摘要
免疫球蛋白A(IgA)肾病是指肾小球系膜区以IgA或IgA沉积为主的原发性肾小球疾病,目前较为公认的发病机制“多重打击”学说符合中医理论体系中“邪伏膜原”的发病观。患者禀赋不足,三焦黏膜免疫缺陷,风、湿、热三种伏邪客于三焦黏膜膜原和肾脏膜原,膜原失于透达,脏腑气化不利,三焦失畅,驱动IgA肾病发病;治疗以祛伏邪、畅三焦、达膜原为原则。急性发作期宜分消三焦之伏邪为主,慢性持续期扶正气、散余邪兼顾,同时需考虑蛋白尿对证型的影响,肾功能衰竭期宜扶正为主,培补肾元,兼以化瘀泄浊,分期辨证论治,消散伏邪,畅达膜原,通调三焦,复肾气化,延缓疾病进展。
Immunoglobulin A(IgA)nephropathy is a primary glomerular disease characterized by predominant IgA or IgA deposition in the mesangial region of the glomerulus.The currently widely recognized"multiple-hits"theory of pathogenesis corresponds with the traditional Chinese medicine(TCM)concept of"latent pathogen in the pleurodiaphragmatic interspace".Patients often have congenital deficiency and mucosal immune defects of the Sanjiao.Latent pathogenic factors of wind,dampness,and heat reside in the pleurodiaphragmatic interspace of the Sanjiao and kidney,resulting in impaired permeability of the interspace,disrupted qi transformation of the Zangfu organs,and disharmony of the Sanjiao,ultimately driving the onset of IgA nephropathy.Treatment should follow the principles of eliminating latent pathogens,regulating the Sanjiao,and restoring permeability of the interspace.During the acute stage,therapy focuses on dispersing the latent pathogens causing stagnation in the Sanjiao.In the chronic persistent stage,the approach emphasizes strengthening healthy qi while also addressing residual pathogens,with attention to the effects of proteinuria on syndromes.In the stage of renal function decline,treatment centers on reinforcing healthy qi,tonifying the kidney,combined with removing blood stasis and eliminating turbidity.Therapy should be guided by disease stage and syndrome differentiation,with the goals of dispersing latent pathogens,restoring interspace permeability,harmonizing the Sanjiao,recovering kidney qi transformation,and slowing disease progression.
作者
王欣怡
孙欣如
辛闯
刘梦超
赵文景
王悦芬
WANG Xinyi;SUN Xinru;XIN Chuang;LIU Mengchao;ZHAO Wenjing;WANG Yuefen(Department of Nephrology,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 10010,China)
出处
《北京中医药》
2025年第10期1341-1346,共6页
Beijing Journal of Traditional Chinese Medicine
基金
北京市属医院科研培育计划(PZ2022022)
张炳厚全国名中医传承工作室项目。
关键词
IGA肾病
伏邪
膜原
三焦
辨证论治
IgA nephropathy
latent pathogens
pleurodiaphragmatic interspace
Sanjiao
syndrome differentiation and treatment
