骨桥蛋白与糖尿病肾病关系的研究进展

骨桥蛋白(OPN)是一种具有细胞粘附和迁移功能的分泌型磷酸化糖蛋白。在肾脏中有广泛分布,研究发现其参与糖尿病肾病(DN)蛋白尿形成、DN的炎症反应及肾脏纤维化过程,抑制OPN可改善糖尿病肾脏病变。     

法尼酯衍生物X受体（FXR）在糖尿病肾病中的研究进展

糖尿病肾病（DN）是糖尿病常见的慢性微血管并发症,最初是由高血糖引起的肾脏适应性高滤过率,进而导致肾脏细胞的代偿性增生、炎症以及纤维化。法尼酯X受体（FXR）被证明对糖尿病肾病有负性调节的作用,FXR可以通过不同的方面（血糖、血脂、炎症以及纤维化）对糖尿病肾病进行调控,从而有效的控制糖尿病肾病的发生和发展。本文将对FXR以及FXR调控糖尿病肾病的不同方面予以综述。     

二苯乙烯苷对糖尿病肾病大鼠氧化应激反应相关因子的影响

目的：探讨二苯乙烯苷（TSG）对糖尿病肾病（DN）大鼠氧化应激效应和肾功能的影响。方法：将雄性大鼠随机分为正常对照 组、DN 大鼠模型组和TSG 治疗组,采用腹腔注射链脲佐菌素（60 mg/kg）建立DN大鼠模型,给药8 周后所有大鼠称体重、肾重。 并且通过腹腔采血的方式,收集各组大鼠的血液,观察、测量各组大鼠血清中相应的生化指标,然后运用比色法测定各组大鼠血 清中氧化应激相关因子活性和含量。结果：TSG能够有效的增强肾脏对血肌酐、尿素氮的清除率,从而减轻由高血糖引起的肾脏 损伤,并且能够显著降低DN大鼠血液中NO、NOS含量,提高T-SOD、CAT 活力值。结论：二苯乙烯苷能够改善DN 大鼠血清中 相应的生化指标,有效抑制DN大鼠肾脏的氧化应激反应,对DN具有显著的治疗作用。     

黄芪皂苷Ⅱ对STZ诱导的糖尿病大鼠的肾脏保护作用研究

摘要 目的：研究黄芪皂苷Ⅱ（Astragaloside-Ⅱ, AS-Ⅱ）对链脲佐菌素（Streptozocin,STZ）诱导的糖尿病肾病（Diabetic nephrology,DN）大鼠肾脏的保护作用。方法：将8周龄雄性SD（Sprague-Dawley）大鼠随机选取5只作为正常对照组,其余大鼠予腹腔注射55 mg/kg剂量STZ建立糖尿病模型。造模成功的大鼠随机分为模型组与AS-Ⅱ 治疗组,每组5只。AS-Ⅱ 治疗组予AS-Ⅱ 3.2mg/(kgod）连续口服灌胃治疗9周,同时正常对照组和模型组给予等量生理盐水溶液灌胃。第9周末,收集大鼠24 h尿液测定尿微量白蛋白浓度,留取肾脏组织观察肾脏病理改变并检测肾组织中足细胞裂孔隔膜蛋白Nephrin、WT1和caspase-3的表达。结果：与糖尿病模型组比较, AS-Ⅱ 治疗组DN大鼠肾脏病理损伤明显改善, caspase-3表达明显减少,Nephrin和WT1表达增加,尿蛋白排泄减轻( P＜0. 05)。结论：AS-Ⅱ 治疗可改善DN大鼠肾脏足细胞凋亡,降低尿蛋白,具有肾脏保护作用。     

骨形态发生蛋白-7及抑制性Smads在糖尿病肾病发生发展中的表达变化

本文采用免疫组化、Western blot及荧光实时定量PCR方法,动态观察链脲佐菌素（streptozocin,STZ）诱导的大鼠糖尿病肾病（diabetic nephropathy,DN）发生早期肾脏骨形态发生蛋白-7（bone morphogenetic protein-7,BMP-7）、Smad6、Smad7蛋白及mRNA表达。结果显示,在正常及DN大鼠肾小管均有BMP-7、Smad6、Smad7蛋白表达,以胞浆表达为主。DN大鼠BMP-7、Smad6蛋白表达较正常大鼠明显增多（P〈0．05）,且BMP-7的mRNA表达呈先增加后降低的状态;而Smad7蛋白和mRNA的表达均呈先增加后降低的状态。转化生长因子-β1（transforming growth factor-β1,TGF-β1）及Ⅰ型胶原（collagen typeⅠ,COL-Ⅰ）mRNA在DN大鼠肾脏表达较正常大鼠明显增多（P〈0．05）,且随着糖尿病进展有逐渐增加的趋势。结果提示,作为TGF-β超家族信号分子的一员,BMP-7信号及抑制性Smad通路在DN肾纤维化发生早期可能起重要的反馈性抑制作用。     

内质网应激及其在糖尿病肾病中的作用机制

糖尿病肾病（diabetic nephropathy,DN）是糖尿病最常见的微血管并发症,是导致终末期肾脏疾病（end-stage renal disease,ESRD）的继发性肾脏疾病的主要病因之一。多种因素如缺氧、氧化应激、病毒感染、遗传突变等,可导致内质网内稳态失衡,大量未折叠蛋白和错误折叠引起蛋白堆积,即形成内质网应激(endoplasmic reticulum stress, ERS),从而激活未折叠蛋白反应(unfolded protein response, UPR)介导的三条经典的细胞适应性应答通路以恢复内质网稳态和细胞活性。但如果刺激过强或持续存在,便会启动细胞凋亡信号通路。大量研究表明ERS与DN的发生发展相关,并参与不同类型肾细胞损伤的过程,因此ERS作为治疗DN的有效靶点具有很重要的研究前景,调控ERS可为DN的治疗提供新的理论支持。从ERS相关信号通路及其在DN中的作用和新进展领域作一综述,以期为DN的治疗研究提供参考。     

金樱子提取液对糖尿病肾病大鼠的肾脏保护作用

目的:研究金樱子提取液对糖尿病肾病(Diabetic Nephropathy,DN)大鼠的肾脏保护作用。方法:在高糖高脂饲料喂食SD(Sprague-Dawley)大白鼠的基础上腹腔注射链脲佐菌素(streptozotocin,STZ)诱导糖尿病肾病大鼠模型,随机分为糖尿病肾病模型组(DN组)和金樱子治疗组(DN+RLM组),同时另设正常对照组(NC组)和金樱子对照组(NC+RLM组)。检测金樱子提取液对各组大鼠血糖(fasting blood-glucose,FBG)、糖化血红蛋白(glycosylated haemoglobin,GHb)、24小时尿微量白蛋白和尿量、血尿素氮(BUN)、血肌酐(Scr)、胆固醇(TC)、甘油三酯(TG)及肾脏结构的影响。结果:与DN大鼠相比,糖尿病肾病大鼠经金樱子提取液治疗后,大鼠FBG、GHb水平、24 h尿微量白蛋白、24 h尿量、肾脏指数明显降低,血脂紊乱、肾功能损害以及DN肾脏病理明显改善,且无明显副作用。结论:金樱子提取液可明显降低DN大鼠血糖,改善DN大鼠血脂、肾功能紊乱及肾脏病理变化,对糖尿病大鼠肾脏具有较强的保护作用。     

肾小管脂毒性在糖尿病肾病发病机制中的研究进展

糖尿病肾病(diabetic nephropathy,DN)是糖尿病的重要并发症，是终末期肾病的重要病因。DN患者常伴脂质代谢紊乱。脂代谢紊乱可致肾小管内脂质分布异常，引起肾脏脂肪堆积、脂滴积累、肾小管损伤等一系列“脂毒性”现象，进而诱发DN肾脏炎症、纤维化等病理改变。作为肾脏中的高耗能结构，肾小管脂代谢产能对维持其正常生理功能具有重大意义。脂质能量代谢在DN发病机制中发挥不可或缺的作用，本文从胆固醇代谢引起DN肾小管脂毒性、脂肪酸代谢引起DN肾小管脂毒性、脂代谢异常在肾小管与肾小球间的“串扰”作用以及肾小管脂毒性靶向药物治疗等方面进行阐述，旨在为今后临床防治DN新角度与新方案的提出提供参考。     

超声在糖尿病肾病诊断中的应用价值

由于快速变化的生活方式,我国糖尿病的患病率呈逐年上升趋势。糖尿病肾病(diabetic nephropathy,DN)是糖尿病最常见、最严重的微血管病变并发症之一,并且已经成为全球终末期肾病的最常见病因。因此,早期诊断、早期治疗是延缓DN进展的重点。超声是临床评价肾脏形态、功能常用的检查方法,与血、尿实验室检查相比,具有方便、快捷、无创、经济的优势。随着科学技术的发展,越来越多的超声新技术应用于临床,极大的丰富了诊断信息。本文就各项超声检查技术在检测DN患者肾脏体积、实质回声、血流动力学改变中的应用价值作一综述。得出结论:在DN早期血、尿实验室检查正常时超声已经可以发现肾脏体积、血流动力学发生了变化。因此,超声在DN的早期诊断、动态监测病程进展方面所发挥的作用是其他检查方法所不可替代的。三维超声技术和超声弹性成像在DN患者肾脏功能评价方面有着广泛研究空间及临床应用前景。     

维吾尔族2型糖尿病患者糖尿病肾病相关因素分析

目的：探讨维吾尔族2型糖尿病肾病（DN）发病的相关临来因素。方法：分析292例维吾尔族2型糖尿病患者的临床资科。结果：维吾尔族2型糖尿病患者糖尿病肾病（DN）发病率为43,49％（127／292）。DN患者的病程、SBP、TC、TG、FBG、HbAIC、LDL—C、BUN和Cr均显著高于NDN患者（P〈0．05）;但DBP、HDL．C、BMI之间无统计学差异（P〉0．05）。Logistic归分析结果显示,DM病程、患病年龄、SBP、FBP、TC、TG、LDL—C、HbAlc、BUN、Cr是DN的危险因素（OR值〉1）。结论：维吾尔族2型糖尿病患者的Did病程、患病年龄、SBP、FBP、TC、TG、LDL—C、HbAlc、BUN、Cr等参数与糖尿病肾病并发率之间有相关性。     

Absence of increased alpha1-microglobulin in IgA nephropathy proteinuria

To search for biomarkers of IgA nephropathy, protein profiles of urine samples from patients with IgA nephropathy and normal volunteers were compared using two-dimensional DIGE. Most of the 172 spots identified in the urine were serum proteins, and their amounts in IgA nephropathy urine were much higher than those in normal urine; this can be explained as proteinuria caused by glomerular dysfunction. However, only alpha(1)-microglobulin, also one of the major serum proteins, in IgA nephropathy urine was not higher in amount than that in normal urine. We confirmed using ELISA analysis that the amounts of transferrin and albumin in IgA nephropathy and diabetic nephropathy urine were much higher than those in normal urine, whereas the amount of alpha(1)-microglobulin in IgA nephropathy urine was not higher than that in normal urine and was much lower than that in diabetic nephropathy urine. Approximately 50% of alpha(1)-microglobulin forms a complex with IgA in serum. These results suggest that alpha(1)-microglobulin in IgA nephropathy urine is a characteristic protein and might be a biomarker for IgA nephropathy and that alpha(1)-microglobulin might have a relationship with IgA nephropathy pathology.     

The role of IL-18 in type 1 diabetic nephropathy: The problem and future treatment

Diabetic vascular complication is a leading cause of diabetic nephropathy, a progressive increase in urinary albumin excretion coupled with elevated blood pressure leading to declined glomerular filtration and eventually end stage renal failure. There is growing evidence that activated inflammation is contributing factor to the pathogenesis of diabetic nephropathy. Meanwhile, IL-18, a member of the IL-1 family of inflammatory cytokines, is involved in the development and progression of diabetic nephropathy. However, the benefits derived from the current therapeutics for diabetic nephropathy strategies still provide imperfect protection against renal progression. This imperfection points to the need for newer therapeutic agents that have potential to affect primary mechanisms contributing to the pathogenesis of diabetic nephropathy. Therefore, the recognition of IL-18 as significant pathogenic mediators in diabetic nephropathy leaves open the possibility of new potential therapeutic targets.     

糖尿病肾病发病分子机制

糖尿病肾病(DN)是高血糖所导致的一种主要的微血管并发症。在全世界糖尿病病人中,糖尿病肾病都有着非常高的发病率和致死率。并且在中国,糖尿病肾病已经成为一种常见的导致末期肾衰竭的因素。由于糖尿病肾病患者不断增多,传统的单纯通过控制血糖来控制糖尿病肾病并没有取得理想的效果,因此临床上迫切需要一些新的治疗方法来控制糖尿病肾病的发生和发展。最近的研究表明肾素-血管紧张素-醛固酮系统(RAAS)、蛋白激酶-C(PKC)、还原型烟酰胺腺嘌呤二核苷酸磷酸(NADPH)氧化酶、转化生长因子-β(TGF-β)等都单独的或共同的参与了DN的发生和发展过程。这些通路彼此交叉,十分复杂,因此需要对糖尿病肾病发病分子机制进行全面的综合的理解。这篇文章旨在讨论已发现的与糖尿病肾病密切相关的分子机制以及下调通路。     

Genetic and clinical profile of Indian patients of idiopathic restrictive cardiomyopathy with and without hypertrophy

Diabetic nephropathy is associated with high morbidity and mortality and the prevalence of this disease is continuously increasing world wide. Though, the major risk factors like hyperglycemia and hypertension play a pivotal role in the pathogenesis of diabetic nephropathy, the etiology of this insidious disorder is not well understood. Mast cells are pluripotent bone marrow derived cells that play a key role in inflammation. Degranulation of mast cells releases various mediators including inflammatory cytokines, endothelins, growth factors, and proteolytic enzymes. Infiltration of mast cells has been noted to occur in renal diseases. In addition, the renal density of mast cells is significantly increased in diabetic patients with nephropathy. It remains unclear whether resident renal mast cells derived mediators play a role in the pathogenesis of diabetic nephropathy. Recent studies suggest the involvement of renal mast cell infiltration and degranulation in diabetic nephropathy. The present review focuses on the role of resident renal mast cells in diabetic nephropathy.     

IgA肾病预后的相关影响因素分析

目的：分析IgA肾病预后的相关影响因素,为[gA肾病的治疗提供可靠的依据。方法：选择我市三家医院经病理确诊的143例IgA肾病患者,记录其临床资料,根据随访结果将患者的预后分为优、良、中、差4个档次,通过单因素、多因素等方法获得IgA肾病预后的影响因素。结果：1．LEE氏病理组织学分级是[gA肾病患者预后的危险因素,分级越高预后越差,P〈0．01。2．单因素分析：年龄、病程、高血压、尿蛋白含量、水肿程度、肉眼血尿均为其危险因素,ACEI治疗为其保护因素,P〈0．01。3．多因素分析显示尿蛋白含量、LEE肾组织学分级、病程、高血压及ACEI治疗纳入的累计概率模型有统计学意义。结论：尿蛋白含量、LEE肾组织学分级、病程、高血压是IgA肾病预后的危险因素,ACEI治疗是其保护因素。     

Urinary adiponectin excretion is increased in patients with overt diabetic nephropathy

Adiponectin, a novel adipose-derived adipocytokine, has beneficial effects not only on improvement of insulin sensitivity but also on mitigation of vascular damage. To evaluate whether adiponectin is implicated in the pathogenesis of diabetic nephropathy characterized by microvascular damage, we examined urinary and serum adiponectin levels in type 2 diabetic patients with different stages of nephropathy. We first confirmed adiponectin is excreted into urine through Western blot analysis, followed by measurements of urinary and serum adiponectin levels by radioimmunoassay. Interestingly, urinary adiponectin excretion levels were markedly increased in patient group with overt nephropathy relative to the groups without nephropathy and with incipient nephropathy. Surprisingly, serum adiponectin levels were also elevated in patient group with overt nephropathy. Increased urinary adiponectin excretion may result from elevations in circulating adiponectin levels and enhanced filtration of circulating adiponectin through the damaged kidney. Furthermore, adiponectin synthesis in adipose tissue and its secretion into circulating blood may be enhanced to mitigate microvascular damage in the advanced stage of diabetic nephropathy.     

Cardiovascular disease in patients with diabetic nephropathy

Diabetic nephropathy, which represents a major form of chronic kidney disease (CKD), is a leading cause of end-stage renal disease worldwide, and is also a risk factor for cardiovascular disease (CVD). Patients with diabetes and CKD have poorer outcomes after myocardial infarction. The underlying pathogenic mechanism that links diabetic nephropathy to a high risk of CVD remains unclear. In addition to traditional risk factors, including hypertension, hyperglycemia, and dyslipidemia, identification of novel modifiable risk factors is important in preventing CVD in people with diabetes. Inflammation/oxidative stress are known to be associated with an increased risk for CVD in patients with diabetic nephropathy. Moreover, homocysteine, advanced glycation end products, asymmetric dimethylarginine, and anemia may play a role in the development and progression of atherosclerosis in patients with diabetic nephropathy. This review summarizes the epidemiologic evidence, molecular mechanisms responsible for the increased risk for CVD in patients with diabetic nephropathy, and therapeutic intervention for diabetic nephropathy as evidenced by large-scale clinical trials.     

糖尿病肾病的发病机制和药物干预研究进展

糖尿病肾病作为糖尿病最严重的并发症之一,也是糖尿病患者最主要的死亡原因之一。糖尿病肾病的发病机制主要与代谢紊乱、 血流动力学紊乱、氧化应激、炎症及遗传因素等相关。综述糖尿病肾病发病机制及相关药物治疗的研究新进展,为糖尿病肾病的早期干 预和治疗提供参考。     

Co-regulation of Gremlin and Notch signalling in diabetic nephropathy

Diabetic nephropathy is currently the leading cause of end-stage renal disease worldwide, and occurs in approximately one third of all diabetic patients. The molecular pathogenesis of diabetic nephropathy has not been fully characterized and novel mediators and drivers of the disease are still being described. Previous data from our laboratory has identified the developmentally regulated gene Gremlin as a novel target implicated in diabetic nephropathy in vitro and in vivo. We used bioinformatic analysis to examine whether Gremlin gene sequence and structure could be used to identify other genes implicated in diabetic nephropathy. The Notch ligand Jagged1 and its downstream effector, hairy enhancer of split-1 (Hes1), were identified as genes with significant similarity to Gremlin in terms of promoter structure and predicted microRNA binding elements. This led us to discover that transforming growth factor-beta (TGFbeta1), a primary driver of cellular changes in the kidney during nephropathy, increased Gremlin, Jagged1 and Hes1 expression in human kidney epithelial cells. Elevated levels of Gremlin, Jagged1 and Hes1 were also detected in extracts from renal biopsies from diabetic nephropathy patients, but not in control living donors. In situ hybridization identified specific upregulation and co-expression of Gremlin, Jagged1 and Hes1 in the same tubuli of kidneys from diabetic nephropathy patients, but not controls. Finally, Notch pathway gene clustering showed that samples from diabetic nephropathy patients grouped together, distinct from both control living donors and patients with minimal change disease. Together, these data suggest that Notch pathway gene expression is elevated in diabetic nephropathy, co-incident with Gremlin, and may contribute to the pathogenesis of this disease.     

MTHFR gene variant is not associated with diabetic nephropathy in Japanese.

Genetic predisposition has been implicated in diabetic nephropathy. The C677T variant of the MTHFR gene has been suggested to play a role in the development of not only vascular diseases but also diabetic microangiopathies. By using polymerase chain reaction-restriction length polymorphism (PCR-RFLP) method using Hinf I, we investigated whether this variant is associated with diabetic nephropathy in Japanese. By analysing 274 unrelated Japanese patients with type II DM with or without nephropathy, there was no significant difference in the genotype distribution of this variant. The distribution of the three genotypes were not different among patients with micro- or macroalbuminuria and those without nephropathy. Although previous reports suggest a role of this variant with diabetic microangiopathies, our observations suggest that this variant is does not play an important role in the pathogenesis of diabetic nephropathy in Japanese.