杜亚婷 郭传 饶向荣 尹德海

摘要：慢性肾脏病（chronic kidney disease，CKD）是由多種疾病引起，肾脏结构和功能进行性恶化直至不可逆性损伤，并出现一系列临床症状和代谢紊乱的临床综合征，其认知功能障碍已成为主要的神经系统并发症。西医认为其发病机制主要与血管损伤和神经退行性变相关，而中医理论中“虚气留滞”可概括其病机。“虚气留滞”是指元气亏虚，气血相失，气血津液运化失常而导致气滞、痰阻、血瘀、毒损的病理过程。本文认为CKD合并认知功能障碍病机是虚气为本、留滞为标，虚气与留滞互相影响，形成恶性循环而加重疾病，进而据此提出“补虚消滞”的治疗原则，可为临床施治提供一定参考。

关键词：慢性肾脏病；认知功能障碍；虚气留滞；补虚消滞

DOI：10.3969/j.issn.1005-5304.2018.12.001

中图分类号：R272.969.2 文献标识码：A 文章编号：1005-5304（2018）12-0001-04

Abstract： Chronic kidney disease （CKD） is a clinical syndrome with a series of clinical manifestations and metabolic disorders caused by many diseases， which is characterized by progressive deterioration or irreversible damage of renal structure and functions. Cognitive dysfunction has become its main neurological complication. The pathogenesis of Western medicine is mainly related to vascular injury and neurodegeneration. In TCM theory， “deficient-qi retention” can summarize its pathogenesis. “Deficient-qi retention” refers to the pathogenetic process of qi stagnation， phlegm obstruction， blood stasis and toxin accumulation owing to deficiency of primordial qi， loss of qi and blood， and abnormal transportation of qi， blood， and body fluid. This article believed that deficient-qi is the root and stagnation is the tip for CKD combined with cognitive dysfunction. Deficient-qi and retention affect each other， so as to form a vicious circle and aggravate the disease. Therefore， the treatment principle of “tonify deficiency and remove stasis” was put forward， in order to provide certain references for clinical treatment.

Keywords： chronic kidney disease； cognitive dysfunction； deficient-qi retention； tonify deficiency and remove stasis

慢性肾脏病（chronic kidney disease，CKD）是由多种疾病引起，导致肾脏结构及功能进行性恶化直至不可逆性损伤，并出现一系列临床症状和代谢紊乱的临床综合征。近几年，CKD并发认知功能障碍的现象日益受到重视。资料显示，CKD中认识功能障碍患者与健康人群相比增加3倍，且终末期肾脏病（end stage renal disease，ESRD）患者的神经心理学测试结果发现，认知功能损害的患病率为16%～38%[1]。从中医角度而言，CKD病程日久，脏腑功能受损或气血运行失常，导致痰湿瘀等病理产物聚集，滞而成毒，浊邪上扰清窍，破坏脑髓，夺扰神明，引起认知功能障碍。基于此，其病机可概括为“虚气留滞，浊邪害清”。兹从“虚气留滞”角度探讨CKD合并认知功能障碍，以期为临床诊疗提供新思路。……