1.北京中医药大学东直门医院,北京市东城区海运仓5号,100700
2.北京中医药大学
3.河南中医药大学
wyx3203@sina.com
收稿:2024-06-24,
修回:2024-11-12,
纸质出版:2025-03-17
移动端阅览
孙卫卫,陈荟溪,胡聿昕等.糖尿病肾脏疾病辨治的难点和临床治疗模式[J].中医杂志,2025,66(06):569-574.
SUN Weiwei,CHEN Huixi,HU Yuxin,et al.Difficulties in the Differentiation and Treatment of Diabetic Kidney Disease and Its Clinical Treatment Model[J].Journal of Traditional Chinese Medicine,2025,66(06):569-574.
孙卫卫,陈荟溪,胡聿昕等.糖尿病肾脏疾病辨治的难点和临床治疗模式[J].中医杂志,2025,66(06):569-574. DOI: 10.13288/j.11-2166/r.2025.06.005.
SUN Weiwei,CHEN Huixi,HU Yuxin,et al.Difficulties in the Differentiation and Treatment of Diabetic Kidney Disease and Its Clinical Treatment Model[J].Journal of Traditional Chinese Medicine,2025,66(06):569-574. DOI: 10.13288/j.11-2166/r.2025.06.005.
糖尿病肾脏疾病(DKD)是引起慢性肾脏病的主要原因之一,中西医在防治DKD方面各有优势,但也存在诸多难点。通过梳理中西医辨治DKD面临的难点,在“肾络微型癥瘕”学说基础上,结合长期临床实践,提出“内热致癥”为DKD核心病机,并基于核心病机构建了DKD“病-证-症”三位一体辨治模式,病、证、症三者是在不同角度对疾病本质的反映,该模式突出了“内热致癥”的核心病机地位。希冀规范DKD的全程治疗,启迪临床。
Diabetic kidney disease (DKD) is one of the main causes of chronic kidney disease. Both traditional Chinese medicine (TCM) and western medicine have their own advantages in the prevention and treatment of DKD, but there are also many difficulties. By analysis of the difficulties faced by TCM and western medicine in the differentiation and treatment of DKD, based on the theory of "miniature masses in the renal collaterals", combined with long-term clinical practice, "internal heat leading to mass" is proposed as the core pathogenesis of DKD. Therefore, a trinity model of "disease-syndrome-symptom" for differentiation and treatment of DKD based on the core pathogenesis has been proposed. This model highlights the status of the core pathogenesis of "internal heat leading to mass" in DKD, and conducts a three-dimensional identification from the perspectives of disease, syndrome and symptom, so as to inspire clinical practice.
LI KX , JI MJ , SUN HJ . An updated pharmacological insight of resveratrol in the treatment of diabetic nephropathy [J]. Gene , 2021 , 780 : 145532 . doi: 10.1016/j.gene. 2021.145532 http://dx.doi.org/10.1016/j.gene.2021.145532 .
ZHANG XX , KONG J , YUN K . Prevalence of diabetic nephropathy among patients with type 2 diabetes mellitus in China: a meta-analysis of observational studies [J]. J Diabetes Res , 2020 , 2020 : 2315607 . doi: 10.1155/2020/2315607 http://dx.doi.org/10.1155/2020/2315607 .
XIE D , MA T , CUI H , et al . Global burden and influencing factors of chronic kidney disease due to type 2 diabetes in adults aged 20-59 years, 1990-2019 [J]. Sci Rep , 2023 , 13 ( 1 ): 20234 .
王耀献 , 刘尚建 , 付天昊 , 等 . 肾络微型癥瘕三态论探析 [J]. 北京中医药大学学报(中医临床版) , 2010 , 17 ( 3 ): 17 - 18 .
中华医学会肾脏病学分会专家组 . 糖尿病肾脏疾病临床诊疗中国指南 [J]. 中华肾脏病杂志 , 2021 , 37 ( 3 ): 255 - 304 .
魏茂碧 , 吴小燕 . 糖尿病肾病的早期诊断相关指标研究进展 [J]. 武汉大学学报(医学版) , 2023 , 44 ( 3 ): 380 - 386 .
KDOQI . KDOQI Clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease [J]. Am J Kidney Dis , 2007 , 49 (2 Suppl 2 ): S12 - S154 .
朱凤娟 , 罗姣 , 陈晓琼 , 等 . 507例2型糖尿病合并慢性肾脏病患者肾活检的临床病理特点 [J]. 中华肾脏病杂志 , 2020 , 36 ( 3 ): 207 - 213 .
中华医学会糖尿病学分会(CDS) . 国家基层糖尿病肾脏病防治技术指南(2023) [J]. 中华内科杂志 , 2023 , 62 ( 12 ): 1394 - 1405 .
赵乐滢 , 王珍 , 刘晴晴 , 等 . 基于辨机论治探讨伏热在糖尿病肾脏疾病中的作用 [J]. 北京中医药大学学报 , 2024 , 47 ( 4 ): 454 - 458 .
KITTIPIBUL V , COX ZL , CHESDACHAI S , et al . Genitourinary tract infections in patients taking SGLT2 inhibitors: JACC review topic of the week [J]. J Am Coll Cardiol , 2024 , 83 ( 16 ): 1568 - 1578 .
Kidney Disease : Improving Global Outcomes (KDIGO) CKD Work Group . KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease [J]. Kidney Int , 2024 , 105 ( 4S ): S117 - S314 .
BAKRIS GL , AGARWAL R , ANKER SD , et al . Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes [J]. N Engl J Med , 2020 , 383 ( 23 ): 2219 - 2229 .
NAAMAN SC , BAKRIS GL . Diabetic nephropathy: update on pillars of therapy slowing progression [J]. Diabetes Care , 2023 , 46 ( 9 ): 1574 - 1586 .
LEENEN FH , NWACHUKU CE , BLACK HR , et al . Clinical events in high‑risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin‑converting enzyme inhibitor in the antihypertensive and lipid‑lowering treatment to prevent heart attack trial [J]. Hypertension , 2006 , 48 ( 3 ): 374 - 384 .
TANG G , LI S , ZHANG C , et al . Clinical efficacies, underlying mechanisms and molecular targets of Chinese medicines for diabetic nephropathy treatment and management [J]. Acta Pharmaceutica Sinica B , 2021 , 11 ( 9 ): 2749 - 2767 .
张婧 , 王奕祺 , 王耀光 . 师承薛伯寿教授经验以三焦辨证指导糖尿病肾病治疗体会 [J]. 天津中医药 , 2020 , 37 ( 4 ): 398 - 401 .
李次艳 , 李迈 , 杨丽霞 , 等 . 仝小林院士治疗糖尿病并发症的学术思想 [J]. 中医研究 , 2021 , 34 ( 9 ): 67 - 70 .
陈姣伊 , 李佳霖 , 严美花 , 等 . 李平教授诊治糖尿病肾病思路与方法 [J]. 中国中西医结合肾病杂志 , 2017 , 18 ( 6 ): 473 - 474 .
LI P , CHEN Y , LIU J , et al . Efficacy and safety of Tangshen formula on patients with type 2 diabetic kidney disease: a multicenter double-blinded randomized placebo-controlled trial [J]. PLoS One , 2015 , 10 ( 5 ): e0126027 . doi: 10.1371/journal.pone.0126027 http://dx.doi.org/10.1371/journal.pone.0126027 .
谢柯欢 , 张浩军 , 谭睿陟 , 等 . 柴黄益肾颗粒对单侧输尿管梗阻小鼠肾纤维化的作用及其机制 [J]. 解放军医学杂志 , 2024 , 49 ( 7 ): 804 - 813 .
LIU X , GE M , ZHAI X , et al . Traditional Chinese medicine for the treatment of diabetic kidney disease: a study-level pooled analysis of 44 randomized controlled trials [J]. Front Pharmacol , 2022 , 13 : 1009571 . doi: 10.3389/fphar.2022.1009571 http://dx.doi.org/10.3389/fphar.2022.1009571 .
周学平 , 叶放 , 郭立中 , 等 . 以病机为核心构建中医辨证论治新体系:国医大师周仲瑛教授学术思想探讨 [J]. 中医杂志 , 2011 , 52 ( 18 ): 1531 - 1534 .
仝小林 , 周强 , 赵林华 , 等 . 糖尿病肾病的中医辨治经验 [J]. 中华中医药杂志 , 2014 , 29 ( 1 ): 144 - 146 .
张勉之 , 张大宁 . 张大宁治疗糖尿病肾病的临床经验 [J]. 中华中医药杂志 , 2016 , 31 ( 8 ): 3141 - 3143 .
于敏 , 张波 , 史耀勋 , 等 . 南征教授“毒损肾络”理论学说探析及临床运用 [J]. 中华中医药学刊 , 2010 , 28 ( 2 ): 243 - 246 .
王耀献 , 孙卫卫 , 刘伟敬 , 等 . 辨机论治诊疗模式及其临床应用意义 [J]. 中医杂志 , 2021 , 62 ( 23 ): 2025 - 2031 .
孙卫卫 , 滕福斌 , 刘忠杰 , 等 . 王耀献从辨机理论论治糖尿病肾病 [J]. 中华中医药杂志 , 2017 , 32 ( 8 ): 3394 - 3396 .
陈荟溪 , 王耀献 , 郑慧娟 , 等 . 基于“内热致癥”探讨铁死亡在糖尿病肾脏病中的作用机制 [J]. 中国中医药信息杂志 , 2025 , 32 ( 3 ): 24 - 28 .
胡聿昕 , 曹博宁 , 王琳 , 等 . 基于“糖毒”探讨糖尿病肾脏疾病“内热致癥”病机及其辨治思路 [J/OL]. 北京中医药大学学报 .( 2025-02-12 )[ 2025-02-19 ]. http://kns.cnki.net/kcms/detail/11.3574.R.20250211.1752. 004.html http://kns.cnki.net/kcms/detail/11.3574.R.20250211.1752.004.html .
胡聿昕 , 陈晔欣 , 薛泽宇 , 等 . 基于“阳虚三夺统于脾”理论论治Ⅳ型心肾综合征 [J]. 中医杂志 , 2024 , 65 ( 22 ): 2363 - 2367 .
王梦迪 , 崔瑾 , 郑桂敏 , 等 . “病-证-症”三位一体辨治思维模式在临床教学中的运用 [J]. 时珍国医国药 , 2021 , 32 ( 8 ): 2009 - 2010 .
王颖航 , 王耀献 . “三位一体”论治糖尿病肾病 [J]. 中国社区医师(综合版) , 2007 , 9 ( 11 ): 70 .
吴巧茹 , 王耀献 , 王奕萱 , 等 . 清热消瘕方延缓糖尿病肾脏病大鼠肾损伤作用机制 [J]. 现代中西医结合杂志 , 2023 , 32 ( 10 ): 1334 - 1340 .
WU Q , YAN R , YANG H , et al . Qing-Re-Xiao-Zheng-Yi-Qi formula relieves kidney damage and activates mitophagy in diabetic kidney disease [J]. Frontiers in Pharmacology , 2022 , 13 : 992597 . doi: 10.3389/fphar. 2022.992597 http://dx.doi.org/10.3389/fphar.2022.992597 .
YU B , ZHOU M , DONG Z , et al . Integrating network pharmacology and experimental validation to decipher the mechanism of the Chinese herbal prescription modified Shen-Yan-Fang-Shuai formula in treating diabetic nephro-pathy [J]. Pharm Biol , 2023 , 61 ( 1 ): 1222 - 1233 .
高亚斌 , 王耀献 , 杨蕊冰 , 等 . 糖尿病肾脏病早期内热证与非内热证患者肠道菌群及脂多糖的相关性分析 [J]. 中华中医药杂志 , 2022 , 37 ( 3 ): 1735 - 1739 .
高亚斌 , 王耀献 , 郭敬 , 等 .“ 以热为本,以期为纲”论治中期糖尿病肾病 [J]. 中华中医药杂志 , 2019 , 34 ( 12 ): 5723 - 5725 .
田哲菁 , 王耀献 , 韩雪婷 , 等 . 糖尿病肾脏病Ⅴ期阳虚证分布规律及与甲状腺功能相关性分析 [J]. 中国中西医结合肾病杂志 , 2019 , 20 ( 5 ): 434 - 435 .
高亚斌 , 郭敬 , 苗润培 , 等 . 王耀献清热消癥法治疗糖尿病肾病经验 [J]. 北京中医药 , 2020 , 39 ( 2 ): 152 - 154 .
侯金易 , 李垚锬 , 王耀献 , 等 . 基于辨机论治谈对症治疗 [J]. 中医杂志 , 2023 , 64 ( 15 ): 1608 - 1611 .
尹诗卉 , 王耀献 , 郭小乐 , 等 . 基于“藏泄互用”三位一体辨治糖尿病肾脏疾病 [J]. 环球中医药 , 2023 , 16 ( 12 ): 2512 - 2515 .
孙卫卫 , 刘尚建 , 刘忠杰 , 等 . 王耀献教授三位一体论治慢性肾脏病 [J]. 中华中医药杂志 , 2014 , 29 ( 9 ): 2820 - 2822 .
0
浏览量
0
下载量
2
CSCD
关联资源
相关文章
相关作者
相关机构
京公网安备11010102007558号