中西医结合视角下黄芪甲苷治疗糖尿病肾病的作用机制探析

Analysis of the Mechanism of Astragaloside IV in the Treatment of Diabetic Nephropathy from the Perspective of Integrated Traditional Chinese and Western Medicine

摘要: 糖尿病肾病(diabetic kidney disease, DKD)是糖尿病最常见和最严重的并发症之一，也是全球慢性肾脏病和终末期肾病的主要病因。其发病机制涉及炎症、氧化应激及纤维化等多个环节。在中医理论中，DKD属“消渴肾病”范畴，病机被认为是消渴日久耗伤正气，以气阴两虚为本，渐至阴阳两虚，常兼夹瘀血与湿浊内蕴。中药治疗DKD具有多成分、多靶点、多通路及成本较低的优势。黄芪甲苷(Astragaloside IV, AS-IV)作为黄芪的主要活性成分，具有改善胰岛素抵抗、抗炎、抗氧化、抗纤维化及保护血管内皮等多种药理作用，从而发挥肾保护效应。该机制与黄芪“补气活血、利水消肿”的功效高度吻合，显示出在DKD治疗中的重要潜力。近年来，AS-IV已成为研究热点，有望成为DKD辅助治疗的重要选择。本文基于中西医结合视角，系统综述AS-IV防治DKD的作用机制与最新进展，以期为临床开发与应用提供理论依据。

Abstract: Diabetic kidney disease (DKD) is one of the most common and serious complications of diabetes, as well as a leading cause of chronic kidney disease and end-stage renal disease worldwide. Its pathogenesis involves multiple mechanisms, including inflammation, oxidative stress, and fibrosis. In traditional Chinese medicine (TCM), DKD falls under the category of “Xiao Ke” (consumptive thirst). The pathogenesis is believed to involve consumption of healthy qi due to prolonged Xiao Ke, with qi and yin deficiency as the root, which may progress to yin and yang deficiency, often accompanied by blood stasis and damp-turbidity retention. Chinese herbal medicine offers advantages in treating DKD through multiple components, multiple targets, multiple pathways, and relatively low cost. Astragaloside IV (AS-IV), the main active component of Astragalus membranaceus, exerts renal protective effects by improving insulin resistance, anti-inflammation, anti-oxidation, anti-fibrosis, and protecting vascular endothelium. These mechanisms align closely with the TCM efficacy of Astragalus in “tonifying qi, promoting blood circulation, and inducing diuresis to reduce edema”, highlighting its potential in DKD treatment. In recent years, AS-IV has become a research focus and is expected to be a promising adjunct therapy for DKD. This article provides a systematic review of the mechanisms and recent advances in AS-IV for the prevention and treatment of DKD from an integrated perspective of traditional Chinese and Western medicine, aiming to offer a theoretical basis for its clinical development and application.