基于“肾主骨”理论探讨慢性肾脏病及骨代谢紊乱的发病机制

Discussion on the pathogenesis of chronic kidney disease and bone metabolism disorders based on the theory of the kidney controlling the bone

慢性肾脏病矿物质和骨代谢紊乱(Chronic Kidney Disease-Mineral and Bone Metabolism Disorder,CKD-MBD)是指由慢性肾功能不全所引起的矿物质病理改变、骨骼和激素变化等。这类疾病是透析患者的典型并发症之一,严重影响患者的生活质量,住院率和骨折风险比正常人高许多。“肾主骨”是指肾精生髓而充养骨的功能,这是中医最重要的理论之一,几千年来一直被有效地用于指导临床实践。CKD-MBD的发病机制复杂,与钙磷代谢紊乱、甲状旁腺激素(Parathyroid Hormone,PTH)、成纤维细胞生长因子23(Fibroblast Growth Factor 23,FGF23)、Klotho蛋白、Wnt信号通路等因素相关。文章基于中医“肾主骨”理论探讨CKD-MBD的发病机制。

Chronic kidney disease-mineral and bone metabolism disorder(CKD-MBD) refers to one of the important complications of chronic renal insufficiency, especially in dialysis patients. The mineral pathological changes, bone and hormone changes caused by CKD-MBD seriously affect the life quality. “The theory of the kidney controuing the bone” refers to the kidney function of generating marrow and filling bone, which is one of the most important theories in TCM. It has been effectively used as a clinical practice guide for thousands of years. The pathogenesis of CKD-MBD is complex, and is related to calcium and phosphorus metabolism disorders, paruthyroid hormone, hyperparathyroidism, fibroblast growth factor 23, Klotho protein, Wnt signal pathway and other foctors. This artcle discusses pathogenesis of CKD-MBD based on the theory of the kidney controlling the bone in TCM.