余承惠教授治疗免疫球蛋白G4相关肾病经验拾遗  

Experience summary of Professor Yu Chenghui in treating immunoglobulin G4-related kidney diseases

作　　者：王旭方 刘琼 刘利华 WANG Xufang;LIU Qiong;LIU Lihua(Department of Nephrology,Affiliated Hospital of Nanjing University of Chinese MedicineJiangsu Province Hospital of Chinese Medicine,Jiangsu Province,Nanjing210029,China)

机构地区：[1]南京中医药大学附属医院江苏省中医院肾内科,江苏南京210029

出　　处：《中国医药导报》2024年第9期137-140,共4页China Medical Herald

基　　金：国家自然科学基金资助项目(82104750)。

摘　　要：免疫球蛋白G4(Ig G4)相关疾病临床表现异质性大,易误诊。在肾脏方面,Ig G4相关疾病常表现为膜性肾病、肾间质纤维化或腹膜后纤维化引起泌尿道梗阻。余承惠教授是江苏省著名中西医结合治疗专家,在肾病治疗方面具有独到见解。余教授认为,Ig G4相关肾病的发病机制为脾肾气虚,合并肝郁气滞,进而导致痰浊、瘀血积聚。治疗方面应根据患者不同临床表现辨证论治,Ig G4相关膜性肾病病机多为脾肾气虚、水湿内停,治疗上以扶正祛瘀清肾为则;肾间质纤维化则为脾肾正虚基础上合并湿热、痰浊、瘀血等邪实,以湿邪为著,属微型癥积,治疗上应在益肾健脾基础上着重化湿;而腹膜后纤维化则存在肝郁气滞、痰瘀互结,属有形之癥积,治疗方面,在化痰祛瘀散结的同时应注重条达肝气。The clinical manifestations of immunoglobulin G4(IgG4)-related diseases are heterogeneous and easy to be misdiagnosed.In the kidneys,IgG4-related diseases are often characterized by membranous nephropathy,renal interstitial fibrosis,or retroperitoneal fibrosis resulting in urinary tract obstruction.Professor Yu Chenghui is a famous expert in the treatment of integrative Chinese and Western medicine in Jiangsu Province,and has unique insights in the treatment of kidney disease.Professor Yu believes that the pathogenesis of IgG4 related kidney disease is based on the deficiency of the spleen and kidney qi,combined with liver depression and qi stagnation,which could cause accumulation of phlegm and blood stasis.In terms of treatment,differentiation and treatment should be based on the different clinical manifestations of patients.The pathogenesis of IgG4 related membranous nephropathy is mostly spleen and kidney qi deficiency,and internal stagnation of water and dampness,and the treatment mainly focuses on nourishing the body,removing blood stasis,and clearing the kidney.Renal interstitial fibrosis is characterized by the combination of dampness heat,phlegm turbidity,blood stasis,and other pathogenic factors on the basis of spleen and kidney deficiency,with dampness as the cause,it is a miniature abdominal mass disease,and the treatment should focus on resolving dampness on the basis of tonifying the kidney and spleen.Retroperitoneal fibrosis is characterized by liver stagnation and qi stagnation,as well as the accumulation of phlegm and blood stasis,and it is a abdominal mass disease with tangible symptom.In terms of treatment,attention should be paid to regulating liver qi while resolving phlegm,removing blood stasis,and dispersing stasis.

关 键 词：免疫球蛋白G4相关肾病 腹膜后纤维化 膜性肾病 余承惠 

分 类 号：R256.5[医药卫生—中医内科学]