基于PIgR-CR1介导的“黏膜-肾轴”探析补肾健脾、解毒利咽法防治IgA肾病的研究思路  

Treatment of IgA Nephropathy by Tonifying Kidney and Invigorating Spleen as Well as Detoxifying and Relieving Sore-throat Based on PIgR-CR1-mediated Mucosal-renal Axis

作　　者：李凡 王宏安[2] 南赫 何鸣宇 崔成姬[2] 王银萍[2] 刘禹彤 张守琳[2] LI Fan;WANG Hongan;NAN He;HE Mingyu;CUI Chengji;WANG Yinping;LIU Yutong;ZHANG Shoulin(Changchun University of Chinese Medicine,Changchun 130117,China;Affiliated Hospital of Changchun University of Chinese Medicine,Changchun 130021,China)

机构地区：[1]长春中医药大学,长春130117 [2]长春中医药大学附属医院,长春130000

出　　处：《中国实验方剂学杂志》2025年第7期237-244,共8页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金项目(82374432)。

摘　　要：免疫球蛋白A肾病(IgAN)是世界范围内发病率最高的原发性肾小球肾炎,也是导致我国终末期肾病(ESRD)的主要病因,给社会和家庭带来了沉重的经济负担,中医药在治疗本病上具有一定的优势。中医可将其归属于“虚劳”“血尿”“水肿”等范畴,传统认为病位在肾,与肺肝脾等密切相关。而国医大师任继学教授认为“肾虚脾亏是IgAN发病之本,而咽喉是发病之源”,提出“喉肾相关”理论,以补肾健脾、解毒利咽法治疗IgAN,疗效显著。研究表明IgAN与黏膜免疫防御功能密切相关,IgAN患者常因黏膜感染而诱发病情反复发作并逐渐加重,而多聚免疫球蛋白受体(PIgR)是黏膜防御功能的重要组成部分,PIgR缺乏导致IgA分子积聚于黏膜固有层,大量进入血液循环,最终沉积于肾脏引起肾损伤,补体调节蛋白补体受体1型(CR1)存在于红细胞及肾小球上,具有抑制B细胞活化、分化、清除免疫复合物及抑制补体系统过度激活等作用,因此通过PIgR-CR1介导的“黏膜-肾轴”调控机体免疫防御功能将是防治IgAN的重要靶点。该文基于“喉肾相关”理论,探析补肾健脾、解毒利咽法通过调控PIgR-CR1介导的“黏膜-肾轴”进而防治IgAN的作用与分子机制,为中医药基于“喉肾相关”理论防治IgAN提供有效的理论支撑及科学依据。Immunoglobulin A nephropathy(IgAN)is the primary glomerulonephritis with the highest incidence rate in the world.It is also the main cause of end-stage renal disease(ESRD)in China,which has brought heavy economic burden to the society and patient families.Traditional Chinese medicine(TCM)has certain advantages in treating IgAN.In TCM,IgAN is classified into consumptive disease,hematuria,and edema categories,with the location in the kidney and involving the lung,liver,and spleen.Professor Ren Jixue,a master of TCM,believes that kidney deficiency and spleen deficiency are the root causes of IgAN,and the throat is the source of the disease.He proposed the theory of throat-kidney correlation and used the method of tonifying kidney and invigorating spleen as well as detoxifying and relieving sore-throat to treat IgAN,achieving significant therapeutic effects.Studies have shown that IgAN is closely related to mucosal immune defense.IgAN patients often experience recurrent and gradually worsening symptoms due to mucosal infections,and polymeric Ig receptor(PIgR)is an important component of mucosal defense function.The lack of PIgR leads to the accumulation of IgA molecules in the mucosal lamina propria,and the molecules enter the bloodstream in large quantities and ultimately deposit in the kidneys,causing kidney damage.Complement regulatory protein complement receptor type 1(CR1)exists on red blood cells and glomeruli and has the function of inhibiting the activation and differentiation of B cells,clearing immune complexes,and inhibiting excessive activation of the complement system.Therefore,regulating the immune defense function through the mucosal-renal axis mediated by PIgR-CR1 will be an important target for preventing and treating IgAN.Based on the theory of throat-kidney correlation,this article explores the effects and molecular mechanisms of tonifying kidney and invigorating spleen as well as detoxifying and relieving sore-throat in preventing and treating IgAN by regulating the mucosal-kidney axis mediated by

关 键 词：免疫球蛋白A肾病(IgAN) 黏膜-肾轴 多聚免疫球蛋白受体 补体受体1型(CR1) 补肾健脾 解毒利咽 

分 类 号：R259[医药卫生—中西医结合] R285[医药卫生—中医内科学] R692[医药卫生—中医学]