要为浊热、湿热,阳虚证比例升高,浊毒内生.中医药对延缓DKD的进展有明确效果,清热消癥法可减轻机体蛋白尿、改善自噬受阻状态.探讨清热消癥法能否通过调控能量代谢的关键传感器——AMPK-ULK1通路,激活线粒体自噬,清除损伤的线粒体,改善线粒体功能,减轻肾小球硬化,延缓DKD发展.
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Key words
diabetic kidney disease,mitochondria,autophagy,"internal Heat induced lump" syndrome,clearing Heat and eliminating lump method,Qing Re Xiao Zheng Yi Qi prescription,lump in collateral,internal Heat
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