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摘要
肾病已成为世界范围内终末期肾病的最常见原因。糖尿病患者肾小球滤过率降低、肾小球毛细血管损伤或心血管疾病发病和死亡风险较高,是导致终末期肾病进展的主要原因。通过AGEs的产生、生长因子的升高、血流动力学和代谢因子的改变、炎症介质、氧化应激和血脂异常等机制参与肾病的发展。印度慢性肾脏疾病的患病率将从1990年的370万上升到2020年的763万,成为死亡和发病的主要原因。肾病的发病机制是由引起肾脏结构和功能改变的各种分子介导的,如生长因子、内皮素、转化生长因子(TGF-β)、血管紧张素转换酶(ACE)、纤维连接蛋白和促炎细胞因子、肥大细胞和血脂异常。VEGF、IGFs、PDGF、EGFR和TGF-β等生长因子有助于细胞外基质的过度积累,同时肾小球和肾小管基底膜增厚,系膜基质增加,导致肾小球硬化和肾小管间质纤维化。氧化应激和炎症因子如TNF-α、IL-1和IL-6被假设在肾病病理改变的发展中发挥作用,如肾过渗和肥厚、肾小球基底膜(GBM)增厚、肾小球病变和小管间质纤维化。血脂异常通过脂蛋白脂肪酶、卵磷脂胆固醇酰基转移酶(LCAT)和胆固醇酯转移酶蛋白(CETP)的作用受损,导致LDL-C、甘油三酯水平升高,HDL-C降低,从而增强巨噬细胞浸润,细胞外基质过度生成,并随着蛋白尿的发展加速炎症反应,参与了肾病的进展。RAS中断、氧化应激和血脂异常在肾脏保护和肾病进展方面产生了更好的结果。在这篇综述中,我们将重点介绍在许多肾病实验模型中已被证明有助于肾损伤的各种因素。
关键词: 肾病,肾素-血管紧张素,系统,氧化应激,血脂异常,生长因子。
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