中医药基于肠道菌群机制治疗糖尿病肾病研究进展

Research Progress on the Treatment of Diabetic Nephropathy Based on the Mechanism of Intestinal Flora in Traditional Chinese Medicine

摘要: 糖尿病肾病(diabetic nephropathy, DN)是糖尿病最主要的微血管并发症之一，其发病率持续攀升，临床缺乏特异性治疗手段。近年来“肠–肾轴”理论的提出为DN的发病机制与治疗策略提供了全新视角。研究表明，DN患者普遍存在肠道菌群失调，表现为多样性下降、有益菌减少、致病菌增多，进而通过破坏肠黏膜屏障、促进内毒素入血、改变代谢产物等机制，加剧肾脏炎症与纤维化进程。中医药在防治DN方面展现出多靶点、整体调节的优势，大量研究证实，中药单药及复方可通过调节肠道菌群结构、修复肠屏障、调控代谢产物、抑制炎症通路等途径，发挥肾脏保护作用。本文系统综述了中医药基于肠道菌群机制治疗糖尿病肾病的最新研究进展，以期为临床治疗提供新思路。

Abstract: Diabetic nephropathy (DN) is one of the most significant microvascular complications of diabetes. Its incidence rate continues to rise, and there is a lack of specific treatment methods in clinical practice. In recent years, the proposal of the “gut-kidney axis” theory has provided a brand-new perspective for the pathogenesis and treatment strategies of DN. Studies have shown that patients with DN generally have an imbalance of intestinal flora, manifested as a decrease in diversity, a reduction in beneficial bacteria, and an increase in pathogenic bacteria. This, through mechanisms such as destroying the intestinal mucosal barrier, promoting the entry of endotoxins into the bloodstream, and altering metabolic products, aggravates the process of renal inflammation and fibrosis. Traditional Chinese medicine has demonstrated the advantages of multi-target and holistic regulation in the prevention and treatment of DN. A large number of studies have confirmed that both single and compound traditional Chinese medicines can exert a protective effect on the kidneys through regulating the structure of intestinal flora, repairing the intestinal barrier, regulating metabolic products, and inhibiting inflammatory pathways. This article systematically reviews the latest research progress of traditional Chinese medicine in the treatment of diabetic nephropathy based on the intestinal flora mechanism, with the aim of providing new ideas for clinical treatment.