甘安平　　吴满满　　张文　　何灵芝

[摘要] 膜性肾病（MN）是一类发病类型复杂、病因病机尚未完全明确的一种疾病，分为特发性（IMN）和继发性（SMN），随病情发展可至终末期肾衰竭，其中病因尚未明确的称为IMN。近年来临床研究表明，中医药在用于治疗该疾病时对症状缓解、防治并发症及延缓特发性膜性肾病的发展进程等方面有明显疗效。参考各家文献，大多数医家认为特发性膜性肾病的基本病机是本虚标实，风、湿、热、瘀是在影响疾病发生发展的四大重要病机。在临床指导治疗IMN中从不同临床表现来探讨中医病因病机的研究具有重要意义。

[关键词] 特发性膜性肾病;中医;临床表现;病因病机

[中图分类号] R277.5          [文献标识码] B          [文章编号] 1673-9701（2021）09-0139-04

Discussion on the traditional Chinese medicine etiology and pathogenesis of idiopathic membranous nephropathy

GAN Anping1   WU Manman1   ZHANG Wen1   HE Lingzhi2

1.The First Clinical Medical College of Zhejiang Chinese Medicine University， Hangzhou  310053， China; 2.The First Affiliated Hospital of Zhejiang Chinese Medicine University， Hangzhou   310006， China

[Abstract] Membranous nephropathy（MN） is a type of disease with complex pathogenesis and unclear etiology and pathogenesis. It is divided into idiopathic membranous nephropathy（IMN） and secondary membranous nephropathy（SMN）. With the development of the disease， it can reach end-stage renal failure. The membranous nephropathy with unclear etiology is called IMN. In recent years， clinical studies have shown that traditional Chinese medicine has obvious effects on symptom relief， prevention and treatment of complications， and delaying the development of idiopathic membranous nephropathy when used in the treatment of diseases. With reference to various literature， most physicians believe that the basic pathogenesis of idiopathic membranous nephropathy is the Benxu Biaoshi. Wind， dampness， heat， and blood stasis are the four important pathogenesis that affects the disease's development. The study of the etiology and pathogenesis of TCM from different clinical manifestations is of great significance in clinical guidance and treatment of IMN.

[Key words] Idiopathic membranous nephropathy; Traditional Chinese medicine; Clinical manifestations; Etiology and pathogenesis

膜性腎病（Membranous nephropathy，MN）是肾病综合征常见病理类型之一[1]，有研究表明，其发病率占原发性肾小球疾病（Primary glomerular disease，PGD）的23.4%[2]，近年来MN发病率逐渐升高[3]。MN可由糖尿病、系统性红斑狼疮、乙型肝炎、恶性肿瘤及药物中毒等因素引起，这一类称为继发性膜性肾病（Secondary membranous nephropathy，SMN）[4]，原因尚未明确的为特发性膜性肾病（Idiopathic membranous nephropathy，IMN），在我国IMN占原发性肾小球疾病的9.89%[5]，与体液免疫、炎症介质及遗传因素等有关[6]。除此之外，易感因素与环境污染也可能成为引发疾病的因素[7-8]。有研究报道，14%～56%的患者可自发缓解，而34%～62%的患者会出现肾功能不全，且自发性缓解者病死率相对较低，预后良好，复发率低，约40%的成年患者最终可进展至肾病终末期，其中以肾病综合征患者表现尤为突出[9-11]。IMN好发于30～50岁，80%～90%见于30岁以上，男女比例为1.2～2.4∶1[12-14]。近年我国有研究报道，IMN好发于中老年男性[15]。……