基于脂质肾毒性学说探析慢性肾脏病“湿邪内蕴”的现代生物学机制及“从湿论治”的潜在靶点  

Analysis of the Modern Biological Mechanism of"Dampness Evil Accumulation"in Chronic Kidney Disease Based on Lipid Nephrotoxicity Theory and Potential Targets of"Treating from Dampness"

作　　者：吴爱君 程冉[1,2] 曾艳秋 黎创 黄丽华 王晓婉[1,2,3] 胡天祥 陆智昇[1,2] 黄清明 毛炜 徐鹏 田瑞敏 WU Aijun;CHENG Ran;ZENG Yanqiu;LI Chuang;HUANG Lihua;WANG Xiaowan;HU Tianxiang;LU Zhisheng;HUANG Qingming;MAO Wei;XU Peng;TIAN Ruimin(State Key Laboratory of Dampness Syndrome of Chinese Medicine,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510120,China;The Second Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Guangdong Provincial Academy of Chinese Medical Sciences,Guangzhou 510006,China;Foshan Hospital of Traditional Chinese Medicine,Foshan 52800,China)

机构地区：[1]省部共建中医湿证国家重点实验室/广州中医药大学第二附属医院,广州510120 [2]广州中医药大学第二临床医学院,广州510405 [3]广东省中医药科学院,广州510006 [4]佛山市中医院,广东佛山528000

出　　处：《中国中医基础医学杂志》2024年第2期269-274,共6页JOURNAL OF BASIC CHINESE MEDICINE

基　　金：省部共建中医湿证国家重点实验室专项(SZ2021ZZ1003,SZ2021ZZ11);国家自然科学基金项目(82004157,82074376);广东省中医院专项(ZY2022KY13)。

摘　　要：慢性肾脏病(chronic kidney disease,CKD)是由多种病因引起肾脏结构损伤和功能障碍的临床综合征。CKD起病隐匿、病程缠绵,“湿”既是病理产物,又可作为致病因素,还能夹杂风、水、热、瘀、痰、浊、毒等一种或多种实邪加重CKD的病情,“湿邪内蕴”在CKD发生发展中起到重要作用,临床“从湿论治”CKD也取得了较好的疗效。自“脂质肾毒性”学说提出以来,越来越多的现代生物学研究逐步揭示了脂代谢在CKD进展中的关键作用与机制。笔者通过对“脂代谢”与“湿”的特点进行梳理,认为脂代谢紊乱可看作是CKD中“湿邪内蕴”的重要微观表现,脂代谢重编程通过影响机体免疫、炎症、水液代谢等方面从而呈现“风湿”“水湿”“湿热”等证,同时“调控脂代谢”亦是“从湿论治”CKD的潜在靶点。本文基于脂质肾毒性学说探析CKD中“湿邪内蕴”的现代科学内涵,并从调控脂代谢角度解析CKD“从湿论治”的生物学机制,希冀为临床中医治疗CKD提供理论依据与新的思路,发挥中医既病防变的优势。Chronic kidney disease(CKD)is a clinical syndrome with abnormalities of renal structure or function caused by multiple factors.Generally,CKD has an occult onset and lingering course."Dampness"is not only the pathologic results but also pathogenic factors,and can mixed with wind,water,heat,blood stasis,turbidity,toxins,thus delaying progress.From the perspective of traditional Chinese Medicine(TCM),"Dampness evil accumulation"plays an essential role in the development of CKD,and clinical treatment of CKD from the perspective of"eliminating dampness"has also achieved good efficacy.Since the theory of"lipid nephrotoxicity"was proposed,more and more modern biological researches have revealed the mechanism and key role of lipid metabolism in CKD progression.By sorting and comparing the characteristics of"lipid metabolism"and"dampness",we think that"the disorder of lipid metabolism"can be regarded as an important microscopic manifestation of"dampness"in CKD.Reprogramming of lipid metabolism affects immunity,inflammation,and fluid metabolism,thus leading to"wind-dampness""water-dampness""damp-heat",etc."Lipid metabolism regulation"also serve as the potential targets of"treating from dampness"of CKD.Herein,we try to explore the modern scientific connotation of"dampness evil accumulation"in CKD based on the theory of"lipid nephrotoxicity",and analyzes the modern biological mechanism of"treating from dampness"of CKD from the perspective of regulating lipid metabolism,hoping to provide a theoretical basis and new ideas for the clinical treatment of CKD in TCM.Our research will provide a theoretical basis and new ideas for the clinical treatment of CKD in TCM,and try to take the advantages of TCM in disease prevention.

关 键 词：慢性肾脏病 脂质肾毒性 脂代谢 湿邪 从湿论治 

分 类 号：R259[医药卫生—中西医结合]