摘要
儿童狼疮性肾炎是系统性红斑狼疮最重要的脏器并发症,临床以血尿、蛋白尿及进展性肾功能不全为主要表现,起病隐匿、病情急重、病程缠绵,远期预后较差。当前,儿童狼疮性肾炎的病因病机和辨治体系尚未形成一致观点。本团队结合临证经验,认为儿童狼疮性肾炎的核心病机为邪伏焦膜、正虚毒发,即热瘀互结成邪,邪气伏藏于焦膜,正虚之时内外相应,毒邪循三焦膜系损伤脏腑,累及肾脏,疾病全过程分为邪伏焦膜期、邪发累肾期及邪恋三焦期。临证时当分期辨治:邪伏焦膜期,外来之邪与内伤之邪相合,邪气蛰伏于焦膜,此期当祛邪清热、顾护正气;邪发累肾期,伏邪经焦膜系统迅速布达全身,肾元失固,精微物质外泄,此期当解毒散瘀、利膜固肾;邪恋三焦期,正气未复,伏邪暂安,伺机而动,此期当纳气归元、清透余邪,以减少疾病反复,延缓肾脏损伤的慢性进展。
Pediatric lupus nephritis(LN),the most severe visceral complication of systemic lupus erythematosus,is characterized by hematuria,proteinuria,and progressive renal dysfunction.It typically presents with an insidious onset,rapid progression,a prolonged disease course,and an unfavorable longterm prognosis.Currently,no consensus exists on the etiology,pathogenesis,or diagnostic-treatment framework for pediatric LN.Based on clinical experience,the proposed core pathogenesis involves"latent pathogens in the triple energizer membrane system with deficiency-induced toxin activation."This mechanism entails the intermingling of heat and blood stasis,forming pathogenic factors that lodge within the triple energizer membrane system.In states of healthy qi deficiency,internal and external factors interact,allowing pathogenic toxins to damage the viscera via the triple energizer membrane network,ultimately targeting the kidneys.The disease progression is classified into three distinct phases.In the latent pathogen phase,internal or external pathogens accumulate in the triple energizer membrane system.Treatment emphasizes pathogen elimination,heat clearance,and healthy qi preservation.In the active renal involvement phase,latent pathogens rapidly disseminate systemically via the membrane network,destabilizing renal essence and causing micro-substance leakage.Treatment focuses on toxin resolution,stasis dispersion,membrane regulation,and renal stabilization.During the triple energizer residual phase,incomplete restoration of healthy qi permits the persistence of dormant pathogens,predisposing to reactivation.Therapeutic focus during this phase includes qi consolidation to restore primordial essence,residual pathogen clearance,and mitigating disease recurrence to delay chronic renal deterioration.This phase-specific differentiation-treatment strategy aims to address disease complexity while optimizing therapeutic outcomes through targeted interventions.
作者
任翎嘉
张霞
许济祥
宋纯东
任献青
丁樱
REN Lingjia;ZHANG Xia;XU Jixiang;SONG Chundong;REN Xianqing;DING Ying(School of Pediatrics,Henan University of Traditional Chinese Medicine,Zhengzhou 450046,China;The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450099,China)
出处
《北京中医药大学学报》
北大核心
2025年第8期1115-1120,共6页
Journal of Beijing University of Traditional Chinese Medicine
基金
国家自然科学基金面上项目(No.82474568)
中华中医药学会青年求实项目(No.2023-QNQS-06)
河南省中青年学科带头人培养项目(豫卫人[2022]26号)。
关键词
儿童狼疮性肾炎
三焦膜系理论
邪伏焦膜理论
分期辨治
pediatric lupus nephritis
sanjiao membrane system theory
latent pathogen theory
stageoriented pattern differentiation and treatment
