肺肾同治法治疗IgA 肾病

高向峰 1，2，饶向荣 2，李深2，成庭柱 1，2，方吕贵 3，王秀娟 3

1.北京中医药大学，北京 100029；2.中国中医科学院广安门医院，北京 100053；

3.中国中医科学院广安门医院南区，北京 102618

摘要：目前，我国 IgA 肾病（IgA nephropathy，IgAN）占肾活检病例 40%～50%，其中 50%患者会进展至终末期肾病。中医认为，“本虚标实”是 IgAN 主要病机。先天禀赋不足，饮食内伤，导致肺气失宣，卫外不固，外邪内侵，内归于肾，终致IgAN发生。据此，本文提出肺肾同治的思路：①益肺气以固护卫表，溯本清源；②宣肺气以祛风清解，阻邪内扰；③利肾邪以澄流复旧。以此既对疾病上游黏膜免疫，又针对下游肾脏免疫炎性反应，进行系统干预，可奏溯本清源、澄流复旧之功。

关键词：肺肾同治；IgA肾病

中图分类号：R272.969.26 文献标识码：A

DOI：10.3969/j.issn.1005-5304.201907456

Treatment of IgA Nephropathy with Simultaneously Treating Lung-kidney Therapy

GAO Xiangfeng1,2, RAO Xiangrong2, LI Shen2, CHENG Tingzhu1,2, FANG Lügui3, WANG Xiujuan3

1. Beijing University of Chinese Medicine, Beijing 100029, China; 2. Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China; 3. Southern District of Guang'anmen Hospital, China Academy of

Chinese Medical Sciences, Beijing 102618, China

Abstract: At present, IgA nephropathy (IgAN) accounts for 40%–50% of renal biopsy cases in China, and 50% of them will progress to end-stage renal disease. TCM believes that the main pathogenesis of IgAN is “deficiency of origin and excess of symptoms”. Inadequate innate endowment and dietary injury lead to loss of lung qi, incomplete external defense, invasion of external pathogens and internal attribution to kidney, which ultimately lead to the occurrence of IgAN. In view of the above, this article put forward the idea of simultaneously treating lung and kidney:Benefiting lung qi to invigorate qi for strengthening superficies, tracing back to the source; Promoting the dispersing function of the lung to dispel wind and clear away evil and internal disturbance; Benefiting kidney to recover. In this way, we can not only immunize the upstream mucosa of the disease, but also intervene systemically in the immuno-inflammatory reaction of the downstream kidney, so as to trace the origin of the disease and recover the disease.

Keywords: simultaneously treating lung and kidney; IgA nephropathy

IgA 肾病（IgA nephropathy，IgAN）是 IgA 为主的免疫复合物沉积于肾小球系膜区的原发性肾小球疾病。有资料显示，我国肾活检病例中IgAN 占 40%～ 50%[1]。IgAN 发病机制复杂，迄今尚未完全阐明，“多重打击”学说目前被广泛接受，即基因、个体与环境因素的相互作用使血清中异常糖基化 IgA1 （galactose-deficient IgA1，Gd-IgA1）增多，特异性抗 Gd-IgA1 自身抗体产生，自身抗体与 Gd-IgA1 结合

基金项目：国家自然科学基金（81973675）；北京市科学技术

委员会首都临床特色应用研究（Z181100001718123）

通讯作者：王秀娟，E-mail：xiuxiu_584843252@126.com

文章编号：1005-5304(2020)03-0118-04开放科学（资源服务）标识码（OSID）：形成免疫复合物，以及免疫复合物沉积于肾小球系膜

区，触发炎症反应，激活补体，造成肾脏损伤[2]。循环中 Gd-IgA1 增多是导致 IgAN 发病的关键环节[3]。近年研究表明，高达 50%的 IgAN 患者 20～25 年内

可进展至终末期肾病[4]。笔者认为，“肺肾同治”作为中医辨治 IgAN 的重要思想，与现代医学对 IgAN 发病机制的认识相吻合，在 IgAN 的治疗上有重要的理论指导与实践意义。兹阐述如下。

中医对 肾病的认识

病因

先天禀赋不足《类经》有“夫禀赋为胎元之本，精气之受于父