【摘要】 糖尿病肾病(DN)是糖尿病的严重并发症，可进展至终末期肾病。近年研究发现肾小管间质病变在DN的发生发展中具有重要作用。肾小管间质病变以炎症反应、间质纤维化及肾功能下降为特征，关键机制涉及高血糖及晚期糖基化终末产物驱动的炎症通路、线粒体质量控制失衡及微环境结构连接异常，并伴有固有免疫细胞、T淋巴细胞及巨噬细胞间相互作用紊乱。临床上，病理评估联合多种新型生物标志物有助于早期识别DN肾小管间质病变患者并进行风险分层。在治疗方面，近年来多种作用于DN肾小管间质通路的药物已显示出明确的肾脏保护作用。本文系统综述DN肾小管间质病变的发病机制、病理评估、生物标志物及治疗策略，强调其在DN发生与发展中的重要地位。更多还原

【Abstract】 Diabetic nephropathy(DN) is a serious complication of diabetes, which can progress to end-stage renal disease. Recent studies have found that renal tubulointerstitial lesions play an important role in the occurrence and development of DN. It is characterized by inflammatory response, interstitial fibrosis and decreased renal function. The key mechanisms involve inflammatory pathways driven by high glucose and advanced glycation end product, imbalance of mitochondrial quality control and abnormal connection of microenvironment structure, accompanied by disorder of interaction among innate immune cell, lymphocyte T and macrophage. Clinically, pathological score combined with a variety of new biomarkers is helpful for early identification of DN patients with tubulointerstitial lesions and risk stratification. In terms of treatment, in recent years, a variety of drugs acting on the tubulointerstitial pathway of DN have shown clear renal protective effects. This article systematically reviews the pathogenesis, pathological evaluation, biomarkers and treatment strategies of DN renal tubulointerstitial lesions, and emphasizes its important role in the occurrence and development of DN.更多还原