论文摘要
糖尿病。肾病（DN）是糖尿病（DM）患者临床常见而难治的微血管并发症之一，是导致终末期肾病（ESRD）和DM患者死亡的主要原因。约40％的1型DM和5～20％的2型DM患者可以发生DN。随着人们生活习惯、饮食结构的改变，DM的发病率在全球迅速上升，DN的发病率也在不断上升。因此，如何有效地预防、治疗DN已成为医学界共同关注的问题。 DM可由多种途径损害肾脏，并累及肾脏的所有结构，导致肾小球细胞增殖、肥大，基底膜增厚和进行性细胞外基质（ECM）堆积，最终导致弥漫性或结节性肾小球硬化。转化生长因子-β1（TGF-β1）是一种多功能的细胞因子，在DN发病中起着非常重要的作用。包括：促使肾脏固有细胞发生增殖、肥大，增加系膜细胞（MC）合成和分泌ECM，并通过增加基质降解酶抑制物活性而减少ECM的降解等方面作用。Smad蛋白是是TGF-β1与其细胞表面丝／苏氨酸激酶受体结合后，将其信号从细胞膜传递到细胞核过程中极其重要的细胞内信号介导分子。在哺乳动物细胞中，其家族可分为3大类：一是受体激活型Smad （R-Smads），包括Smad 1、Smad 2、Smad 3、Smad 5和可能的Smad 8和Smad9；二是共同通路型Smad（Co-Smad）即Smad 4；三是抑制型Smad（I-Smad），包括Smad 6和Smad 7。其中参与TGF-β1信号传导的Smad蛋白主要包括Smad2、Smad 3、Samd 4和Smad 7。TGF-β1／Smad信号通路在介导ECM代谢异常，促进DN发病中起着重要的作用。 西医在治疗DN上主要是控制高血糖、减少蛋白尿、控制高血压等对症治疗，
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