湖南中医药大学学报2026，Vol.46Issue(1)：126-133,8.DOI:10.3969/j.issn.1674-070X.2026.01.017
从"虚损痨瘵,燮理气阴"探讨糖尿病肾病铁死亡病机及防治思路
Pathogenesis and prevention-treatment strategies of ferroptosis in diabetic kidney disease from the perspective of"treating consumptive deficiency by harmonizing qi and yin"
摘要
Abstract
Based on the theory of"treating consumptive deficiency by harmonizing qi and yin",this paper explores ferroptosis-centered pathological mechanisms and corresponding prevention and treatment strategies for diabetic kidney disease(DKD).Deficiency of the spleen and kidney serves as the root cause,while damp-heat,phlegm-stasis,and turbidity-toxin represent the manifestations.Together,these factors disrupt iron homeostasis,characterized by downregulation of solute carrier family 7 member 11(SLC7A11,xCT)and glutathione peroxidase 4(GPX4)and upregulation of long-chain acyl-CoA synthetase family member 4(ACSL4).These imbalance triggers lipid peroxidation and ferroptosis,damaging renal tubular epithelial cells and podocytes.Subsequently,through damage-associated molecular patterns(DAMPs),transforming growth factor-β(TGF-β)/Smad,and nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)signaling pathways,it promotes fibroblast activation and collagen deposition,ultimately leading to renal fibrosis.Guided by the concept of"preventing a disease before it arises",a three-tier prevention and treatment strategy is proposed:in the early stage,strengthening the spleen,replenishing qi,nourishing yin,and transforming dampness,combined with antioxidant and anti-ferroptotic interventions,to delay the onset of microalbuminuria;during the moderate stage,clearing heat and removing toxins,circulating blood and unblocking collaterals,while synergistically modulating the nuclear factor E2-related factor 2(Nrf2)/GPX4,ACSL4,as well as the TGF-β/Smad axis,to suppress inflammation and fibrosis amplification;in the late stage,reinforcing healthy qi,consolidating the root,warming yang and disinhibiting water,while integrating toxin removing,collateral unblocking,and renal protection,to alleviate symptoms and improve prognosis.关键词
糖尿病肾病/铁死亡/虚损痨瘵/燮理气阴/脾肾两虚/溶质载体家族7成员11/长链酰基辅酶A合成酶家族成员4Key words
diabetic kidney disease/ferroptosis/consumptive deficiency/harmonizing qi and yin/deficiency of the spleen and kidney/solute carrier family 7 member 11/long-chain acyl-CoA synthetase family member 4分类
医药卫生引用本文复制引用
吴源陶,傅馨莹,王智槟,邹晓玲,邹译娴..从"虚损痨瘵,燮理气阴"探讨糖尿病肾病铁死亡病机及防治思路[J].湖南中医药大学学报,2026,46(1):126-133,8.基金项目
湖南省自然科学基金面上项目(2024JJ5317) （2024JJ5317）
湖南省教育厅资助科研项目(25A0293). （25A0293）
