中西医结合诊治环孢素A慢性肾毒性的思路与方法  

Ideas and methods of diagnosis and treatment of cyclosporine A chronic nephrotoxicity by integrative Chinese and western medicine

作　　者：高冉冉 周乐[2] 韩聪 李伟[2] GAO Ran-ran;ZHOU Le;HAN Cong;LI Wei(College of Traditional Chinese Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250014,China;Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,China;Shandong University of Traditional Chinese Medicine,Jinan 250014,China)

机构地区：[1]山东中医药大学中医学院,山东济南250014 [2]山东中医药大学附属医院,山东济南250014 [3]山东中医药大学,山东济南250014

出　　处：《中草药》2023年第24期8273-8281,共9页Chinese Traditional and Herbal Drugs

基　　金：国家自然科学基金资助项目(82204886);国家自然科学基金资助项目(82174179);山东省自然科学基金资助项目(ZR2022QH133);山东省自然科学基金资助项目(ZR2021LZY041);中国博士后科学基金项目(2021M702039);山东省中医药科技项目(2020Q012)。

摘　　要：环孢素A长期使用所致慢性肾毒性限制其临床应用。环孢素A慢性肾毒性发病机制涉及内质网和氧化应激、炎症反应、自噬、细胞凋亡、肾素-血管紧张素系统等方面,中医病机以气虚为本,湿、热、浊毒、血瘀等病理实邪为标。现代西医传统治疗手段难以有效抑制其进展,中医药防治多以益气、活血、清泄为治则,多靶点抑制炎症、凋亡、自噬、抗氧化、改善血流动力学等。通过对近年来在益气活血清泄治则指导下中医药治疗环孢素A慢性肾毒性的研究综述,结合西医病理及相关通路,深入探讨不同病理阶段的病因病机及中西医结合遣方用药的思路与方法,更好地发挥中西医结合优势,为环孢素A安全有效地应用于临床提供理论依据。Chronic nephrotoxicity caused by long-term use of cyclosporine A limits its clinical application.The pathogenesis of chronic nephrotoxicity of cyclosporin A involves endoplasmic reticulum and oxidative stress,inflammatory reaction,autophagy,apoptosis,renin-angiotensin system,etc.The pathogenesis of traditional Chinese medicine(TCM)is based on qi deficiency,and pathological excess pathogens such as dampness,heat,turbid toxins,and blood stasis.The traditional treatment method of modern western medicine is difficult to effectively inhibit its progress,and the prevention and treatment of cyclosporin A chronic nephrotoxicity by TCM have outstanding advantages.The therapeutic principle is replenishing qi,invigorating blood,and discharging,multiple targets inhibiting inflammation,apoptosis,autophagy,antioxidant,improving hemodynamics and so on.The author reviews the research progress of TCM treatment of chronic nephrotoxicity of cyclosporin A under the guidance of replenishing qi and activating blood and combine with western medicine pathology and related pathways,discuss the etiology and pathogenesis of different pathological stages and the ideas and methods of integrated Chinese and western medicine,in order to better play the advantages of integrated Chinese and western medicine,which provide a theoretical basis for the safe and effective application of cyclosporin A in clinical application.

关 键 词：环孢素A 慢性肾毒性 络病理论 中西医结合 气虚湿瘀 益气活血清泄法 

分 类 号：R283[医药卫生—中药学]