Yu Wen-Xia, Yan Wen, Dai En-Lai, Tian Wen-Xuan, Dang Wen-Jing
Gansu University of Chinese Medicine Lanzhou 730000, China.
Zhongguo Zhong Yao Za Zhi. 2023 Jun;48(12):3246-3254. doi: 10.19540/j.cnki.cjcmm.20230313.601.
As one of the main diseases leading to end-stage renal disease, steroid-resistant nephrotic syndrome(SRNS) can cause serious complications such as infection. Without effective control, this disease can further lead to the malignant development of the renal function, bringing serious social and economic burdens. As previously reported, the formation of SRNS is mostly related to the podocyte injury in the body, i.e., the injury of glomerular visceral epithelial cells. Phosphatidylinositol 3-kinase(PI3K)/protein kinase B(Akt) signaling pathway, nuclear transcription factor-κB(NF-κB) signaling pathway, mammalian target of rapamycin(mTOR)/adenosine monophosphate(AMP)-activated protein kinase(AMPK), transforming growth factor(TGF)-β1/Smads, and other signaling pathways are classical signaling pathways related to podocyte injury. By regulating the expression of signaling pathways, podocyte injury can be intervened to improve the adhesion between podocyte foot processes and glomerular basement membrane and promote the function of podocytes, thereby alleviating the clinical symptoms of SRNS. Through the literature review, traditional Chinese medicine(TCM) has unique advantages and an important role in intervening in podocyte injury. In the intervention in podocyte injury, TCM, by virtue of multi-target and multi-pathway role, can regulate and intervene in podocyte injury in many ways, alleviate the clinical symptoms of SRNS, and interfere with the progress of SRNS, reflecting the unique advantages of TCM. On the other hand, TCM can directly or indirectly inhibit podocyte injury by regulating the above signaling pathways, which can not only promote the effect of hormones and immunosuppressants and shorten the course of treatment, but also reduce the toxic and side effects caused by various hormones and immunosuppressants to exert the advantages of small side effects and low price of TCM. This article reviewed TCM in the treatment of SRNS by interfering with podocyte injury-related signaling pathways and is expected to provide a reference for the in-depth study of TCM in the treatment of SRNS, as well as a theoretical basis and a new direction for the clinical application of TCM to shorten the course of treatment of SRNS and delay the progression to end-stage renal disease.
作为导致终末期肾病的主要疾病之一，激素抵抗型肾病综合征（SRNS）可引发感染等严重并发症。若未得到有效控制，该疾病会进一步导致肾功能恶性发展，带来沉重的社会和经济负担。如先前报道，SRNS的形成大多与机体足细胞损伤有关，即肾小球脏层上皮细胞损伤。磷脂酰肌醇3激酶（PI3K）/蛋白激酶B（Akt）信号通路、核转录因子-κB（NF-κB）信号通路、雷帕霉素靶蛋白（mTOR）/单磷酸腺苷（AMP）激活蛋白激酶（AMPK）、转化生长因子（TGF）-β1/Smads等信号通路是与足细胞损伤相关的经典信号通路。通过调节信号通路的表达，可干预足细胞损伤，改善足细胞足突与肾小球基底膜之间的黏附，促进足细胞功能，从而缓解SRNS的临床症状。通过文献回顾发现，中医药在干预足细胞损伤方面具有独特优势和重要作用。在干预足细胞损伤过程中，中医药凭借多靶点、多途径作用，可从多方面调节和干预足细胞损伤，缓解SRNS临床症状，干预SRNS进展，体现了中医药的独特优势。另一方面，中医药可通过调节上述信号通路直接或间接抑制足细胞损伤，不仅能提高激素和免疫抑制剂疗效、缩短疗程，还能减少各种激素和免疫抑制剂所致的毒副作用，发挥中医药副作用小、价格低廉的优势。本文综述了中医药通过干扰足细胞损伤相关信号通路治疗SRNS的研究，期望为中医药治疗SRNS的深入研究提供参考，也为中医药临床应用缩短SRNS疗程、延缓进展至终末期肾病提供理论依据和新方向。
