从浊毒病机理论探讨糖尿病肾病

A study on diabetic nephropathy based on the theory of the pathogenesis of turbid toxin

糖尿病肾病是糖尿病常见并发症之一,其发病率随着糖尿病患者老龄化的加重呈逐年上升的趋势,不仅给患者带来极大的经济压力,还严重危害患者的生命健康。糖尿病肾病的发生与血糖代谢紊乱引起的肾小球内高灌注、高滤过相关,最终肾小球基底膜增厚,系膜扩张以及胞外基质增生,从而出现蛋白尿和血肌酐升高。浊毒是各种疾病过程中所产生的病理产物,包括高血糖、高血脂、高尿酸和尿蛋白等,具有秽浊黏滞、胶着难解的特点。浊毒内蕴作为2型糖尿病的病机关键这一观点正在受到越来越多的的关注。研究认为浊毒作为糖尿病的病理产物,也是糖尿病肾病发病的启动因素,浊毒贯穿于糖尿病肾病的发生发展。糖尿病肾病早期以尿蛋白升高引起的泡沫尿为主,其证型表现为气虚浊毒或痰湿浊毒;中期以低蛋白血症引起的双下肢浮肿为主要表现,其证型常表现为痰结浊毒;到了晚期,长期低蛋白血症引起全身器官功能失代偿,从而表现出不同症状,其证型常表现为血瘀浊毒、正虚浊毒等。治疗上不能单纯划分为早期、中期、晚期,化浊解毒应作为治疗原则,灵活运用,湿浊重者应辅以芳香化浊,浊毒蕴结应辅以清热解毒,瘀血阻络者宜重视活血祛瘀,正气不足者当扶正固本。

Diabetic nephropathy is one of the common complications of diabetes,and its incidence is increasing year by year with the aggravation of aging of diabetic patients,which not only brings great economic pressure to patients,but also seriously endangers their life and health.The occurrence of diabetic nephropathy is associated with glomerular hyperperfusion and hyperfiltration caused by blood glucose metabolism disorder,resulting in glomerular basement membrane thickening,mesangial dilation,and extracellular matrix hyperplasia,which causes increased albuminuria and serum creatinine.Turbid toxin is the pathological product produced in the course of various diseases,including hyperglycemia,hyperlipids,hyperuric acid and urinary protein,etc.,with the characteristics of turbidness,viscosity,glue and insoluble.More and more attention has been paid to the idea that internal turbid toxin is the key pathogenesis of type 2 diabetes.This paper holds that turbid toxin,as the pathological product of diabetes,is also the initiating factor of diabetic nephropathy,and that turbid toxin runs through the occurrence and development of diabetic nephropathy.In the early stage of diabetic nephropathy,foaming urine caused by elevated urinary protein is the main symptom,and its syndrome type is Qi(虚)deficiency and turbid toxin or phlegm-dampness-turbid toxin.In the middle stage,edema of both lower limbs caused by hypoproteinemia is the main manifestation,and the syndrome type is often phlegm turbidiosis.In the late stage,chronic hypoproteinemia causes systemic organ function decompensation,which presents different symptoms,and the syndrome types are often manifested as toxin such as blood stasis and deficient healthy Qi(气).Treatment can not be completely divided into early,middle and late period,but turbidification and detoxification should be taken as the treatment principle flexibly.For those with heavy wet turbid,the method of eliminating dampness with aromatics should be supplemented,for those with turbid accumulation,the clearing heat and removing toxicity method should be supplemented,for those with blood stasis blocking meridians,attention should be paid to promoting blood circulation and removing blood stasis,for those with deficient healthy Qi,the method of strengthening and consolidating body resistance should be used peripherally.