从“脾为之卫”探讨IgA肾病的黏膜免疫机制

Mucosal Immune Mechanism of IgA Nephropathy fromPerspective of "Spleen Acting as Guard"

IgA肾病是临床常见的原发性肾小球疾病,黏膜免疫是其发病机制研究的热点及新方向。“脾为之卫”经历代医家完善、继承及发展,成为中医学独特的理论,是对脾主运化、脾主升清所发挥的保卫机体、抗病祛邪功能的高度概括,亦是现代医学黏膜免疫功能的体现,可作为连接IgA肾病与黏膜免疫的桥梁。若脾虚致脾失之卫,则表现为肠黏膜机械屏障损伤、肠道菌群失调、肠道代谢失常,细菌等有害物质可刺激机体炎症反应,参与IgA1的产生及其半乳糖基化异常,导致IgA肾病。由此观之,“脾失之卫”与IgA肾病的黏膜免疫机制密切相关。

IgA nephropathy is a common primary glomerular disease in clinical practice,and mucosal immunity is a hot topic and new direction in its pathogenesis research.The theory that"Spleen acting as guard"has been perfected,inherited and developed by generations of medical experts,becoming a unique theory in traditional Chinese medicine.It highly summarizes the functions of the Spleen,which is responsible for digestion,nutrition transmission and clear essence dispersing,in protecting the body,resisting disease,eliminating evil factors as well as reflecting the mucosal immune function of modern medicine.It can serve as a bridge connecting IgA nephropathy and mucosal immunity.If Spleen deficiency leads to its dysfunction in protection,it is manifested as damage to the intestinal mucosal mechanical barrier,imbalance of intestinal flora,and abnormal intestinal metabolism.Harmful substances such as bacteria can stimulate the body′s inflammatory response,participate in the production of IgA1 and abnormal galactosylation,leading to IgA nephropathy.Therefore,the loss of Spleen′s protection function is closely related to the mucosal immune mechanism of IgA nephropathy.