刘文娟 姜晨

[摘要] 目的 通過文献分析慢性肾脏病血管钙化的危险因素，为中医药预防慢性肾脏病血管钙化提供理论依据及思路。 方法 检索EMbase、PubMed、中国知网、万方、维普收录的研究慢性肾脏病血管钙化危险因素的中英文献，将符合搜索条件的文献191篇，通过Cochrane 系统评价手册进行文献的选择实施，排除不符合纳入、排除标准的文献154篇，对符合标准的37篇文献进行危险性因素分析的研究;根据文献研究所得的危险性因素，探索在中医“治未病”思想指导下预防慢性肾脏病血管钙化的措施。结果 与慢性肾脏病血管钙化成正相关的危险因素包括年龄、透析龄、血FGF-23水平、高血磷、糖尿病、超敏C-反应蛋白、钙磷乘积、甲状旁腺激素、高脂血症、高血钙、BMI值、碱性磷酸酶水平等;与慢性肾脏病血管钙化呈负相关的危险因素包括血清镁水平、血红蛋白水平、可溶性Klotho水平;在“治未病”思想指导下预防慢性肾脏病血管钙化的措施有早期筛查，对FGF-23、血清钙磷水平、甲状旁腺素及血糖血脂情况进行随访和控制;选择有研究证实的对血管钙化有干预作用的中药进行干预治疗。 结论 基于中医“治未病”思想，重视CKD血管钙化的一级预防，运用中医药防治方法调节患者血管功能的平衡，干预钙化进展，对预防血管钙化及减少慢性肾脏病心血管并发症具有重要意义。

[关键词] “治未病”思想;慢性肾脏病;血管钙化;危险性因素

[中图分类号] R692.5          [文献标识码] A          [文章编号] 1673-9701（2021）33-0035-06

[Abstract] Objective To analyze the risk factors of vascular calcification in chronic kidney disease through literature analysis， and to provide theoretical basis and ideas for the prevention of vascular calcification in chronic kidney disease by traditional Chinese medicine. Methods The Chinese and English literature articles were retrieved on the risk factors of vascular calcification of chronic kidney disease from databases such as EMbase， PubMed， CNKI， Wanfang and Weipu. 191 articles that met the retrieval criteria were selected and implemented through the Cochrane System Evaluation Manual. 154 articles that did not meet the inclusion and exclusion criteria were excluded. 37 articles that met the criteria were studied on the risk factor analysis; based on the risk factors obtained from literature research， the measures to prevent vascular calcification in chronic kidney disease under the guidance of the idea "prevention of disease" in traditional Chinese medicine were explored. Results Risk factors positively related to vascular calcification in chronic kidney disease were age， dialysis age， blood FGF-23 level， hyperphosphate， diabetes，high-sensitivity C-reactive protein， calcium-phosphate product， parathyroid hormone，hyperlipidemia syndrome，hypercalcemia， BMI value， and alkaline phosphatase level; risk factors negatively related to vascular calcification in chronic kidney disease were serum magnesium level，hemoglobin level， and soluble Klotho level; measures to prevent vascular calcification in chronic kidney disease under the guidance of the idea of "prevention of disease" included early screening， follow-up and control of FGF-23， serum calcium and phosphorus levels， parathyroid hormone， and blood sugar and blood lipids; the traditional Chinese medications that had been proven by research to interfere with vascular calcification were selected for interventional treatment. Conclusion Based on the idea of "prevention of treatment" in traditional Chinese medicine， emphasizing the primary prevention of CKD vascular calcification and using the prevention and treatment methods in traditional Chinese medicine to adjust the balance of patients' vascular function to intervene in the progress of calcification are of great significance for preventing vascular calcification and reducing cardiovascular complications of chronic kidney disease.

[Key words] Idea of “Prevention of disease”; Chronic kidney disease; Vascular calcification; Risk factors

慢性肾脏病（Chronic kidney disease，CKD）是全球性公共健康问题，CKD导致的钙磷代谢紊乱、尿毒症毒素、微炎症、氧化应激等多种机制导致异位钙化的发生。……