膜性肾病的中医药诊疗研究进展

Research progress of traditional Chinese medicine diagnosis and treatment of membranous nephropathy

膜性肾病(MN)是肾病综合征常见病理类型之一,病程长且病情迁延难愈,根据不同的发病原因将其分为特发性膜性肾病(IMN)和继发性膜性肾病(SMN)。其中SMN多继发于肿瘤、感染、药物、自身免疫疾病等。MN为病理诊断病名,中医古籍对于MN没有明确记载,可归于"关格"、"水肿"、"尿浊"、"虚劳"等范畴。西医对于MN的治疗多选择激素、免疫抑制剂等,同时也会产生相关的药物不良反应。中医各家均认为MN的基本病机为本虚标实,治疗原则在扶正基础上,又形成各家学术观点,如从瘀论治、从情志论治、从络论治、从毒论治、从水论治等。通过检索近些年的相关文献,本文从各家临床经验、临床观察研究、中医药基础研究三方面对近几年来关于MN的诊疗及研究进展进行综述,旨在讨论中医药对于MN的治疗有效性、安全性以及降低西药不良反应等方面的优势,为临床治疗MN提供新的思路。

Membranous nephropathy(MN)is one of the common pathological types of nephrotic syndrome.The course of the disease is long and the condition is persistent and difficult to heal. According to the different causes of the disease,it can be divided into idiopathic membranous nephropathy(IMN) and secondary membranous nephropathy(SMN), among which, SMN is mainly secondary to tumors,infections,drugs,autoimmune diseases and other diseases. MN is the name of pathological diagnosis.There is no clear record of MN in ancient books of Traditional Chinese medicine,which can be attributed to the categories of "Guange", "edema", "turbid urine",and "consumptive disease". For the treatment of MN,Western medicine mostly selects hormones,immunosuppressants,etc.,and will also cause related adverse drug reactions. Traditional Chinese medicine experts all believe that the basic pathogenesis of MN is based on deficiency in origin and excess in superficiality,and the principle of treatment is based on strengthening vital qi,and various academic viewpoints have been formed,such as treatment from static blood,emotions,meridian,toxin,fluid retention,etc. By searching the relevant literature in recent years,from three parts of clinical experience,clinical observation and research,and basic research of traditional Chinese medicine,this article summarizes the diagnosis and treatment and research progress of MN in recent years. The purpose is to discuss the effectiveness and safety of traditional Chinese medicine for the treatment of MN,as well as the advantages of reducing the adverse reaction of western medicine,and provide new ideas for clinical treatment of MN.