基于咽–肠–肾轴理论探讨清咽健脾方治疗IgA肾病
Exploring the Treatment of IgA Nephropathy with Qingyan Jianpi Formula Based on the Pharynx Intestine Kidney Axis Theory

目的：基于咽–肠–肾轴理论探讨清咽健脾方加减治疗IgA肾病的效果。方法：IgA肾病是临床比较常见的一种原发性肾小球疾病，其主要症状为血尿，伴有不同程度的蛋白尿，高血压、肾病综合征等肾损害。电镜下表现为肾小球体积系膜区免疫复合物IgA的大量沉淀，或以IgA沉淀为主兼见补体C3等沉积。将从中西医两方面角度探讨咽–肠–肾轴理论的可行性及相关治疗方案异同，传统中医学认为，IgA发病责之于肺、脾、肾；西医目前相关主要理论有两点：一是肠肾轴理论，肠道菌群免疫功能在IgA肾病的发生及治疗中起重要作用，二是咽肾密切相关，咽喉为其纽带。本文通过对IgA肾病肠咽肾轴病机的阐释，相关病因阐述以及中西医对于本病的观点及当前治疗方案，并结合本汤药药物作用机制研究，从而进一步探讨清咽健脾方治疗IgA肾病的可行性。结论：基于咽–肠–肾轴理论探讨清咽健脾方治疗IgA肾病的效果良好，能够降低患者24 h尿蛋白定量及尿红细胞计数，有助于改善肾脏功能，延缓肾脏纤维化进展，值得临床采纳。
Objective: To investigate the effect of Qingyan Jianpi decoction on IgA nephropathy based on the theory of pharyngoenteric-instine kidney axis. Methods: IgA nephropathy is a common primary glomerular disease. The main symptoms of IGA nephropathy are hematuria, proteinuria, hypertension, nephrotic syndrome and other renal damage. Under electron microscope, the immunocomplex IgA was deposited in the mesangial area of the glomerular volume, or IgA deposition was mainly accompanied by complement C3 deposition. The feasibility of the pharyngoentero-renal axis theory and the similarities and differences of related treatment schemes will be discussed from the perspectives of traditional Chinese and Western medicine. Traditional Chinese medicine believes that the pathogenesis of IgA is the lung, spleen and kidney. At present, there are two main theories related to Western medicine: Firstly, the enterorenal axis theory which means the immune function of intestinal flora plays an important role in the occurrence and development of IgA nephropathy; secondly, the kidney and throat are connected closely, and the throat is its link. In this paper, through the explanation of the pathogenesis of enteropharyngorenal axis of IgA nephropathy, together with the related etiology, and the views of traditional Chinese and western medicine on this disease and the current treatment plan, we combine these with the study of the mechanism of action of this decoction, to further explore the feasibility of Qingyan Jianpi prescription for the treatment of IgA nephropathy. Conclusion: Based on the theory of pharyng-instine-kidney axis, Qingyan Jianpi formula has a significant effect on IgA nephropathy, which can reduce 24 h urinary protein quantity and urinary red blood cell count, and help to improve renal fibrosis, which is worthy of clinical adoption.