蛋白结合尿毒素在心肾综合征的作用研究进展

Development of research in association of protein-bound uremic toxins and cardiorenal syndrome

心肾综合征（CRS）因心血管疾病与肾脏疾病共存,二者相互影响并产生恶性循环,导致临床用药矛盾,治疗困难,死亡风险高于单一心血管疾病或肾脏疾病,故引起广泛关注。关于其病理生理机制已在神经内分泌激活、血流动力学紊乱、全身炎症激活等方面有了较为系统的研究,然而,临床实践证实尽管控制了这些发病途径却仍未能阻止CRS的进展,这提示可能存在其他途径导致心、肾交互损害。随着肾移植技术的发展,

Protein-bound urimic toxins（PBUTs）accumulate once renal excretory function declines,and are not cleared by dialysis.There are increasing experimental studies have shown that PBUTs are involved not only in the progression of chronic kidney disease（CKD）,but also in the generation and aggravation of cardiovascular disease.It has been suggested that PBUTs are likely to be a potential missing link in cardiorenal syndrome（CRS）.They are derived from dietary amino acid metabolites by colonic microbial organisms.Therefore,targeting the colon where these toxins are initially produced appears to be a potential therapeutic alternative for the progression of CKD as well as the development of CRS.The aim of this review is to evaluate the causal role of PBUTs in the pathogenesis of CRS and their elimination based on recent clinical studies.