张大宁教授基于补肾活血法治疗局灶节段性肾小球硬化致慢性肾功能衰竭临证经验  

Professor ZHANG Daning’s clinical experience in the treatment of chronic renal failure caused by focal segmental glomerulosclerosis based on kidney tonifying and blood activating therapy

作　　者：高垒 何亚鑫 朱媛媛[1] 褚明妍 樊威伟 GAO Lei

机构地区：[1]天津中医药大学,天津301617 [2]天津市卫生委员会中医药重点学科中医肾病学/天津市中医肾病研究所,天津300120

出　　处：《中医临床研究》2025年第2期98-102,共5页Clinical Journal Of Chinese Medicine

基　　金：天津市卫生健康委员会中医药重点领域科研项目(2020002)。

摘　　要：局灶节段性肾小球硬化(Focal Segmental Glomerulosclerosis,FSGS)属于临床公认的难治性肾病综合征,是以肾小球局灶或节段硬化为主要病理改变的肾小球疾病,以光镜下足细胞增生改变、节段硬化,电镜下足突细胞广泛融合及足细胞数目减少为主要特征。研究表明,20%的患者会发展到终末期肾病,而FSGS的具体病因、发病机制至今不详。此病临床表现多样,西医治疗采用激素和免疫抑制剂,但足量、长时间的使用会带来一系列问题,如消化道溃疡、感染、肝脏损伤等。中医药治疗可以很大程度减轻西药带来的不良反应,并改善水肿、血尿、乏力等诸多症状。国医大师张大宁教授从多年临床经验总结得出,FSGS的基本病机为本虚标实,本虚以正气虚损、脾肾俱虚为主;标实以湿浊、瘀血为主,在此基础上提出补肾、健脾、活血、化瘀、行气、化湿、利水之法。临床做到辨证论治、证法统一,并多种治法结合可取得显著疗效。研究具体阐述张教授的理论,以期为临床诊疗提供新思路。Focal segmental glomerular sclerosis(FSGS)is a clinically recognized refractory nephrotic syndrome.FSGS is a glomerular disease with focal or segmental glomerular sclerosis as the main pathological change.This disease is characterized by proliferation of podocytes,segmental sclerosis,extensive fusion of podocytes and reduction of podocyte number under light microscope.Studies have shown that 20%of patients will develop to end-stage renal disease.However,the specific etiology and pathogenesis of FSGS are still unknown,and the clinical manifestations are diverse.Hormones and immunosuppressants are often used in western medicine treatment to treat this disease.However,adequate and long-term use of Western medicine therapy often brings a series of problems,such as peptic ulcer,infection,liver injury and so on.Traditional Chinese medicine treatment can largely avoid the side effects of Western medicine,and improve edema,hematuria,fatigue and many other symptoms.Professor ZHANG Daning,a master of Chinese medicine,concluded from many years of clinical experience that the pathogenesis of FSGS is based on the syndrome of difficiency in origin and excess in superficiality.Deficiency in origin is mainly due to deficiency of vital energy and deficiency of both spleen and kidney.Excess in superficiality is mainly due to dampness,turbidity and blood stasis.Professor ZHANG Daning proposed the methods of tonifying the kidney,strengthening the spleen,activating blood circulation,removing dampness and diuresis for the above pathogenesis.In clinical practice,Professor ZHANG treated with syndrome differentiation,combined with a variety of therapies,and achieved remarkable curative effect.This paper expounds Professor ZHANG’s theory in detail,in order to provide new ideas for clinical diagnosis and treatment.

关 键 词：终末期肾病 肾功能衰竭 局灶节段性肾小球硬化 名医经验 

分 类 号：R692.5[医药卫生—泌尿科学]