基于肠道菌群及脂质代谢探讨慢性肾脏病微炎症状态“湿瘀互结”的病机内涵

Pathogenesis Connotation of"Dampness Stasis Conglutination"in Microinflammatory State of Chronic Kidney Disease from Perspective of Intestinal Microbiota and Lipid Metabolism

慢性肾脏病(chronic kidney disease,CKD)微炎症状态发生发展常伴随肠道菌群紊乱与脂质代谢的异常,肠道菌群紊乱与中医痰湿证密切相关,肠道菌群平衡是脾肾运化水液功能的基本前提,CKD患者肠道菌群失调,肠道屏障功能受损,脾肾运化水液功能失职,脾失健运,水湿内停,是中医痰湿证的生物学基础,亦是导致CKD患者炎症因子增加、免疫系统紊乱的重要病理机制。CKD患者常涉及全身和局部的脂质代谢异常,影响机体免疫、循环、内分泌等多个系统的功能,与血瘀证致病范围广泛,症状多变的特点相合,脂质代谢异常可能为血瘀证的微观表现。故“肠道菌群-脂质代谢”互作失调引发免疫微环境异常的病理过程与“湿瘀互结”中医病机契合。祛湿化瘀药物有较好的广谱抗菌消炎作用,可以降低炎症区毛细血管的通透性,减少炎症渗出,并能改善肾脏微循环、调节机体代谢及免疫功能。

The occurrence and development of micro-inflammatory state of chronic kidney disease(CKD)is often accompanied by intestinal microflora disorder and abnormal lipid metabolism,and intestinal microbiota disorder is closely related to the"Phlegm-Dampness syndrome"in traditional Chinese medicine.The balance of intestinal flora is the basic premise of the function of Spleen and Kidney in transporting Water and Fluid.In patients with CKD,when there is an intestinal flora imbalance and the intestinal barrier function is impaired,the function of the Spleen and Kidney in transporting Water and Fluid is injured,which means that the Spleen is not healthy,and Water is stagnated.This is the biological basis of phlegm-dampness syndrome in traditional Chinese medicine and it is also an important pathological mechanism that leads to the increase of inflammatory factors and immune system disorders in CKD patients.Patients with CKD often involve systemic and local lipid metabolism abnormalities,affecting the functions of the body′s immune,circulatory,endocrine and other systems,which is consistent with the characteristics of blood stasis syndrome,which has a wide range of pathogenic pathologies and variable symptoms,and abnormal lipid metabolism may be a microscopic manifestation of"blood stasis syndrome".Therefore,the pathological process of abnormal immune microenvironment caused by the interaction dysregulation of"intestinal microbiota-lipid metabolism"is consistent with the pathogenesis of"Dampness stasis conglutination"in TCM.Drugs that relieve Dampness and stasis have good broad-spectrum antibacterial and anti-inflammatory effect and can reduce the permeability of capillaries in the inflammatory area,reduce the exudation of inflammation,improve renal microcirculation,and regulate the body′s metabolism and immune function.