從新陳代謝與免疫機制的觀點探討PPARγ扮演的角色與對糖尿病腎病變的影響

Role of PPAR γ for Immuno-Metabolic Influences and Impacts on Diabetic Nephropathy

洪薇雯(Wei-Wen Hung) ； 辛錫璋(Shyi-Jang Shin) ； 張哲銘(Jer-Ming Chang)

《內科學誌》 19卷2期 (2008/04) Pp. 121-127

https://doi.org/10.6314/JIMT.2008.19(2).04

摘要

自從TZD這一類促進PPARγ作用的抗糖尿病藥物在西元1997年上市以來，不管是在臨床或基礎醫學研究，TZD都受到廣泛的注意，有許多學者不斷地在探討它臨床藥效背後的藥理機轉。在糖尿病合併微白蛋白尿的患者身上，已有臨床證據顯示TZD可以顯著降低尿液中的微白蛋白排出量。在本文中，我們冀望從新陳代謝與免疫機制的觀點切入，來討論糖尿病的基礎病理生理學；接著我們試圖去探究TZD對於新陳代謝與免疫系統的影響，並詳加描述TZD的胰島素增敏作用及抗發炎效應；最後，我們將深入分析TZD降低尿液白蛋白排出量及減少腎臟傷害的作用機轉。由於糖尿病腎病變是現今世界上造成末期腎病最常見的原因，藉著探究PPARγ的過程中所發現的奧妙機制，將有助於未來發明新藥應用於延緩或預防糖尿病腎病變的發生。

關鍵字

PPARγ ； 胰島素阻抗性 ； 脂肪細胞激素 ； 糖尿病腎病變

並列摘要

As an antidiabetic agent introduced in 1997, PPAR γ agonist, or thiazolidinediones (TZD), has received much attention not only in clinical research but also in basic study about its mechanism behind the clinical effects. Evidence from clinical study of TZD use in type 2 diabetes with microalbuminuria had proved that TZD treatment significantly reduced urine albumin excretion (UAE). In this article, we intended to discuss the basic patho-physiology of diabetes from an immuno-metabolic viewpoint in the beginning. Then we tried to analyze the impacts on immuno-metabolic systems with regards to TZD treatment, and describe in detail about its insulin-sensitizing and anti-inflammatory effects. Finally, we went on to explore the actions of TZD on the reduction of UAE and attenuation of renal injury. As diabetic nephropathy being the leading cause of end-stage renal disease worldwide, the exploration of PPAR γ would be promising for the development of drugs to delay or prevent diabetic nephropathy.

並列關鍵字

Peroxisome proliferator activated receptor-γ ； Insulin resistance ； Adipocytokine ； Diabetic nephropathy