中华中医药学刊

黄芪甲苷对糖尿病视网膜病变作用机制研究进展

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刘小通 ¹ , 牛军强 ¹ , 姚晓泉 ¹ , 孙邈 ¹ , 张文丽 ¹ , 陈亭亭 ² , 詹玉蕊 ¹

中华中医药学刊 | 省级项目平台 2026,44(9): 236-241

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中华中医药学刊 |省级项目平台 2026 , 44 (9) : 236 -241

黄芪甲苷对糖尿病视网膜病变作用机制研究进展

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刘小通¹, 牛军强¹, 姚晓泉¹, 孙邈¹, 张文丽¹, 陈亭亭², 詹玉蕊¹

作者信息

^1.兰州大学第一医院，甘肃　兰州　730000

^2.兰州大学第一临床医学院，甘肃　兰州　730000

通讯作者:

牛军强（1984-），男，甘肃天水人，副主任医师，博士，研究方向：中医内科疾病诊疗。E-mail：njqldyy@126.com。

作者简介:

刘小通（1994-），男，甘肃定西人，医师，硕士，研究方向：中西医结合防治眼病。

Research Progress on Mechanism of Astragaloside Ⅳ in Treatment of Diabetic Retinopathy

Xiaotong LIU¹, Junqiang NIU¹, Xiaoquan YAO¹, Miao SUN¹, Wenli ZHANG¹, Tingting CHEN², Yurui ZHAN¹

Affiliations

^1.Department of Traditional Chinese Medicine, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu, China

^2.The First School of Clinical Medicine of Lanzhou University, Lanzhou 730000, Gansu, China

出版时间: 2026-09-10 doi: 10.13193/j.issn.1673-7717.2026.09.044

文章导航

摘要

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糖尿病视网膜病变（diabetic retinopathy，DR）是糖尿病（diabetic mellitus，DM）常见且严重的视网膜微血管并发症之一，属中医内障眼病范畴。黄芪甲苷（astragaloside Ⅳ，AS-Ⅳ）是中药黄芪的主要活性成分，其综合的多药理靶点契合DR复杂的病理机制。近年来，众多研究聚焦于AS-Ⅳ对DR的影响，各类研究验证了AS-Ⅳ具有降糖作用、抗氧化应激损伤、抑制血管内皮生长因子（vascular endothelial growth factor，VEGF）、抗视网膜细胞凋亡、抑制炎症反应、抑制铁死亡等作用机制，通过多通路、多靶点途径阻碍DR的发生发展。对AS-Ⅳ治疗DR的相关研究进展进行综述，为其进一步研发利用及临床应用提供参考依据。

关键词

中医药 / 中药单体 / 黄芪甲苷Ⅳ / 糖尿病视网膜病变 / 作用机制 / 综述

Abstract

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Diabetic retinopathy (DR) is one of the most frequent and serious retinal microvascular complications of diabetic mellitus (DM), which belongs to the category of intraocular disturbance diseases of traditional Chinese medicine. Astragaloside Ⅳ (AS-Ⅳ), the main active component of Huangqi (Astragali Radix), integrates multiple pharmacological targets that align with the complex pathogenesis of DR. For the past few years, numerous studies have focused on the impact of AS-Ⅳ on DR, confirming its effects through various mechanisms such as hypoglycemic effect, anti-oxidative stress damage, inhibition of vascular endothelial growth factor (VEGF), anti-apoptosis of retinal cells, suppression of inflammatory responses, and inhibition of ferroptosis, thereby obstructing the occurrence and progression of DR through multiple pathways and targets. This paper mainly reviewed the research progress of AS-Ⅳ on the treatment of DR in order to provide reference for its further development and utilization and clinical application.

Key words

traditional Chinese medicine / traditional Chinese medicine monomer / astragaloside Ⅳ / diabetic retinopathy / mechanism of action / review

引用本文

刘小通, 牛军强, 姚晓泉, 孙邈, 张文丽, 陈亭亭, 詹玉蕊. 黄芪甲苷对糖尿病视网膜病变作用机制研究进展. 中华中医药学刊, 2026 , 44 (9) : 236 -241 . DOI: 10.13193/j.issn.1673-7717.2026.09.044

Xiaotong LIU, Junqiang NIU, Xiaoquan YAO, Miao SUN, Wenli ZHANG, Tingting CHEN, Yurui ZHAN. Research Progress on Mechanism of Astragaloside Ⅳ in Treatment of Diabetic Retinopathy[J]. Chinese Archives of Traditional Chinese Medicine, 2026 , 44 (9) : 236 -241 . DOI: 10.13193/j.issn.1673-7717.2026.09.044

基金

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甘肃省自然科学基金项目(22JR5RA903)
甘肃省科技计划项目青年科技基金项目(25JRRA1020)

参考文献

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排序方式：

[1]

TÖNNIES T, RATHMANN W, HOYER A, et al. Quantifying the underestimation of projected global diabetes prevalence by the International Diabetes Federation (IDF) Diabetes Atlas[J]. BMJ Open Diabetes Res Care, 2021, 9(1): e002122.

[2]

TEO Z L, THAM Y C, YU M, et al. Global prevalence of diabetic retinopathy and projection of burden through 2045: systematic review and meta-analysis[J]. Ophthalmology, 2021, 128(11): 1580-1591.

[3]

FLETCHER E L, PHIPPS J A, WARD M M, et al. Neuronal and glial cell abnormality as predictors of progression of diabetic retinopathy[J]. Curr Pharm Des, 2007, 13(26): 2699-2712.

[4]

YU M Y, NING F T E, LIU C, et al. Interconnections between diabetic corneal neuropathy and diabetic retinopathy: diagnostic and therapeutic implications[J]. Neural Regen Res, 2025, 20(8): 2169-2180.

[5]

ROSSINO M G, DAL MONTE M, CASINI G. Relationships between neurodegeneration and vascular damage in diabetic retinopathy[J]. Front Neurosci, 2019, 13: 1172.

[6]

FRAGIOTTA S, PINAZO-DURÁN M D, SCUDERI G. Understanding neurodegeneration from a clinical and therapeutic perspective in early diabetic retinopathy[J]. Nutrients, 2022, 14(4): 792.

[7]

CHEN G M, JIANG N, ZHENG J P, et al. Structural characterization and anti-inflammatory activity of polysaccharides from Astragalus membranaceus[J]. Int J Biol Macromol, 2023, 241: 124386.

[8]

于乃馨, 李国琼, 李标, 等. 基于网络药理学和分子对接探讨黄芪甲苷治疗糖尿病视网膜病变的作用机制[J]. 中国实验方剂学杂志, 2022, 28(13): 209-216.

[9]

赵灵改, 吕学泽, 刘毅, 等. 黄芪中皂苷类成分的研究进展[J]. 食品安全质量检测学报, 2021, 12(12): 4937-4946.

[10]

ZHANG J Q, WU C X, GAO L, et al. Astragaloside IV derived from Astragalus membranaceus: a research review on the pharmacological effects[J]. Adv Pharmacol, 2020, 87: 89-112.

[11]

LIU N, JI Y S, LIU R, et al. The state of astragaloside IV research: a bibliometric and visualized analysis[J]. Fundam Clin Pharmacol, 2024, 38(2): 208-224.

[12]

ZHANG Z, WANG J, ZHU Y W, et al. Astragaloside IV alleviates myocardial damage induced by type 2 diabetes via improving energy metabolism[J]. Mol Med Rep, 2019, 20(5): 4612-4622.

[13]

BAO M L, BADE R G, LIU H, et al. Astragaloside IV against Alzheimer's disease via microglia-mediated neuroinflammation using network pharmacology and experimental validation[J]. Eur J Pharmacol, 2023, 957: 175992.

[14]

YIN Y H, QI F H, SONG Z H, et al. Ferulic acid combined with astragaloside IV protects against vascular endothelial dysfunction in diabetic rats[J]. Biosci Trends, 2014, 8(4): 217-226.

[15]

HELLIWELL R M, SHIOUKHUEY C O, DHUNA K, et al. Selected ginsenosides of the protopanaxdiol series are novel positive allosteric modulators of P2X7 receptors[J]. Br J Pharmacol, 2015, 172(13): 3326-3340.

[16]

PLATANIA C B M, GIURDANELLA G, DI PAOLA L, et al. P2X7 receptor antagonism: Implications in diabetic retinopathy[J]. Biochem Pharmacol, 2017, 138: 130-139.

[17]

尚孟秋, 梁丽娜, 周维, 等. 黄芪甲苷治疗眼科疾病药理作用的研究进展[J]. 中国中医眼科杂志, 2024, 34(11): 1077-1080, 1100.

[18]

万光明, 薛瑢. 从视网膜氧化应激与微血管改变谈糖尿病视网膜病变的发病机制和防治策略[J]. 眼科新进展, 2022, 42(7): 505-509.

[19]

杨赞章, 李静, 李志金. 早期糖尿病视网膜病变发病机制中相关因子的研究进展[J]. 广东医学, 2014, 35(9): 1455-1456, 1457.

[20]

LV L, WU S Y, WANG G F, et al. Effect of astragaloside IV on hepatic glucose-regulating enzymes in diabetic mice induced by a high-fat diet and streptozotocin[J]. Phytother Res, 2010, 24(2): 219-224.

[21]

HAN D. Treatment with astragaloside IV reduced blood glucose, regulated blood lipids, and protected liver function in diabetic rats[J]. J Int Med Res, 2021, 49(3): 300060519841165.

[22]

WANG L, SHI H, ZHAO C C, et al. Astragaloside IV protects diabetic cardiomyopathy against inflammation and apoptosis via regulating TLR4/MyD88/NF-κB signaling pathway[J]. J Funct Foods, 2022, 88: 104905.

[23]

LU W S, LI S, GUO W W, et al. Effects of Astragaloside IV on diabetic nephropathy in rats[J]. Genet Mol Res, 2015, 14(2): 5427-5434.

[24]

郭维文, 黎帅, 陈玲玲, 等. 黄芪甲苷对糖尿病肾病大鼠肾脏的保护作用及其机制[J]. 中国病理生理杂志, 2014, 30(2): 351-354.

[25]

谢春英. 黄芪甲苷降血糖作用的实验研究[J]. 中药材, 2010, 33(8): 1319-1320.

[26]

KASSAB A, PIWOWAR A. Cell oxidant stress delivery and cell dysfunction onset in type 2 diabetes[J]. Biochimie, 2012, 94(9): 1837-1848.

[27]

BHATTACHARYYA A, CHATTOPADHYAY R, MITRA S, et al. Oxidative stress: an essential factor in the pathogenesis of gastrointestinal mucosal diseases[J]. Physiol Rev, 2014, 94(2): 329-354.

[28]

杨馥宇, 苏杰, 王玲, 等. 还原型谷胱甘肽对DR大鼠细胞凋亡、氧化应激及Akt蛋白的作用及机制[J]. 中国老年学杂志, 2024, 44(2): 429-433.

[29]

邓望月, 胡大军, 鲁碧玉, 等. 血液透析对糖尿病视网膜病变影响的研究进展[J]. 中国血液净化, 2023, 22(2): 136-140.

[30]

MEAD B, TOMAREV S. Evaluating retinal ganglion cell loss and dysfunction[J]. Exp Eye Res, 2016, 151: 96-106.

[31]

SACHDEVA M M. Retinal neurodegeneration in diabetes: an emerging concept in diabetic retinopathy[J]. Curr Diab Rep, 2021, 21(12): 65.

[32]

YANG X G, HUO F Q, LIU B, et al. Crocin inhibits oxidative stress and pro-inflammatory response of microglial cells associated with diabetic retinopathy through the activation of PI3K/Akt signaling pathway[J]. J Mol Neurosci, 2017, 61(4): 581-589.

[33]

李昌, 王爱玲, 赵增强, 等. 黄芪甲苷Ⅳ对2型糖尿病大鼠视网膜的保护作用[J]. 中药药理与临床, 2024, 40(5): 63-67.

[34]

KASETTI R B, MADDINENI P, KODATI B, et al. Astragaloside IV attenuates ocular hypertension in a mouse model of TGFβ2 induced primary open angle glaucoma[J]. Int J Mol Sci, 2021, 22(22): 12508.

[35]

LI M, XU J, WANG Y J, et al. Astragaloside a protects against photoreceptor degeneration in part through suppressing oxidative stress and DNA damage-induced necroptosis and inflammation in the retina[J]. J Inflamm Res, 2022, 15: 2995-3020.

[36]

黎昌江, 李秋慧, 洪娟, 等. 黄芪甲苷对蓝光诱导损伤的视网膜色素上皮细胞的保护作用及其机制[J]. 眼科新进展, 2021, 41(11): 1006-1011.

[37]

余婵娟, 赵进东, 杨迪, 等. 黄芪甲苷对糖尿病大鼠视网膜病变的防治作用及对氧化应激通路的影响[J]. 中华中医药学刊, 2020, 38(11): 194-197.

[38]

ZHANG X Y, QIU B J, WANG Q Y, et al. Dysregulated serum lipid metabolism promotes the occurrence and development of diabetic retinopathy associated with upregulated circulating levels of VEGF-A, VEGF-D, and PlGF[J]. Front Med, 2021, 8: 779413.

[39]

LENG B, ZHANG Y J, LIU X R, et al. Astragaloside IV suppresses high glucose-induced NLRP3 inflammasome activation by inhibiting TLR4/NF-κB and CaSR[J]. Mediators Inflamm, 2019, 2019: 1082497.

[40]

ROTHSCHILD P R, SALAH S, BERDUGO M, et al. ROCK-1 mediates diabetes-induced retinal pigment epithelial and endothelial cell blebbing: Contribution to diabetic retinopathy[J]. Sci Rep, 2017, 7(1): 8834.

[41]

FOGLI S, MOGAVERO S, EGAN C G, et al. Pathophysiology and pharmacological targets of VEGF in diabetic macular edema[J]. Pharmacol Res, 2016, 103: 149-157.

[42]

何斌斌, 刘宇翔, 魏丽. 糖尿病视网膜病变研究进展[J]. 江苏医药, 2011, 37(15): 1821-1824.

[43]

易茜璐, 于明香. 糖尿病视网膜病变的发病机制[J]. 复旦学报(医学版), 2010, 37(5): 604-607.

[44]

CATRINA S B, ZHENG X W. Hypoxia and hypoxia-inducible factors in diabetes and its complications[J]. Diabetologia, 2021, 64(4): 709-716.

[45]

GARBER D, ZHU S. Implications of caspase 1/interleukin-1 beta (IL-1β) signaling and hypoxia-inducible factor 1-alpha (HIF-1α) on diabetic retinopathy pathology[J]. Cureus, 2023, 15(7): e42479.

[46]

QIU F, TONG H J. Inhibitory effect of maspinon neovascularization in diabetic retinopathy[J]. World J Diabetes, 2021, 12(12): 2050-2057.

[47]

栾智华, 张东坡, 刘必旺, 等. 黄芪甲苷对肺纤维化小鼠VEGF/VEGFR2信号通路的影响[J]. 时珍国医国药, 2019, 30(7): 1611-1613.

[48]

唐甜甜, 刘文, 王群, 等. 基于糖尿病肾病大鼠模型黄芪六一汤药效组分的PK-PD结合模型的建立[J]. 药物评价研究, 2024, 47(8): 1804-1819.

[49]

怀宝赓, 李昌玲, 宋民, 等. 中药防治糖尿病视网膜神经病变研究进展[J]. 辽宁中医杂志, 2024, 51(5): 206-210.

[50]

MESQUIDA M, DRAWNEL F, FAUSER S. The role of inflammation in diabetic eye disease[J]. Semin Immunopathol, 2019, 41(4): 427-445.

[51]

NODA K, NAKAO S, ISHIDA S, et al. Leukocyte adhesion molecules in diabetic retinopathy[J]. J Ophthalmol, 2012, 2012: 279037.

[52]

ARAÚJO R S, SANTOS D F, SILVA G A. The role of the retinal pigment epithelium and Müller cells secretome in neovascular retinal pathologies[J]. Biochimie, 2018, 155: 104-108.

[53]

RANGASAMY S, MCGUIRE P G, FRANCO NITTA C, et al. Chemokine mediated monocyte trafficking into the retina: role of inflammation in alteration of the blood-retinal barrier in diabetic retinopathy[J]. PLoS One, 2014, 9(10): e108508.

[54]

张敬法. 炎症在糖尿病视网膜病变中的作用: 发病机制及治疗策略[J]. 眼科新进展, 2024, 44(1): 1-12.

[55]

LIU N, JI Y S, LIU R, et al. The state of astragaloside IV research: a bibliometric and visualized analysis[J]. Fundam Clin Pharmacol, 2024, 38(2): 208-224.

[56]

YARMOHAMMADI F, HAYES A W, KARIMI G. Natural compounds against cytotoxic drug-induced cardiotoxicity: a review on the involvement of PI3K/Akt signaling pathway[J]. J Biochem Mol Toxicol, 2021, 35(3): e22683.

[57]

DHANDAPANI K M, WADE F M, WAKADE C, et al. Neuroprotection by stem cell factor in rat cortical neurons involves AKT and NFkappaB[J]. J Neurochem, 2005, 95(1): 9-19.

[58]

王晓亮, 谭鹏, 孔维信. 黄芪甲苷Ⅳ通过抑制TIM-1信号通路增加Th1/Th2细胞比率减轻IgA肾病小鼠肾损伤[J]. 细胞与分子免疫学杂志, 2024, 40(6): 501-507.

[59]

ZHAO Z X, TANG X H, JIANG S L, et al. Astragaloside IV improves the pharmacokinetics of febuxostat in rats with hyperuricemic nephropathy by regulating urea metabolism in gut microbiota[J]. Front Pharmacol, 2022, 13: 1031509.

[60]

桑智慧, 李慧红, 周丽娟. 加味四妙勇安汤通过ERS通路对高糖诱导的人视网膜内皮细胞的保护作用[J]. 中国医院药学杂志, 2024, 44(21): 2440-2446.

[61]

解颖, 李洋, 董志军. 糖尿病视网膜病变神经损伤的研究进展[J]. 国际眼科杂志, 2023, 23(8): 1323-1327.

[62]

SPEKKER-BOSKER K, UFERMANN C M, OLDENBURG M, et al. Interplay between IDO1 and iNOS in human retinal pigment epithelial cells[J]. Med Microbiol Immunol, 2019, 208(6): 811-824.

[63]

SIMÓ R, VILLARROEL M, CORRALIZA L, et al. The retinal pigment epithelium: something more than a constituent of the bloodretinal barrier—implications for the pathogenesis of diabetic retinopathy[J]. J Biomed Biotechnol, 2010, 2010: 190724.

[64]

CHEN M, WANG W, MA J, et al. High glucose induces mitochondrial dysfunction and apoptosis in human retinal pigment epithelium cells via promoting SOCS1 and Fas/FasL signaling[J]. Cytokine, 2016, 78: 94-102.

[65]

WANG T, ZHANG Z W, SONG C P, et al. Astragaloside IV protects retinal pigment epithelial cells from apoptosis by upregulating miR-128 expression in diabetic rats[J]. Int J Mol Med, 2020, 46(1): 340-350.

[66]

TANG X Y, LI X Y, ZHANG D Y, et al. Astragaloside-IV alleviates high glucose-induced ferroptosis in retinal pigment epithelial cells by disrupting the expression of miR-138-5p/Sirt1/Nrf2[J]. Bioengineered, 2022, 13(4): 8240-8254.

[67]

DING Y Z, YUAN S T, LIU X Y, et al. Protective effects of astragaloside IV on db/db mice with diabetic retinopathy[J]. PLoS One, 2014, 9(11): e112207.

[68]

刘建春, 张红珍, 王青, 等. 黄芪甲苷对EAE小鼠轴突修复和再生的促进作用机制[J]. 解放军医学杂志, 2024, 49(8): 914-921.

[69]

田渼雯, 秦波, 刘身文. 铁死亡在眼科疾病中的应用研究进展[J]. 眼科新进展, 2021, 41(2): 182-188.

[70]

张进, 贾爱华, 高岩, 等. 铁死亡在高糖诱导的视网膜色素上皮细胞损伤中的作用及机制[J]. 国际眼科杂志, 2023, 23(6): 894-899.

[71]

黄欣, 徐闪闪, 韩姗姗, 等. 中药调控铁死亡干预急性肾损伤作用机制研究进展[J]. 中国中西医结合杂志, 2025, 45(1): 123-128.

[72]

刘恩旭, 聂颖, 段嘉豪, 等. 黄芪甲苷联合BMSCs-Exos对PC12细胞铁死亡的影响[J]. 中草药, 2024, 55(23): 8056-8066.

[73]

SHENG S, XU J L, LIANG Q Y, et al. Astragaloside IV inhibits bleomycin-induced ferroptosis in human umbilical vein endothelial cells by mediating LPC[J]. Oxid Med Cell Longev, 2021, 2021: 6241242.

[74]

曹慧敏, 单云, 俞曼殊, 等. 黄芪甲苷调控铁死亡途径改善高糖腹透液诱导的人腹膜间皮细胞损伤[J]. 医学研究生学报, 2022, 35(8): 790-797.

2026年第44卷第9期

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doi: 10.13193/j.issn.1673-7717.2026.09.044

首发时间：2026-10-20
出版时间：2026-09-10

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基金

甘肃省自然科学基金项目(22JR5RA903)

甘肃省科技计划项目青年科技基金项目(25JRRA1020)

作者信息

^1.兰州大学第一医院，甘肃　兰州　730000

^2.兰州大学第一临床医学院，甘肃　兰州　730000

通讯作者:

牛军强（1984-），男，甘肃天水人，副主任医师，博士，研究方向：中医内科疾病诊疗。E-mail：njqldyy@126.com。

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2种不同金属材料的力学参数

科 Family	属数 Number of genus	种数 Number of species	占总种数比例 Percentage of total species (%)	属 Genus	种数 Number of species	占总种数比例 Percentage of total species (%)
鹅膏菌科Amanitaceae	2	11	5.26	鹅膏菌属 Amanita	10	4.78
小菇科 Mycenaceae	2	12	5.74	丝盖伞属 Inocybe	5	2.39
多孔菌科 Polyporaceae	8	14	6.70	蜡蘑属 Laccaria	5	2.39
红菇科 Russulaceae	3	23	11.00	小皮伞属 Marasmius	6	2.87
				小菇属 Mycena	11	5.26
				光柄菇属 Pluteus	5	2.39
				红菇属 Russula	17	8.13
				栓菌属 Trametes	5	2.39

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