慢性肾小球肾炎病理与中医辨证相关性的研究
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摘要
慢性肾小球肾炎,以血尿、蛋白尿、水肿、高血压为主要临床表现,起病隐匿,病程迁延,病理类型繁杂,不同的病理改变决定了不同的预后,大部分患者进展为慢性肾衰竭。中医药治疗本病具有显著的优势,尤其在改善临床症状、减少并抑制病情复发、降低药物不良反应、提高机体免疫功能等方面具有不可取代的作用。慢性肾小球肾炎属于中医学"尿血""水肿""虚劳"等病的范畴,中医治疗大都采用宏观的辨证论治。但随着精准医疗战略的提出,如何实现慢性肾小球肾炎中医宏观辨证与微观辨证相结合,既体现治疗的个体化,又便于临床科研的开展,笔者根据近几年国内学者对慢性肾炎病理分型与中医宏观辨证的认识,结合我院临床观察,探讨了慢性肾炎中医辨证论治与肾脏病理的关系,旨在进一步提高临床疗效,为慢性肾炎的科学研究奠定基础。
Chronic glomerulonephritis, hematuria, proteinuria, edema, high blood pressure as the main clinical manifestation of onset conceals, course deferment, pathological types and complex, different pathological changes, determines the different outcomes, the majority of patients progression to chronic renal failure. Traditional Chinese medicine in the treatment of the disease has significant advantages, especially in improving the clinical symptoms, reducing and restraining relapse and reducing adverse drug reactions and improving the body's immune function has the effect that cannot replace. Chronic glomerular nephritis belongs to the traditional Chinese medicine " traces", " edema", " consumptive disease" category, syndrome differentiation and treatment of TCM treatment mostly uses the macro syndrome differentiation. But as precise medical strategy is put forward, how to realize the chronic glomerulonephritis macroscopic syndrome and microcosmic syndrome differentiation of traditional Chinese medicine, the combination of both reflect the individualized treatment, and facilitate the development of clinical scientific research, the author according to the domestic scholars in recent years for chronic nephritis pathological classification and the understanding of the macroscopic syndrome differentiation of traditional Chinese medicine, combined with our clinical observation, this paper discussed the chronic nephritis syndrome differentiation of traditional Chinese medicine's relationship with renal pathology, aimed to further improve the clinical curative effect and laid a foundation for the scientific research of chronic nephritis.
Chronic glomerulonephritis, hematuria, proteinuria, edema, high blood pressure as the main clinical manifestation of onset conceals, course deferment, pathological types and complex, different pathological changes, determines the different outcomes, the majority of patients progression to chronic renal failure. Traditional Chinese medicine in the treatment of the disease has significant advantages, especially in improving the clinical symptoms, reducing and restraining relapse and reducing adverse drug reactions and improving the body's immune function has the effect that cannot replace. Chronic glomerular nephritis belongs to the traditional Chinese medicine " traces", " edema", " consumptive disease" category, syndrome differentiation and treatment of TCM treatment mostly uses the macro syndrome differentiation. But as precise medical strategy is put forward, how to realize the chronic glomerulonephritis macroscopic syndrome and microcosmic syndrome differentiation of traditional Chinese medicine, the combination of both reflect the individualized treatment, and facilitate the development of clinical scientific research, the author according to the domestic scholars in recent years for chronic nephritis pathological classification and the understanding of the macroscopic syndrome differentiation of traditional Chinese medicine, combined with our clinical observation, this paper discussed the chronic nephritis syndrome differentiation of traditional Chinese medicine's relationship with renal pathology, aimed to further improve the clinical curative effect and laid a foundation for the scientific research of chronic nephritis.
引文
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[18]蔡忠钦,钟日荣,陈军林,等.78例小儿原发性肾小球疾病的中医辨证与临床病理关系的研究[J].中医杂志,2000,41(3):169-170.
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[20]袁斌,刘光陵,孙轶秋,等.368例小儿肾病肾活检病理与中医辨证关系探讨[J].辽宁中医杂志,2007,34(9):1223-1224.
[21]王吉耀.内科学[M].北京:人民卫生出版社,2004:575-577.
[2]王海燕.肾脏病临床概览[M].北京:北京大学医学出版社,2009:141.
[3]陈香美,邓跃毅,谢院生.Ig A肾病西医诊断和中医辨证分型的实践指南[J].中国中西医结合杂志,2013,33(5):583-585.
[4]车妙琳,汤璐敏,车琳,等.Ig A肾病中医辨证与牛津病理关系108例临床分析[J].疑难病杂志,2015,14(5):476-479.
[5]李现成,马浩,程小红.46例Ig A肾病患者肾脏病理表现与中医辨证分型的相关性研究[J].天津中医药,2011,28(1):22-23.
[6]仲昱,王钢,邹燕勤.Ig A肾病中医辨证分型与病理类型的相关性分析[J].中医杂志,2003,44(11):854-856.
[7]陈贤峰.Ig A肾病中医辨证与肾组织病理的关系探讨[J].浙江中西医结合杂志,2010,20(3):156-157.
[8]赵著华,万廷信,姜敏,等.Ig A肾病证候分型与肾脏免疫沉积物相关性分析[J].中医药学报,2012,40(3):71-73.
[9]李靖,王硕仁,徐冰,等.基于关联规则的Ig A肾病中医证候与病理相关性的探讨[J].北京中医药,2011,30(9):653-655.
[10]孙瑞涛,王丹.王铁良教授治疗系膜增生性肾小球肾炎摭拾[J].中医药学刊,2003,21(11):1801-1802.
[11]王立新,侯海晶,杨恩恩,等.肾穿刺活检病例的临床、病理分型及与中医证候相关性分析[J].广州中医药大学学报,2012,29(5):505-510.
[12]袁发焕,蔡奇玲,张璟,等.非Ig A系膜增生性肾小球肾炎中医辨证与临床疗效分析[J].西部医学,2009,21(3):393-395.
[13]范军芬,张史昭,郑慧文.IL-13在原发性系膜增生性肾小球肾炎的表达及与中医辨证分型的相关性[J].浙江中医药大学学报,2013,37(3):269-271.
[14]徐大基.原发性肾小球疾病病理类型与中医证型分析[J].福建中医药,1999(1):21-22.
[15]黎民安,卓丽,须冰,等.特发性膜性肾病中医证型与临床相关因素分析[J].上海中医药杂志,2014,48(10):7-9,12.
[16]俞东容,胡云琴,王永钧.28例膜性肾病患者的临床与病理分析[J].浙江医学,2001,23(12):732-734.
[17]毛加荣,刘建红,程小红.101例膜性肾病中医症候与病理分析[J].陕西中医,2012,33(10):1330-1331.
[18]蔡忠钦,钟日荣,陈军林,等.78例小儿原发性肾小球疾病的中医辨证与临床病理关系的研究[J].中医杂志,2000,41(3):169-170.
[19]任艳芸,孙万森,赵艳龙.慢性肾脏病病理类型与证候类型相关性的循证探讨[J].辽宁中医杂志,2009,36(7):1118-1120.
[20]袁斌,刘光陵,孙轶秋,等.368例小儿肾病肾活检病理与中医辨证关系探讨[J].辽宁中医杂志,2007,34(9):1223-1224.
[21]王吉耀.内科学[M].北京:人民卫生出版社,2004:575-577.