摘要
狼疮性肾炎在系统性红斑狼疮患者中发病率约为60%,是判断系统性红斑狼疮患者预后的主要指标之一。从疾病进展程度来看,10%~30%的狼疮性肾炎患者会进展为终末期肾脏疾病。现阶段临床上主要应用糖皮质激素联合免疫抑制剂的方法治疗狼疮性肾炎,但该疗法不良反应较大,易出现骨髓抑制、消化道反应等症状,降低患者的生活质量,危及患者的生命健康。临床证据表明,与单独使用激素治疗相比,西医治疗辅以中医辨证治疗可以起到减毒增效的作用,有效降低激素撤减过程中的疾病复发率。在病因病机部分,文章认为狼疮性肾炎的病因病机主要为本虚标实,其病位在肝、脾、肾三脏,其关键病机为阴虚、热毒、瘀血,同时随着病情的进展,狼疮性肾炎会逐渐呈现正虚邪实、虚实夹杂的复杂病机。在辨证论治部分,简述了不同医家对于狼疮性肾炎的代表性诊疗经验,并对本家张佩青老师诊疗经验做出详细描述,通过探讨知名医家对狼疮性肾炎的认识、总结各医家在治疗狼疮性肾炎时激素与中医辨证结合治疗的方式方法,以此提出对狼疮性肾炎的临床感悟。在本家经验后附一治疗案例,为中医辨证治疗狼疮性肾炎提供真实案例以供各位同仁参考,最后对中医治疗狼疮性肾炎提出展望。
The prevalence of lupus nephritis is about 60%in patients with systemic lupus erythematosus,and it is one of the main indicators for prognosis determination in patients with SLE.In terms of the degree of disease progression,about 10%-30%of patients with lupus nephritis will progress to end-stage renal disease.At the present stage,glucocorticoids plus immunosuppressants are mainly used clinically to treat lupus nephritis,but this therapy has large adverse reactions and is prone to symptoms such as bone marrow suppression and gastrointestinal reactions,which reduces patients’quality of life and endangers their life.Clinical evidence suggests that,compared with hormone therapy alone,Western medical treatment supplemented with TCM evidencebased treatment can reduce toxicity and increase effectiveness,effectively reduce the disease recurrence rate during hormone withdrawal and reduction.It is suggested that the etiology of lupus nephritis is mainly based on root deficiency and excessive symptoms,and the key pathogenic mechanisms are Yin(阴)deficiency,heat toxicity and blood stasis.In this article,we briefly describe the representative experiences of different doctors in the treatment of lupus nephritis and describe in details the experience of our teacher ZHANG Peiqing.We present our clinical insights on lupus nephritis by discussing the knowledge of well-known doctors on lupus nephritis and summarizing the ways and means of combining hormone and TCM syndrome differentiation in the treatment of lupus nephritis.A treatment case is attached to provide a real case for colleagues’reference in the treatment of lupus nephritis with TCM evidence,and the conclusion and outlook on the treatment of lupus nephritis in TCM is presented at the end of the article.
作者
尚晶莹
于卓
SHANG Jingying;YU Zhuo
出处
《中医临床研究》
2022年第30期126-128,共3页
Clinical Journal Of Chinese Medicine
关键词
狼疮性肾炎
中医辨证
治疗
Lupus nephritis
TCM syndrome differentiation
Treatment
