通讯作者: 曹延霞, 2317461232@qq.com

DOI：10.12201/bmr.202607.00028

Research Progress on the Mechanism and Clinical Efficacy of Finerenone in the Treatment of Diabetic Nephropathy

• 摘要：糖尿病肾病（diabetic kidney disease,DKD）是2型糖尿病主要微血管并发症，是导致终末期肾病、心血管不良事件的重要诱因，其病理机制与炎症反应、氧化应激、内皮功能障碍及代谢紊乱密切相关，目前临床缺乏有效改善DKD患者心肾预后的靶向药物。盐皮质激素受体过度激活是DKD进展的关键环节，第三代非甾体盐皮质激素受体拮抗剂非奈利酮通过抗炎、抗纤维化和调节代谢等多重机制改善心肾结局，已成为当前DKD治疗研究热点。本文系统综述近年非奈利酮治疗DKD的基础与临床研究新进展，阐述其调控肾脏病理损伤、干预代谢信号通路的分子机制，深入探讨其抗炎、抗氧化应激、抗纤维化的机制，并结合国内外多项临床试验数据，全面评估非奈利酮治疗DKD的临床疗效及安全性。现有研究证实，非奈利酮不仅减少蛋白尿、延缓肾功能衰退，而且显著降低心血管事件风险，药物耐受性良好，不良反应可控。综上，非奈利酮突破传统DKD治疗局限，为心肾双重获益提供新策略，临床应用前景广阔。但未来仍需开展更多大样本、长期随访的真实世界研究，进一步明确不同人群的个体化用药方案，完善其长期疗效与安全性证据体系，推动其在临床中规范应用。

  关键词： 非奈利酮; 糖尿病肾病; 机制; 炎症; 纤维化; 

   

  Abstract: Diabetic kidney disease (DKD) is the main microvascular complication of type 2 diabetes. It is a significant cause of end-stage renal disease and adverse cardiovascular events. Its pathological mechanism is closely related to inflammatory response, oxidative stress, endothelial dysfunction and metabolic disorders. Currently, there are no effective targeted drugs available in clinical practice to improve the prognosis of patients with DKD in terms of heart and kidney health.Excessive activation of mineralocorticoid receptors is a key factor in the progression of DKD. The third-generation non-steroidal mineralocorticoid receptor antagonist, finerenone, improves cardiovascular and renal outcomes through multiple mechanisms such as anti-inflammation, anti-fibrosis, and regulation of metabolism. It has become a current research hotspot in the treatment of DKD. This article systematically reviews the new progress in basic and clinical research on non-nalidronate treatment for DKD in recent years, elaborates on its molecular mechanisms of regulating renal pathological damage and intervening in metabolic signaling pathways, deeply explores its anti-inflammatory, anti-oxidative stress, and anti-fibrotic mechanisms, and combines multiple clinical trial data from both domestic and international sources to comprehensively evaluate the clinical efficacy and safety of non-nalidronate in the treatment of DKD. Existing studies have confirmed that finerenone not only reduces proteinuria and delays the decline of renal function, but also significantly reduces the risk of cardiovascular events. The drug has good tolerance and manageable adverse reactions. In conclusion, nelarabine breaks through the limitations of traditional DKD treatment and provides a new strategy for achieving dual benefits for the heart and kidneys. Its clinical application prospects are broad. However, more large-sample, long-term follow-up real-world studies are still needed in the future to further clarify individualized medication regimens for different populations, improve the evidence system for its long-term efficacy and safety, and promote its standardized application in clinical practice.

  Key words: Finerenone; Diabetic nephropathy; Mechanisms;   Inflammation; fibrosis

  提交时间：2026-07-21

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2026-06-30	10.12201/bmr.202607.00028V1	下载

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