中药防治糖尿病肾病肾纤维化的作用机制及治疗进展

doi:10.3969/j.issn.1674-8115.2026.01.011

上海交通大学学报（医学版） ›› 2026, Vol. 46 ›› Issue (1): 90-99.doi: 10.3969/j.issn.1674-8115.2026.01.011

中药防治糖尿病肾病肾纤维化的作用机制及治疗进展

张娴静, 陈素贞()

上海交通大学医学院附属第六人民医院上海市糖尿病研究所，上海 200233

收稿日期:2025-08-06 接受日期:2025-09-10 出版日期:2026-01-28 发布日期:2026-01-30
通讯作者: 陈素贞，教授，博士；电子信箱：cszdream@163.com。
作者简介:第一联系人：张娴静负责文献检索与撰写，陈素贞负责论文修改与审核。所有作者均阅读并同意了最终稿件的提交。
基金资助:
国家自然科学基金(32471208)

Mechanisms and therapeutic progress of Chinese materia medica in the prevention and treatment of renal fibrosis in diabetic nephropathy

Zhang Xianjing, Chen Suzhen()

Shanghai Diabetes Institute, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China

Received:2025-08-06 Accepted:2025-09-10 Online:2026-01-28 Published:2026-01-30
Contact: Chen Suzhen, E-mail: cszdream@163.com.
About author:First author contact:Zhang Xianjing contributed to literature search and writing. Chen Suzhen revised and reviewed the manuscript. Both authors have read the final version of manuscript and consented to its submission.
Supported by:
National Natural Science Foundation of China(32471208)

摘要/Abstract

摘要：

糖尿病肾病（diabetic nephropathy，DN）作为糖尿病最严重的微血管并发症之一，其进行性进展可导致不可逆的终末期肾病（end-stage renal disease，ESRD），对全球公共卫生造成重大挑战。肾纤维化作为DN进展的核心病理特征，已成为治疗干预的关键靶点。现行临床管理策略（包括血糖/血压控制、肾素-血管紧张素系统抑制剂应用等）虽能延缓疾病进展，但对于肾纤维化这一关键病理过程的阻断效果仍然有限。近年来研究发现，中药在DN防治领域展现出独特的治疗价值，其通过多组分、多靶点、多通路的协同作用机制，在调节糖脂代谢、抑制炎症反应、减轻氧化应激以及延缓纤维化进程等方面表现出显著优势。临床研究证实，中药方剂及活性成分不仅能有效改善患者临床症状、降低蛋白尿水平，还具有明确的肾功能保护作用和疾病进展延缓效应。基于这些发现，中药调控DN肾纤维化的分子机制已成为新型抗纤维化药物研发的重要研究方向。该综述系统梳理具有明确抗纤维化功效的中药及其活性成分的作用机制，旨在为开发针对DN肾纤维化的创新治疗策略提供科学依据和转化医学思路。

关键词: 糖尿病肾病, 肾纤维化, 中药, 活性成分

Abstract:

Diabetic nephropathy (DN), one of the most severe microvascular complications of diabetes, can progressively lead to irreversible end-stage renal disease (ESRD), posing a major global public health challenge. Renal fibrosis, a core pathological feature of DN progression, has become a key therapeutic target for intervention. Current clinical management strategies (including blood glucose/blood pressure control and the use of renin-angiotensin system inhibitors) can delay disease progression, but their effectiveness in blocking renal fibrosis, a critical pathological process, remains limited. Recent studies have shown that Chinese materia medica demonstrates unique therapeutic value in the prevention and treatment of DN. Through multi-component, multi-target, and multi-pathway synergistic mechanisms, Chinese materia medica has shown significant advantages in regulating glucose and lipid metabolism, inhibiting inflammatory responses, reducing oxidative stress, and attenuating renal fibrosis. Clinical research has confirmed that Chinese materia medica formulas and active ingredients not only effectively improve clinical symptoms and reduce proteinuria excretion but also exert clear renal protective effects and retard the progression of renal lesions. Based on these findings, the molecular mechanisms the molecular mechanisms by which Chinese materia medica regulates renal fibrosis in DN have become an important research direction for the development of novel anti-fibrosis drugs. This review systematically summarizes the mechanisms of action of Chinese materia medica and its active ingredients with clear anti-fibrosis effects, aiming to provide scientific evidence and translational insights for the development of innovative therapeutic strategies targeting renal fibrosis in DN.

Key words: diabetic nephropathy (DN), renal fibrosis, Chinese materia medica, active ingredient

中图分类号:

R284

张娴静, 陈素贞. 中药防治糖尿病肾病肾纤维化的作用机制及治疗进展[J]. 上海交通大学学报（医学版）, 2026, 46(1): 90-99.

Zhang Xianjing, Chen Suzhen. Mechanisms and therapeutic progress of Chinese materia medica in the prevention and treatment of renal fibrosis in diabetic nephropathy[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(1): 90-99.

图/表 3

图1 DN肾纤维化的主要发病机制Note： DN—diabetic nephropathy; TNF-α—tumour necrosis factor-α; NF-κB—nuclear factor κB; ROS—reactive oxygen species; TGF-β—transforming growth factor-β; CTGF—connective tissue growth factor; ECM—extracellular matrix.

Fig 1 Main pathogenesis of renal fibrosis in DN

图2 中药抑制DN肾纤维化作用涉及的信号通路Note： YSHS—Yishen Huashi granules; HPF—hyperforin; PAA—Poricoic acid A; XXD—Xiexin decoction; TXL—Tongxinluo; FX—Fuxin granules; JXPD—Jixue Paidu Tang; AS-Ⅳ—Astragaloside Ⅳ; APS—Astragalus polysaccharides; LDP—Liuwei Dihuang pill; PdⅡ—Picroside Ⅱ; TβR—transforming growth factor-β receptor; YY1—Yin Yang1; DLAT—dihydrolipoamide S-acetyltransferase; VEGF—vascular endothelial growth factor; VEGFR2—vascular endothelial growth factor receptor 2; EMT—epithelial-mesenchymal transition; ICAM1—intercellular adhesion molecule 1; NF-κB—nuclear factor κB; PI3K—phosphoinositide 3-kinase; AKT—AKT serine/threonine kinase; mTOR—mammalian target of rapamycin; TGF-β—transforming growth factor-β; ROS—reactive oxygen species; AMPK—AMP-activated protein kinase; NLRP3—NOD-like receptor family pyrin domain containing 3.

Fig 2 Signaling pathways involved in the inhibition of renal fibrosis in DN by Chinese materia medica

表1 中药治疗DN的临床疗效

Tab 1 Clinical efficacy of Chinese materia medica in treating DN

Chinese materia medica	Main crude drug	Design	Subject	Intervention	Effect	Side effect	Reference
YSHS	Ginseng Radix Et Rhizoma, Astragali Radix, Atractylodis Macrocephalae Rhizoma, Poria, Alismatis Rhizoma, Pinelliae Rhizoma, Notopterygii Rhizoma Et Radix, Angelicae Pubescentis Radix	Meta-analysis	A total of 2 416 DN patients from 28 RCTs	C: conventional therapy T: combined YSHS therapy	Reduced UAER, 24 h-UP, BUN, and Scr	Dizziness, headache, dry cough, and postural hypotension	[22]
LDP	Rehmanniae Radix, Dioscoreae Rhizoma, Alismatis Rhizoma, Moutan Cortex, Poria	Meta-analysis	A total of 1 275 DN patients from 18 RCTs	T: LDP plus Western medicine. C: Western medicine	Reduced UMA, 24 h-UP, UAER, BUN, Scr, FBG, and PBG	Slight cough, hypoglycemia, and gastrointestinal reactions	[77]
Huangqi	Astragali Radix	Meta-analysis	A total of 1 804 DN patients from 21 RCTs and 4 semi-RCTs	T: Astragalus injection with ACEI/ARB. C: ACEI/ARB/placebo	Improved 24 h-UP, UMA, BUN, Scr, Ccr, and serum albumin	N/R	[39]
Salvianolate	Salviae Miltiorrhizae Radix Et Rhizoma	Meta-analysis	A total of 1 030 DN patients from 12 RCTs	T: Salvianolate with Western medicine. C: Western medicine alone	Reduced UMA, 24 h-UP, UAER, BUN, and Scr	N/R	[46]
Dongchongxiacao	Ophiocordyceps	Meta-analysis	A total of 2 198 early-stage DN patients from 26 RCTs	T: Jinshuibao capsule with ARB. C: ARB	Reduced 24 h-UP, UAER, BUN, Scr, and UACR	Emesis	[78]

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中药防治糖尿病肾病肾纤维化的作用机制及治疗进展

Mechanisms and therapeutic progress of Chinese materia medica in the prevention and treatment of renal fibrosis in diabetic nephropathy

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