[1]常 悦,白云绮,严嘉欣,等.从肾小球系膜与膜原联系探讨IgA肾病病机与证治[J].陕西中医,2025,46(5):651-655.[doi:DOI:10.3969/j.issn.1000-7369.2025.05.016]
　CHANG Yue,BAI Yunqi,CHEN Zhenjie,et al.Integrating the glomerular mesangium and Mo Yuan theory for the management of IgA nephropathy[J].,2025,46(5):651-655.[doi:DOI:10.3969/j.issn.1000-7369.2025.05.016]
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从肾小球系膜与膜原联系探讨IgA肾病病机与证治
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《陕西中医》[ISSN:1000-7369/CN:61-1281/TN]

卷:
46
期数:
2025年5期
页码:
651-655
栏目:
学术探讨
出版日期:
2025-05-05

文章信息/Info

Title:
Integrating the glomerular mesangium and Mo Yuan theory for the management of IgA nephropathy
作者:
常 悦1; 2; 白云绮1; 2; 严嘉欣 1; 2; 陈振杰1; 周静威1
(1.北京中医药大学东直门医院肾病科,北京 100070; 2.北京中医药大学,北京 100029)
Author(s):
CHANG Yue1; 2; BAI Yunqi1; 2; CHEN Zhenjie1; ZHOU Jingwei1
(1.Dongzhimen Hospital,Beijing University of Chinese Medicine Department of Nephrology,Beijing 100070,China; 2.Beijing University of Chinese Medicine,Beijing 100029,China)
关键词:
IgA肾病;  膜原理论;  伏邪理论;  肾小球系膜;  肾脏微观病理
Keywords:
IgA nephropathy;  Mo Yuan theory;  Fu Xie theory;  Glomerular mesangium;  Renal microscopic pathology
分类号:
R 592.31
DOI:
DOI:10.3969/j.issn.1000-7369.2025.05.016
文献标志码:
A
摘要:
IgA肾病的主要病理特征为肾小球系膜增生伴IgA为主的免疫复合物沉积,最近的研究表明黏膜免疫尤其是肠道黏膜免疫在IgA肾病的发生发展中起到关键作用。在现代膜原理论中,黏膜免疫屏障可归入广义膜原的范畴。本文立论于在中医视角下人体膜系的整体性,以中医“象思维”视角将肾小球系膜抽象为人体微观之膜原,从IgA肾病中微观膜原与宏观膜原的联系的角度,尝试提出了IgA肾病宏观膜原与微观膜原共病,肾络与肾中膜原相互影响的病机特点,并尝试针对这一特点论治IgA肾病。
Abstract:
IgA nephropathy is characterized primarily by mesangial proliferation of glomeruli and the deposition of immune complexes predominantly composed of IgA.Recent studies have indicated that mucosal immunity,particularly within the gastrointestinal tract,plays a pivotal role in the initiation and progression of IgA nephropathy.In the modern “Mo Yuan” theory,mucosal immune barriers can be considered part of the broader concept of “Mo Yuan”.This paper posits that,from the perspective of traditional Chinese medicine(TCM),the integrity of the human body's membrane system is holistic.Employing the “image thinking” of TCM,the mesangium of the glomerulus is abstracted as the micro-scale “Mo Yuan” within the human body.The paper explores the relationship between the micro-scale and macro-scale “Mo Yuan” in IgA nephropathy,attempting to propose a pathogenic characteristic where the macro-scale “Mo Yuan” and micro-scale “Mo Yuan” coexist,and the renal vessels and the renal “Mo Yuan” mutually influence each other.Furthermore,the paper endeavors to discuss the treatment of IgA nephropathy based on this characteristic.

参考文献/References:

[1] WANG F,YANG C,LONG J,et al.Executive summary for the 2015 Annual Data Report of the China Kidney Disease Network(CK-NET)[J].Kidney Int,2019,95:501-505.
[2] PATTRAPORNPISUT P,AVILA-CASADO C,REICH H N.IgA nephropathy:Core curriculum 2021[J].Am J Kidney Dis,2021,78(3):429-441.
[3] 王永钧.论肾风病的现代观[J].中国中西医结合肾病杂志,2015,16(2):95-98.
[4] 马雪颜,秦雪颖,谷晓红.膜系理论探讨[J].北京中医药大学学报,2023,46(7):931-936.
[5] 王昭博,李家伦,王佳,等.象思维视角下仝小林“糖络病”核心防治策略分析[J].长春中医药大学学报,2024,40(10):1070-1074.
[6] 黄小原,翟双庆.论膜原为周身之间隙[J].中医杂志,2023,64(4):422-424.
[7] 陈鸿森,赵钟文.从三焦膜原论治痹证探讨[J].风湿病与关节炎,2020,9(1):46-47,66.
[8] 陈琪,周静威,陈振杰,等.基于伏邪温病理论探讨IgA肾病中的黏膜免疫机制[J].中医学报,2022,37(12):2525-2529.
[9] 寇富舜,程媛,丁庞华,等.基于“邪伏膜原”理论探讨溃疡性结肠炎炎癌转化的机制及论治[J].中国中西医结合消化杂志,2022,30(2):155-158.
[10] AVRAHAM S,KORIN B,CHUNG J,et al.The Mesangial cell-the glomerular stromal cell[J].Nat Rev Nephrol,2021,17(12):855-864.
[11] SCHLONDORFF D,BANAS B.The mesangial cell revisited:No cell is an island[J].J Am Soc Nephrol,2009,20(6):1179-1187.
[12] 崔佳旗,张书与,韩雅乐,等.基于膜系理论探究疫病的防治[J].中华中医药杂志,2023,38(10):4557-4561.
[13] COPPO R.The intestine-renal connection in IgA nephropathy[J].Nephrol Dial Transplant,2015,30(3):360-366.
[14] JHEE J H,NAM B Y,PARK J T,et al.CD71 mesangial IgA1 receptor and the progression of IgA nephropathy[J].Transl Res,2021,230:34-43.
[15] LAFAYETTE R,KRISTENSEN J,STONE A,et al.Efficacy and safety of a targeted-release formulation of budesonide in patients with primary IgA nephropathy(NefIgArd):2-year results from a randomised phase 3 trial[J].Lancet,2023,402(10405):859-870.
[16] 王永钧.IgAN肾病理的中医微观辨证[J].中国中西医结合肾病杂志,2011,12(2):95-98.
[17] 仝小林,刘文科,田佳星.论脏腑风湿[J].中医杂志,2013,54(7):547-550.
[18] 杨映映,邸莎,顾勤,等.基于“脏腑风湿”论治消化性溃疡——仝小林教授治疗消化性溃疡的新视角[J].中华中医药学刊,2019,37(2):343-346.
[19] 刘玉宁.从肾络微型募原理论探讨肾小球疾病的治疗思路与方法[J].中国中西医结合肾病杂志,2024,25(5):377-380.
[20] ROVIN B H,ADLER S G,BARRATT J,et al.Executive summary of the KDIGO 2021 guideline for the management of glomerular diseases[J].Kidney Int,2021,100(4):753-779.
[21] 王耀献.从肾脏“个性”谈肾脏病的治疗思路[J].中国中西医结合肾病杂志,2023,24(3):189-192.
[22] 毛加荣,刘稳,芮宏亮,等.IgA肾病107例中医证型与临床、病理及实验室检查相关性分析[J].陕西中医,2023,44(9):1231-1236.
[23] 史业骞,初杰.浅谈象思维在认识中药功效方面的应用[J].中华中医药杂志,2015,30(4):1163-1165.
[24] 申玥,王耀献,周静威,等.基于“肠道伏风”论治免疫球蛋白A肾病[J].环球中医药,2021,14(12):2197-2200.
[25] 沈晓琼,姜嫄嫄,沈存,等.赵文景教授运用中医药治疗IgA肾病经验撷英[J].四川中医,2023,41(8):13-17.
[26] 殷敏,钟逸斐,邓跃毅.陈以平教授中西医结合治疗中重症IgA肾病经验[J].中国中西医结合肾病杂志,2009,10(1):8-10.
[27] 须冰,卢嫣,刘育军,等.黏膜方治疗IgA肾病的临床研究[J].上海中医药杂志,2009,43(10):17-18,23.
[28] 卢嫣,韩世盛,王怡.黏膜方对IgA肾病大鼠异常糖基化IgA1及肾间质纤维化的干预及机制研究[J].中国中西医结合肾病杂志,2013,14(5):392-395,472-473.
[29] 马玉芝,曾铁鑫,吴佩玲,等.基于GC-MS和网络药理学的5种柴胡挥发油比较研究[J].中国现代中药,2024,26(8):1366-1373.
[30] WANG Y,GAN T,QU S,et al.MTMR3 risk alleles enhance Toll like receptor 9-induced IgA immunity in IgA nephropathy[J].Kidney Int,2023,104(3):562-576.
[31] WAN R J,LI Y H.Effects of Artesunate prevent nephritis via the Tolllike receptor 4/nuclear factor kappaB signaling pathway in rats[J].Mol Med Rep,2017,16(5):6389-6395.
[32] CHEN Q,WANG Z,LV J,et al.Efficacy and safety of artesunate for patients with IgA nephropathy:A study protocol for a multicenter,double-blind,randomized,placebo-controlled trial[J].Trials,2022,23(1):444.
[33] 陈珑,朱泓,孙伟.朱良春教授治疗慢性肾小球肾炎经验撷菁[J].中西医结合心血管病电子杂志,2017,5(25):34-35.
[34] 田卫卫,魏燕.仝小林教授运用穿山龙经验[J].吉林中医药,2020,40(5):589-592.
[35] 司远.穿山龙总皂苷调控外泌体中TGFβ1抑制系膜细胞增殖减轻肾脏纤维化的作用机制研究[D].北京:中国中医科学院,2019.
[36] 苏奔,金妙文,李柳,等.国医大师周仲瑛运用藤类中药之经验[J].江苏中医药,2024,56(10):6-9.
[37] 赵隽永,刘虹.雷公藤制剂治疗IgA肾病的作用机制[J].中南大学学报(医学版),2022,47(5):573-582.
[38] 王怡杨,韩阳,何学志,等.张宗礼运用僵蚕、蝉蜕治疗顽固性蛋白尿经验[J].湖南中医杂志,2016,32(10):34-36.
[39] 顾威,蒋宏.芪蛭地龙汤对慢性肾衰竭患者微炎症状态的影响[J].现代中西医结合杂志,2021,30(20):2239-2242.
[40] 任现志,汪受传,翟文生.水蛭治疗系膜增生性肾小球肾炎的探讨[J].辽宁中医杂志,2005,32(3):244-245.

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备注/Memo

备注/Memo:
[基金项目]国家自然科学基金资助面上项目(81874401); 中央高校基本科研业务费专项资金资助项目(2020-JYB-ZDGG-118)
更新日期/Last Update: 2025-05-08