糖尿病肾病的中医药治疗研究进展

Research Progress on Traditional Chinese Medicine Treatment of Diabetic Nephropathy

摘要: 糖尿病肾病(Diabetic Kidney Disease, DKD)是糖尿病最常见且危害严重的微血管并发症之一，已成为终末期肾病的主要病因。当前西医治疗DKD以控制血糖、血压及血脂等方法，一定程度上减少患者蛋白尿的产生，从而延缓疾病进展，但对逆转肾功能损伤效果仍有局限性。中医药凭借多靶点、多通路的整体调节优势，在DKD防治领域展现出独特优势。本文系统论述了DKD的中医病因病机理论、中医药内治法、外治法及中西医结合治疗的研究进展。现有研究表明，中医药可通过调控TGF-β/Smad、PI3K/Akt、NLRP3炎症小体等信号通路，发挥抗炎、抗氧化、抗纤维化及调节肠道菌群等多重作用，有效降低尿蛋白、保护肾功能。然而，当前研究仍面临证型分类不统一、高质量临床试验不足等挑战，未来应深化机制研究，推进多中心大样本临床验证，建立规范化诊疗体系，推进标准化中西医联合方案落地，提升DKD全程规范化中医药防治水平。

Abstract: Diabetic kidney disease (DKD) is one of the most common and serious microvascular complications of diabetes, having become a leading cause of end-stage renal disease. Current Western medical treatments for DKD primarily focus on controlling blood glucose, blood pressure, and lipid levels, which to some extent reduce proteinuria and thereby slow disease progression. However, their effectiveness in reversing renal functional damage remains limited. Traditional Chinese medicine (TCM), with its advantages in multi-target and multi-pathway holistic regulation, has demonstrated unique strengths in the prevention and treatment of DKD. This article systematically reviews the TCM theories of etiology and pathogenesis, internal and external therapeutic approaches, as well as research advances in integrative TCM-Western medicine treatments for DKD. Existing studies indicate that TCM can modulate signaling pathways such as TGF-β/Smad, PI3K/Akt, and NLRP3 inflammasome, exerting multiple effects including anti-inflammatory, antioxidant, anti-fibrotic actions, and modulation of gut microbiota, effectively reducing urinary protein and protecting renal function. Nevertheless, current research still faces challenges such as inconsistent syndrome classification and insufficient high-quality clinical trials. Future efforts should deepen mechanistic investigations, promote large-scale, multicenter clinical validation, establish standardized diagnostic and therapeutic systems, advance the implementation of standardized integrated TCM-Western medicine protocols, and improve the overall standardization of TCM-based prevention and treatment for DKD.