中药防治慢性肾功能衰竭的临床及分子生物学机制

Clinical and molecular biological mechanism of Chinese medicine for prevention and treatment of chronic renal failure

目的:分析中药治疗慢性肾功能衰竭生理机制,探讨中药防治慢性肾功能衰竭应关注的重要病理环节。总结了肾纤复原胶囊治疗慢性肾衰的临床和科研研究成果。方法:应用计算机检索Medline1993-01/2006-06关于中药治疗慢性肾功能衰竭的文章。检索词“chronicrenalfailure,TraditionalChineseMedicine”并限定文章的语种类为English。同时利用计算机检索中国期刊全文数据库1994-01/2006-06的相关文章,限定文章语言种类为中文,检索词“慢性肾功能衰竭,中药”。结果:慢性肾功能衰竭中医病机以气、血、阴、阳俱虚,湿热、水毒、痰浊、瘀血内停为主,其正虚诸证演变大致是脾肾气虚(气阴两虚)一脾肾阳虚一阴阳两虚。在治疗中针对其主要病理改变应注意重视补益脾肾,祛邪降浊,养血生血,活血化瘀相互相成,软坚散结,抗纤复原等治疗原则的应用。通过临床资料的分析总结了肾纤复原胶囊具有延缓肾衰、改善患者生活质量、无明显副反应等作用。结论:肾纤复原胶囊治疗慢性肾功能衰竭的疗效可能与减少肌成纤维细胞的活化与形成、下调结缔组织生长因子在残肾组织的表达、抑制细胞外基质的积聚和细胞转分化等有关。

AIM： To analyze the physiological mechanism of Chinese medicine for treatment of chronic renal failure, and explore the important pathological factors on prevention and treatment of chronic renal failure with Chinese medicine, so as to summarize the clinical and scientific research ad- vancement of Shenxian Fuyuan capsule on treatment of chronic renal failure. METHODS： A computer-based online search of Medline was undertaken for articles about treatment of chronic renal failure with Chinese herb pub- lished in English between January 1993 and June 2006 with the key words of ＂chronic renal failure, traditional Chinese medicine＂. Meanwhile, we searched the Chinese Journal Full-text Database for related articles published in Chinese between January 1994 and June 2006 with the same key words in Chinese. RESULTS： Deficiency of qi, blood, yin and yang is the Chinese medi- cal pathogenesis of chronic renal failure, and mainly manifested by damp-heat, noxious water disease, accumulation of phlegm and blood sta- sis. Its development of deficiency of genuine qi is from deficiency of spleen-q/ and kidney-q/ （deficiency of both qi and yin） to deficiency of spleen-yang and kidney-yang and deficiency of both yin and yang. In treatment, it should be paid more attention to the interaction of tonifying spleen and kidney, eliminating pathogenic factor and lowering turbid urine, nourishing blood and activating blood and promoting blood circu- lation by removing blood stasis, and the application of treated p~＇incip!e of resolving hard mass and recovery by anti-fibrosis. The summary of clinical data suggests that Shenxian Fuyuan capsule can delay renal fail- ure, improve the quality of life of patients and has no obvious side reaction. CONCLUSION： The curative effect of Shenxian Fuyuan capsule on chronic renal failure may be related to decrease of activation and formation of myofibroblast, down-regulation of the expression of connective tissue growth factor in injured kidney tissue, inhibition of accumulation of extra- cellular matrix and transdifferentiation of cells.