黄春林教授运用中医药防治环孢素A肾毒性的策略

Professor Huang Chunlin′s Strategy of Preventing and Treating Cyclosporine A Nephrotoxicity with Traditional Chinese Medicine

环孢素A(CsA)急慢性肾毒性副作用明显,虽然其肾毒性呈剂量、浓度依赖性,然而CsA血药浓度在正常治疗范围时,仍有可能发生肾毒性。其主要的肾毒性就是肾纤维化,病变程度与肾功能恶化及慢性肾脏病的预后密切相关,目前尚无直接且有效的方法防治。广东省名中医黄春林教授采用现代中医取象比类、审证求因的辨证思维,在中医病机与现代病理相结合的学术思想指导下,本文提出通过判断CsA的中医药物属性及其肾毒性发生机制,临床运用防己黄芪汤合五子衍宗丸加减治疗,以增强CsA血药浓度减少其用量,同时亦可防治CsA导致的肾纤维化,达到减毒增效的目的,更好地发挥中医药独特优势,对运用中医"病证结合、机理互参"的精准辨证理念治疗临床疑难肾病提供了充分的理论依据,具有很好的临床指导意义。

The side effects of acute and chronic nephrotoxicity of cyclosporine A(CsA)are obvious.although the nephrotoxicity of cyclosporine A is dose-and concentration-dependent,nephrotoxicity may still occur when the blood concentration of CsA is in the normal treatment range.The main nephrotoxicity is renal fibrosis.the degree of lesion is closely related to the deterioration of renal function and the prognosis of chronic kidney disease.at present,there is no direct and effective method to prevent and treat it.Professor Huang Chunlin,a famous traditional Chinese medicine in Guangdong Province,adopts the dialectical thinking of comparing images of modern traditional Chinese medicine and examining syndrome and seeking causes,under the guidance of the academic thought of combining pathogenesis of traditional Chinese medicine with modern pathology.This paper proposes that by judging the TCM drug attribute of CsA and its nephrotoxicity mechanism,the clinical application of Fangji Huangqi decoction combined with Wuzi Yanzong Pill can not only enhance the blood concentration of CsA and reduce its dosage,but also prevent and treat renal fibrosis caused by CsA.To achieve the purpose of reducing toxicity and increasing efficiency,give better play to the unique advantages of traditional Chinese medicine,and provide a sufficient theoretical basis for the use of the accurate syndrome differentiation concept of"combination of disease and syndrome,mechanism mutual reference"in the treatment of clinical difficult kidney disease,which has a good clinical guiding significance.