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果糖诱导盐敏感性高血压的肾脏机制

许传铭^1,2, 杨天新^1,2,*

¹中山大学中山医学院高血压研究所，广州 510080；²犹他大学医学院内科学，退伍军人事务医疗中心，盐湖城，美国

摘要

从过去一个世纪以来，果糖的进食量急剧增加，并且与糖尿病、肥胖、肾衰、高血压等的发生密切相关。目前越来越多的证据证明过量的果糖饮食会引起盐敏感性高血压，其发生机制十分复杂，但是肾脏可能在其中扮演着重要的角色。本文主要阐述了果糖诱导盐敏感性高血压的肾相关机制，包括肾素原受体依赖的肾内肾素-血管紧张素系统的活化，肾内Na+转运体钠氢交换子3 (sodium/hydrogen exchanger 3, NHE3)和Na-K-2Cl共转运体(Na/K/2Cl cotransporter, NKCC2)的活化，肾内尿酸产生的增加，肾内一氧化氮合成的降低，以及肾内活性氧产生的增加，并以此为理论依据提出潜在的治疗盐敏感性高血压的靶点或策略。

关键词： 果糖; 盐敏感性高血压; 肾素原受体; 肾内肾素-血管紧张素系统; Na/H交换子3; Na/K/2Cl共转运体; 尿酸; 一氧化氮; 活性氧

分类号：R334+.1;R544

New advances in renal mechanisms of high fructose-induced salt-sensitive hypertension

XU Chuan-Ming^1,2, YANG Tian-Xin^1,2,*

¹Institute of Hypertension, Sun Yat-sen University School of Medicine, Guangzhou 510080, China；²Internal Medicine, University of Utah and Veterans Affairs Medical Center, Salt Lake City, Utah, USA

Abstract

Fructose intake has increased dramatically over the past century and the upward trend has continued until recently. Increasing evidence suggests that the excessive intake of fructose induces salt-sensitive hypertension. While the underlying mechanism is complex, the kidney likely plays a major role. This review will highlight recent advances in the renal mechanisms of fructose-induced salt-sensitive hypertension, including (pro)renin receptor-dependent activation of intrarenal renin-angiotensin system, increased nephron Na+ transport activity via sodium/hydrogen exchanger 3 and Na/K/2Cl cotransporter, increased renal uric acid production, decreased renal nitric oxide production, and increased renal reactive oxygen species production, and suggest actions based on these mechanisms that have therapeutic implications.

Key words: fructose; salt-sensitive hypertension; intrarenal renin-angiotensin system; (pro)renin receptor; nephron ion transporter; uric acid; nitric oxide; reactive oxygen species;

收稿日期：2018-06-05　　录用日期：2018-11-26

通讯作者：杨天新　　E-mail: tianxin.yang@hsc.utah.edu

DOI: 10.13294/j.aps.2018.0088

引用本文：

许传铭, 杨天新. 果糖诱导盐敏感性高血压的肾脏机制[J]. 生理学报 2018; 70 (6): 581-590.

XU Chuan-Ming, YANG Tian-Xin. New advances in renal mechanisms of high fructose-induced salt-sensitive hypertension. Acta Physiol Sin 2018; 70 (6): 581-590