2型糖尿病肾病(Type 2 diabetic nephropathy,DKD)的基本机制是活性氧(reactive oxygen,ROS)和晚期糖基化终产物(advanced glycation end product,AGEs)的积累.除此之外持续和长期暴露于高血糖环境中,和其他危险因素,如肥胖、血脂异常和胰岛素抵抗都会导致2型糖尿病肾病.中医认为肾为先天之本,脾为后天之本,二者相互充养才能使机体维持正常的生命活动,脾胃虚弱是糖尿病肾病发病的病机之一.另外由于高血糖,炎性反应和胰岛素抵抗等因素可能导致2型糖尿病肾病患者继发骨质疏松.应监测骨代谢标志物包括骨吸收标志物[β-胶原降解产物测定(Beta-col-lagen degradation products,β-CTX)]和骨形成标志物[总 Ⅰ 型胶原氨基端延长肽(Elongation of amino end of total type Ⅰcollagen,PINP)]和骨密度,做到早发现早治疗,减轻患者痛苦.临床应用降糖药物时应该关注其额外的降糖作用,注意降糖药物对患者肾脏和骨质疏松的影响.该文总结研究了 2型糖尿病肾病患者继发骨质疏松的病因病机和降糖药物的额外作用,对今后的临床研究具有指导作用.
Research Progress of Type 2 Diabetes Nephropathy Complicated with Osteoporosis
The basic mechanism of type 2 diabetic nephropathy(DKD)is the accumulation of reactive oxygen species(ROS)and advanced glycation end products(AGEs).In addition,persistent and long-term exposure to hyperglycemia and other risk factors such as obesity,dyslipidemia and insulin resistance can lead to DKD.Traditional Chinese medicine believes that kidney is the foundation of innate development,while spleen is the foundation of acquired development.Only when the two replenish each other can the body maintain normal life activities,the weakness of spleen and stomach is one of the pathogenesis of diabetic ne-phropathy.In addition,factors such as hyperglycemia,inflammation and insulin resistance may lead to secondary osteoporosis in patients with DKD.The bone metabolism markers,including bone resorption markers[β-collagen degradation product assay(β-CTX)]and bone formation markers[total type Ⅰ collagen amino terminal elongation(PINP)]and bone mineral density should be monitored,so as to achieve early detection and early treatment to alleviate patients'pain.Clinical application of hypoglycemic drugs should pay attention to their additional hypoglycemic effects,the effects of hypoglycemic drugs on patients'kidneys and oste-oporosis.In this paper,the etiology and pathogenesis of secondary osteoporosis in patients with DKD and the additional role of hy-poglycemic drugs were summarized,which had a guiding role for future clinical research.
type 2 diabetic nephropathyosteoporosisbone densityhypoglycemic drugs
万方数据
维普
