基于成纤维细胞生长因子23-Klotho探讨中医药治疗慢性肾脏病并发钙磷代谢紊乱研究现状  

study on the treatment of chronic kidney disease complicated with calcium and phosphorus metabolism disorders in TCM based on FGF23-Klotho

作　　者：李佩娥 孙伟[1] 陶静 LI Pei'e

机构地区：[1]南京中医药大学第一临床医学院,江苏南京210004

出　　处：《中医临床研究》2024年第35期105-110,共6页Clinical Journal Of Chinese Medicine

基　　金：江苏省中医肾病医学创新中心(苏卫科教[2022]15号);江苏省中医院科技项目(Y2020CX14)。

摘　　要：钙磷代谢紊乱是慢性肾脏病(Chronic Kidney Disease,CKD)患者常见的合并症,长期的钙磷代谢紊乱不利于保护残余肾功能,还会导致继发性甲状旁腺功能亢进、心血管钙化、骨的代谢与发育异常等,严重影响患者的预期生存率。成纤维细胞生长因子23(Fibroblast Growth Factor,FGF23)-Klotho是近年发现的内分泌轴,具有组织表达的多样性及特异性,不仅参与体内钙磷代谢的调节,还与患者肾功能衰竭的进展及心脑血管意外事件息息相关,影响患者的预后。各医家认为FGF23-Klohto轴与中医“肾藏精,主骨,生髓”理论体系有关联。而目前治疗CKD并发钙磷代谢紊乱的药物并不能有效改善FGF23、Klotho蛋白水平,故从中医角度出发,希望找到可明显改善FGF23、Klotho表达的药物。文章对FGF23、Klotho进行了详细的介绍,从“肾藏精,主骨,生髓”的理论体系入手,阐述了二者之间的关联,抓住CKD并发钙磷代谢紊乱的核心病机“肾精亏虚”,进行总结归纳,发现具有补肾气、通络、泄浊功效的复方可调节FGF23、Klotho的表达,纠正钙磷代谢紊乱,保护残余肾功能、预防血管钙化。因此,以益肾通络泄浊为基本治则组成的方药可上调Klotho蛋白水平,下调FGF23水平,保护骨组织,改善血管钙化,进而防止心脑血管意外事件的发生,延长寿命。现就中医药通过影响FGF23、Klotho的表达调节CKD患者钙磷代谢进行综述,为临床CKD并发钙磷代谢紊乱提供更优的治疗方案。Disturbance of calcium and phosphorus metabolism is a common complication in patients with CKD.Long-term disturbance of calcium and phosphorus metabolism is not beneficial to the protection of residual renal function,and can also lead to secondary hyperparathyroidism,cardiovascular calcification,and abnormal bone metabolism and development,which seriously affect the expected survival rate of patients.FGF23-Klotho is an endocrine axis discovered in recent years,with diverse and specific tissue expression,not only participates in the regulation of calcium and phosphorus metabolism in vivo,but also is closely related to the progression of renal function and cardiovascular and cerebrovascular accidents of patients,and affects the prognosis of patients.Various doctors believe that the FGF23-Klohto axis is related to the theoretical system of“kidney stores essence,manages bone,and produces marrow”in TCM.However,the current drugs for treating CKD complicated with calcium and phosphorus metabolism disorder cannot effectively improve the protein levels of FGF23 and Klotho,so it is expected to find drugs that can significantly improve the expression of FGF23 and Klotho from the perspective of TCM.This paper introduces FGF23 and Klotho in detail,starts with the theoretical system of“kidney stores essence,manages bone,and produces marrow”,expounds the relationship between the two,and summarizes the core pathogenesis of CKD complicated by calcium and phosphorus metabolism disorder of“kidney essence deficiency”.It is found that the compound with the effects of tonifying kidney Qi(气),clearing collages and expelling turbidity could regulate the expression of FGF23 and Klotho,correct the disturbance of calcium and phosphorus metabolism disorders,protect residual renal function and prevent vascular calcification.Therefore,the prescription based on the basic treatment principles of tonifying kidney,dredging collaterals,and releasing turbidity can regulate the expression of fgf23 can up-regulate the level of Klotho pro

关 键 词：中医药 钙磷代谢 慢性肾脏病 成纤维细胞生长因子23 

分 类 号：R256.5[医药卫生—中医内科学]