“枢机不利”致IgA肾病机制探讨

Mechanism of IgA Nephropathy Induced by Dysfunction Acting as a Pivot

IgA肾病无论从发病特点、病变脏腑还是临床表现都显示＂少阳枢机不利＂是其重要病机之一。少阳主枢,其气游行三焦,贯通全身上下,在下络属于肾。三焦总司气化的功能与肾阳气化、主司水液代谢不可分割。＂枢机不利＂则代谢失常,肾不藏精,精气下漏,发生蛋白尿血尿。又柴胡证病在三焦,波及阴阳、表里、上下、内外。故临床采用和解法治疗多获良效。然和解法疗效机制的现代机理如何？文章认为枢机不利导致IgAN与西医发病机制在病变脏腑上具有一致性,且＂外周血B细胞与肠黏膜分泌异常糖基化IgA1生成增多,肝脏清除异常糖基化IgA1减少＂是导致IgAN的关键。以上三者分别与肝、肠密切相关,又是少阳、三焦的功能范围。故而可以从以上角度进一步研究＂枢机不利＂导致IgAN及＂和解法＂治疗IgAN疗效机制。

Shaoyang resembling a pivot dysfunction is the most important pathogenesis of IgA nephropathy analyzed by visceral lesions or clinical manifestations. Qi produced by Shaoyang parade through the triple energizer enters into the channel of kidney.＂Triple energizer controlling Qi transformation＂is closed to the function of＂Kidney governing water metabolism＂.＂Shaoyang resembling a pivot＂dysfunction results in metabolic disorders,kidney failing to store essence and protein urine because of essential Qi leakage. Syndrome of Chaihu decoction originate from Triple energizer,but transpire Yin and Yang,and throughout the body. In the clinic,reconciliation method is used to treat syndrome of Chaihu decoction,but its modern mechanism remains unknown. The present study was conducted to demonstrate the correlation between ＂Shaoyang resembling a pivot＂dysfunction and pathogenesis of IgA nephropathy. It is concluded that the increase of abnormal glycosylation of IgA1 and the decrease of abnormal glycosylated IgA1 in the peripheral blood B cells and intestinal mucosa are the key to IgA nephropathy. The above three were closely related with the liver and intestine,but also involved in Shaoyang and Triple energizer function. Therefore,from the above point of view,further study is needed to ascertain how＂Shaoyang resembling a pivot＂dysfunction leads to IgAN and＂reconciliation＂treatment of IgAN efficacy mechanism.