糖尿病对维持性血液透析患者慢性肾脏病矿物质与骨代谢异常影响的研究进展

Research progress of diabetes on chronic kidney disease mineral and bone metabolism disorders in maintenance hemodialysis patients

  • 摘要: 慢性肾脏病(CKD)具有高发病率, 其常见并发症慢性肾脏病矿物质与骨代谢异常(CKD-MBD)已成为影响患者长期预后的重要因素。CKD-MBD的发病机制复杂,涉及Klotho-成纤维细胞生长因子23(FGF23)-成纤维细胞生长因子受体(FGFR)信号通路失调、钙磷代谢紊乱、1, 25-二羟维生素D31, 25-(OH)2D3合成障碍、甲状旁腺激素(PTH)分泌调节异常以及Wnt/β-catenin信号通路参与等多重机制。其病理表现不仅包括肾性骨营养不良,还涵盖骨骼外的并发症,如血管钙化及心血管事件风险增加。糖尿病作为CKD最常见的病因,通过高血糖状态、氧化应激、炎症因子激活及骨微血管病变等多种机制进一步加剧CKD-MBD的发展。在维持性血液透析人群中,糖尿病肾病患者的钙磷水平、PTH浓度及FGF23表达模式与非糖尿病CKD患者存在差异,但这些变化的具体机制尚未在大规模流行病学研究中得到充分阐明。本文综述糖尿病肾病与非糖尿病CKD患者在CKD-MBD方面的临床特征,以期为未来的精准治疗提供理论依据和实践指导。

     

    Abstract: Chronic kidney disease (CKD) has a high prevalence rate. Its common complication, chronic kidney disease-mineral and bone disorder (CKD-MBD), has become an important factor affecting the long-term prognosis of patients. The pathogenesis of CKD-MBD is complex, involving multiple mechanisms such as dysregulation of the Klotho-fibroblast growth factor 23 (FGF23)-FGF receptor (FGFR) signaling pathway, calcium-phosphorus metabolism disorders, impaired synthesis of 1, 25-dihydroxyvitamin D31, 25-(OH)2D3, abnormal regulationof parathyroid hormone (PTH) secretion, and the involvement of the Wnt/β-catenin signaling pathway. Its pathological manifestations not only include renal osteodystrophy but also involve in extraskeletal complications, such as vascular calcification and increased risk of cardiovascular events. Diabetes, as the most common cause of CKD, further exacerbates the development of CKD-MBD through various mechanisms, including hyperglycemia, oxidative stress, activation of inflammatory factors, and bone microvascular disease. In the population undergoing maintenance hemodialysis, there are differences in calcium-phosphorus levels, PTH concentrations, and FGF23 expression patterns between diabetic nephropathy patients and non-diabetic CKD patients. However, the specific mechanisms underlying these changes have not been fully elucidated in large-scale epidemiological studies. This article aimed to review the basic research and clinical characteristics of CKD-MBD in diabetic nephropathy patients and non-diabetic CKD patients, with the hope of providing theoretical basis and practical guidance for future precision treatment.

     

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