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中华肾病研究电子杂志 ›› 2026, Vol. 15 ›› Issue (04) : 195 -201. doi: 10.3877/cma.j.issn.2095-3216.2026.04.003

综述

Nrf2调控糖尿病肾脏疾病巨噬细胞代谢重编程和极化的分子机制
张紫玥, 王晓晨, 付章宁, 邓蔚竹, 迟坤, 孙冠南, 洪权()   
  1. 100853 解放军总医院肾脏病医学部、肾脏疾病全国重点实验室、肾病与泌尿系统疾病国家临床医学研究中心、重症肾脏疾病器械与中西医药物研发北京市重点实验室、数智中医泛血管疾病防治北京市重点实验室、国家中医药管理局高水平中医药重点学科(zyyzdxk-2023310)、国家中医药管理局中医药创新团队及人才支持计划项目(ZYYCXTD-D-202402)
  • 收稿日期:2025-09-11 出版日期:2026-08-28
  • 通信作者: 洪权
  • 基金资助:
    国家自然科学基金项目(82270758)

Molecular mechanisms of Nrf2 in regulating metabolic reprogramming and polarization of macrophage in diabetic kidney disease

Ziyue Zhang, Xiaochen Wang, Zhangning Fu, Weizhu Deng, Kun Chi, Guannan Sun, Quan Hong()   

  1. Senior Department of Nephrology, Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney and Urological Diseases, Beijing Key Laboratory of Medical Devices and Integrated Traditional Chinese and Western Drug Development for Severe Kidney Diseases, Beijing Key Laboratory of Digital Intelligent TCM for Prevention and Treatment of Pan-vascular Diseases, Key Disciplines of National Administration of Traditional Chinese Medicine (zyyzdxk-2023310), Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine (ZYYCXTD-D-202402), Beijing 100853, China
  • Received:2025-09-11 Published:2026-08-28
  • Corresponding author: Quan Hong
引用本文:

张紫玥, 王晓晨, 付章宁, 邓蔚竹, 迟坤, 孙冠南, 洪权. Nrf2调控糖尿病肾脏疾病巨噬细胞代谢重编程和极化的分子机制[J/OL]. 中华肾病研究电子杂志, 2026, 15(04): 195-201.

Ziyue Zhang, Xiaochen Wang, Zhangning Fu, Weizhu Deng, Kun Chi, Guannan Sun, Quan Hong. Molecular mechanisms of Nrf2 in regulating metabolic reprogramming and polarization of macrophage in diabetic kidney disease[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2026, 15(04): 195-201.

糖尿病肾脏疾病(diabetic kidney disease, DKD)作为终末期肾病的主要病因,其发病机制涉及复杂的病理生理过程。近年来,巨噬细胞介导的免疫代谢紊乱被认为是DKD进展的关键环节,其M1/M2表型转换受控于特定的代谢重编程(糖酵解与氧化磷酸化)。核因子红系2相关因子2(nuclear factor erythroid 2-related factor 2,Nrf2)作为细胞抗氧化应激的核心转录因子,不仅能调控氧化还原平衡,还可影响巨噬细胞的极化方向,从而发挥肾脏保护作用。然而,Nrf2在DKD微环境中如何通过调控巨噬细胞的代谢重编程来影响其极化表型,其具体分子机制尚不明晰。本综述旨在系统阐述Nrf2调控DKD巨噬细胞代谢重编程和极化的分子机制,以期为DKD的精准治疗提供新的思路与潜在靶点。

Diabetic kidney disease (DKD), as the leading cause of end-stage renal disease, involves complex pathophysiological mechanisms. In recent years, macrophage-mediated immune metabolic dysregulation has been identified as a critical driver of DKD progression, where the phenotypic switching between M1 and M2 macrophages is governed by specific metabolic reprogramming (glycolysis versus oxidative phosphorylation). Nuclear factor erythroid 2-related factor 2 (Nrf2), a core transcription factor for cellular antioxidant response, not only regulates redox homeostasis but also influences macrophage polarization, thereby exerting renoprotective effects. However, the precise molecular mechanisms by which Nrf2 modulates macrophage metabolic reprogramming to affect polarization within the DKD microenvironment remain elusive. This review aims to systematically elucidate the molecular mechanisms of Nrf2 in regulating metabolic reprogramming and polarization of macrophage in DKD, providing new insights and potential therapeutic targets for the precision treatment of DKD.

图1 Nrf2的作用机制注:Macrophage为巨噬细胞;Cytoplasm为细胞质;Nucleus为细胞核;Nrf2,nuclear factor erythroid 2-related factor 2,核因子红系2相关因子2;Keap1,Kelch-like erythroid cell homeostasis-associated protein 1,Kelch样红细胞稳态相关蛋白1;sMaf, small musculoaponeurotic fibrosarcoma,小肌肉腱膜纤维肉瘤蛋白;AREs, antioxidant response elements,抗氧化反应元件;ROS, reactive oxygen species活性氧;electrophiles为亲电体;Gene transcription为基因转录;Antioxidant proteins expression为抗氧化蛋白表达
表1 M1与M2巨噬细胞在糖尿病肾脏病中的代谢特征与功能对比
图2 Nrf2对巨噬细胞极化的影响注:Nrf2,nuclear factor erythroid 2-related factor 2,核因子红系2相关因子2;Macrophages为巨噬细胞
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