基于肠道微生态探索“补脾益肾”法治疗慢性肾脏病的新思路

Exploration of “Spleen-tonifying and Kidney-nourishing” Method in Traditional Chinese Medicine Treatment for Chronic Kidney Disease: from Insight of Gut Microbiome and Metabolism

慢性肾脏病(chronic kidney disease,CKD)是由各种原因引起的慢性肾脏结构和功能障碍,发病率、患病率已呈上升趋势,成为全球性的重要健康问题。越来越多的研究表明,慢性肾脏病进展的重要指标因素之一是患者肠道菌群发生紊乱,血清内毒素水平升高。现代中医学家认为,慢性肾脏病主要病机为脾肾亏虚,治疗大法为健脾补肾。而脾居中焦,具有运化抗邪之功能,这种运化抗邪的功能与肠道菌群对机体代谢、免疫等功能极其相似,后者可能是脾生理功能的生物学基础之一。本文从现代肠道微生态与代谢的角度系统阐述了从中医"脾"论治慢性肾脏病(CKD)的现代理论基础,主要包括:1.肠道微生物及其代谢与脾胃的联系:中医"脾"生理功能的现代生物学基础可能与肠道微生物对机体代谢及免疫功能等的影响有关;2.肠道微生物及其代谢与慢性肾脏病的关系:慢性肾脏病患者胃肠功能紊乱,其肠道微生态也发生紊乱,从而产生蛋白结合毒素,影响慢性肾脏病患者的愈后,基于此对CKD进行防治是现在研究的热点;3.慢性肾脏病从脾胃论治的源流和现状:慢性肾脏病迁延日久,损耗人体正气,属于慢性疾病中虚劳性疾病的一种,脾虚是其核心病机之一,因此健脾法应该贯穿治疗的始终。且在前期临床研究的基础上,结合肠道菌群及其代谢的理论,提出了基于系统生物学技术开展进一步研究的思路。

Chronic kidney disease（CKD） is a chronic renal structure change and dysfunction caused by a variety of causes. The incidence and prevalence of CKD have been on the rise, becoming a major global health problem. An increasing number of studies had shown that one of the important indicators of CKD progression was the disorder of gut microbiome and elevated levels of serum endotoxin. Modern physicians of traditional Chinese medicine（TCM） believed that the main pathogenesis of CKD was spleen and kidney deficiency. And the therapeutic regimen was invigorating spleen and nourishing the kidney. Spleen is in the middle burner. It has the function of transportation and resistance to evil, which was extremely similar to the function of gut microbiome in metabolism and immunity. The latter might be one of the biological bases of physiological function of spleen. This comprehensive review presented the modern theoretical basis of spleen-based TCM treatment methods for CKD from the insight of modern gut microbiome and metabolism.Firstly, gut microbiome and its metabolism were associated with the spleen in TCM theory. Gut microbiome affected individual metabolism and immune function, which could provide a modern biological basis for explaining the physiological function of the spleen. Secondly, gut microbiome and its metabolism were correlated with CKD： intestinal flora disturbance occurred in CKD patients, producing enterogenous toxins as their metabolites, which become the important factors affecting prognosis. Thirdly, as for its origin, development and current status based on the spleen theory,CKD was one of various consumptive diseases. Spleen insufficiency was one of their critical pathogenic mechanisms.Therefore, tonifying the spleen should be a treatment method to maintain throughout the entire treatment. On the basis of our previous clinical studies and the hypothesis of gut microbiome and metabolism, we proposed further studies which were also based on system biology and its technology.