BACKGROUND:Chronic kidney disease (CKD) represents one of the most significant risk factors for adverse cardiovascular events and mortality. Data on real-world clinical practice of Chinese patients with CKD in the cardiology department is limited. OBJECTIVES:This study aims to investigate the proportion of underdiagnosis, guideline-directed therapy and awareness of CKD among Chinese patients. METHODS:It was a multicentre observational study conducted in 25 tertiary hospitals across China. Patients with two consecutive measurements (separated by 90-730 days) of either: (1) estimated glomerular filtration rate 20-60 mL/min/1.73 m², or (2) urinary albumin-to-creatinine ratio (UACR) ≥30 mg/g, with documented cardiology hospitalisation from 2022 to 2024 were eligible. Participants completed a lifestyle and awareness questionnaire after inclusion. The proportion of underdiagnosis, guideline-directed therapy and awareness of CKD was calculated. RESULTS:Among 2099 participants (median age 74.0 years; 64.6% male), 76.7% were underdiagnosed with CKD (lacked a CKD diagnostic code at discharge). Only 16.7% of participants underwent UACR testing and all individuals with isolated albuminuria (UACR >30 mg/g) remained underdiagnosed. Underdiagnosis was more common in patients aged 60-75, those with early-stage CKD, hospital stays <6 days or without comorbidities. The proportion of guideline-directed treatment was suboptimal: sodium-glucose cotransporter-2 inhibitors (36.5%), renin-angiotensin system inhibitors (56.5%) and only 32.2% of patients received guideline-directed treatment. CKD awareness lagged behind hypertension and diabetes, with <25% achieving guideline-recommended blood pressure and glycaemic targets. CONCLUSIONS:Alarmingly high proportion of underdiagnosed CKD, suboptimal guideline-directed treatment, and poor disease awareness of CKD in cardiology practice require urgent action. Closing these gaps is needed to reduce preventable cardiovascular morbidity and mortality.

OBJECTIVE:To investigate the effect of No. 2 Kangxianling decoction (，No. 2 KXLD) on renal tubular injury in renal ischemia/reperfusion injury (RIRI) rats and explore the mechanisms. METHODS:Male Sprague-Dawley rats were divided into sham group, RIRI group, No. 2 KXLD group, and FG-4592 group. Rats were pretreated with No. 2 KXLD (30 g·kg-1·d-1, i.g.) or FG-4592 (10 mg·kg-1·d-1, i.p.) for 7 d and then subjected to renal I/R. Serum creatinine (Scr) and blood urine nitrogen (BUN) were tested after I/R. Periodic acid-Schiff staining and tubular injury biomarkers were measured. Hypoxia-inducible factor (HIF), inflammatory response, and B-cell lymphoma 2/Bcl-2-associated X protein/caspase-9/3 (Bcl-2/Bax/caspase-9/3) signaling were determined. We used human kidney 2 (HK-2) cells in a hypoxia/reoxygenation (H/R) model to verify the study. RESULTS:No. 2 KXLD significantly decreased the levels of Scr by 22.4% and BUN by 19.7% at 48 h after I/R and improved the renal pathological changes in RIRI rats. No. 2 KXLD attenuated the expression of kidney injury molecule-1, neutrophil-gelatinase-associated lipocalin, and tissue inhibitor of metalloproteinase-2 in RIRI rats and H/R-induced HK-2 cells (P < 0.05). Both in vivo and in vitro studies demonstrated that No. 2 KXLD increased hypoxia-inducible factor, erythropoietin, and heme oxygenase 1 levels, suppressed tumor necrosis factor-α and interleukin-6 expressions, and boosted Bcl-2/Bax/caspase-9/3 pathway. CONCLUSIONS:No. 2 KXLD might have therapeutic potential on RIRI by inhibiting HIF-mediated inflammation and apoptosis, which provides a theoretical basis for the treatment of patients with renal tubulointerstitial injury.

ETHNOPHARMACOLOGICAL RELEVANCE:Wenyang Xiaozheng Decoction (WYXZ), a traditional Chinese medicine formula based on the principles of "warming Yang and resolving blood stasis," has been clinically shown to improve renal function in patients with chronic kidney disease (CKD). However, the precise mechanisms underlying its therapeutic effects remain to be elucidated. AIM OF THE STUDY:To investigate whether WYXZ alleviates renal fibrosis by modulating macrophage polarization via JAK2/STAT3 signaling. MATERIALS AND METHODS:Renal fibrosis was induced in C57BL/6J mice by 5/6 nephrectomy, followed by treatment with WYXZ (4.94 or 9.88 g/kg) or valsartan for 8 weeks. Kidney function (serum creatinine/blood urea nitrogen), histopathology (HE/Masson staining), and macrophage polarization (CD86+/CD206+ flow cytometry) were assessed. In vitro, RAW264.7 macrophages were polarized to M1/M2 phenotypes and treated with WYXZ-medicated serum (2.5-7.5 %) ± JAK2 agonist Butyzamide or STAT3 shRNA. Inflammatory responses (IL-6/IL-10 secretion by ELISA), polarization status (flow cytometry), and JAK2/STAT3 pathway activation (phosphorylated-JAK2/STAT3 by Western blot) were analyzed. Fibrosis markers (α-smooth muscle actin, α-SMA/collagen I, Col-I) were evaluated in RAW264.7/HK-2 co-cultures. RESULTS:WYXZ significantly attenuated renal fibrosis and improved kidney function in 5/6 nephrectomized mice, concurrently suppressing M1 macrophage polarization while enhancing M2 polarization. In vitro, WYXZ-medicated serum reduced inflammatory cytokine secretion and inhibited JAK2/STAT3 pathway activation in LPS-stimulated macrophages. These effects were reversed by JAK2 agonism with Butyzamide and abolished through STAT3 knockdown. Critically, in macrophage-renal tubular cell co-cultures, WYXZ diminished fibrotic marker expression via suppression of macrophage JAK2/STAT3 signaling. CONCLUSIONS:WYXZ attenuates renal fibrosis by reprogramming macrophage polarization through JAK2/STAT3 inhibition, validating its traditional use for CKD.

Objective:To observe the effect of Yiqi Huoxue Recipe（YQHX） combined with enalapril on vascular endothelial function in elderly patients with essential hypertension.Methods:A total of 120 elderly patients with grade Ⅰ essential hypertension who were admitted to Shanghai Seventh People′s Hospital from October 2017 to December 2020 were selected and randomly assigned into a Chinese medicine group（YQHX）,an integrated Chinese and western group（YQHX+enalapril）,and a western medicine group（enalapril）（n=40） according to the random number table method.All the patients received diet, exercise, and basic therapy（blood pressure-lowering, lipid-lowering, and antiplatelet therapy）.Each course of the treatment was 12 weeks.The levels of endothelin-1（ET-1）,angiotensin Ⅱ（AngⅡ）,interleukin-6（IL-6）,C-reactive protein（CRP）,tissue-type plasminogen activator（t-PA）,plasminogen activator inhibitor-1（PAI-1）,and flow-mediated dilation（FMD） were compared among the three groups.Results:The therapeutic effects on blood pressure of the integrated Chinese and western medicine group, the Chinese medicine group, and the western medicine group were 95%,92.5%,and 90%,respectively, which showed no statistical significance between each other（P＞0.05）.The effective rates for TCM syndromes in the three groups were 87.5%,75%,and 62.5%,respectively, and the integrated group outperformed the western medicine group（Z=6.667,P=0.010）.The integrated group outperformed the Chinese medicine group in the down-regulation of ET-1,IL-6,CRP,and PAI-1 and the improvement of FMD（P＜0.05）,and it was superior to the western medicine group in the down-regulation of AngⅡ and CRP（P＜0.05）.Conclusion:YQHX combined with enalapril can improve the vascular endothelial function in elderly hypertensive patients by down-regulating the expression of ET-1,AngⅡ,IL-6,CRP,and PAI-1,up-regulating the expression of t-PA,and increasing FMD.Therefore, this therapy is worth popularizing in elderly hypertensive patients.

目的:观察温阳消癥方对5/6肾切除小鼠残肾功能及肾脏纤维化的影响,并探讨其作用机制.方法:随机从32只小鼠中取24只制作5/6肾切除慢性肾功能衰竭肾纤维化模型,2周后根据血清肌酐值将24只小鼠分为5/6肾切除组、代文组和温阳消癥方组,另8只作为假手术组.治疗8周后,Western blot检测各组小鼠肾组织JAK2、STAT3、p-JAK2、p-STAT3、转化生长因子β1(TGF-β1)、Smad3、I型胶原蛋白(Col-I)、III型胶原蛋白(Col-III)、α-SMA蛋白表达水平,免疫组织化学染色法测定小鼠肾组织Col-I、Col-III、α-SMA水平,用RT-qPCR法测定TGF-β1、Smad3 mRNA水平.结果:治疗8周后,模型组小鼠肾组织JAK2、STAT3、p-JAK2、p-STAT3、TGF-β1、Smad3、Col-I、Col-III、α-SMA蛋白表达均较假手术组上调(P<0.01),模型组小鼠肾组织TGF-β1、Smad3 mRNA表达较假手术组上调(P<0.01);与模型组比较,代文组、温阳消癥方组JAK2、STAT3、p-JAK2、p-STAT3、TGF-β1、Smad3、Col-I、Col-III、α-SMA蛋白表达和TGF-β1、Smad3 mRNA表达均下调(P<0.01);与代文组比较,除TGF-β1、α-SMA外,温阳消癥方组其余指标均下调(P<0.01).结论:温阳消癥方能够保护5/6肾切除小鼠残肾功能,减轻肾纤维化病变程度,其机制可能与抑制TGF-β1/Smad3、JAK2/STAT3通路相关.

目的 从MMP-9调节COL4α3基因及Ⅳ型胶原蛋白表达的角度,研究抗纤灵冲剂干预肾间质纤维化的机制.方法 72只SD大鼠,成功制备单侧输尿管梗阻(unilateral ureteral obstruction,UUO)模型后,再随机分为模型组、抗纤灵组、氯沙坦组.另24只大鼠,制备假手术模型.药物干预后处死,留取左侧肾组织.应用免疫组化法测定MMP-9、Ⅳ型胶原(Col-Ⅳ)蛋白在肾间质的阳性表达;采用PCR Array法,检测肾组织COL4α3基因的表达.结果 UUO假手术组大鼠MMP-9表达极微;在模型组大鼠其阳性表达显著增加;与模型组比较,抗纤灵组4个时间点MMP-9的阳性表达均明显增加;氯沙坦组各时间点MMP-9阳性表达均较模型组增加,但无统计学差异.14d、28d时MMP-9阳性表达抗纤灵组显著高于氯沙坦组.各时间点模型组COL4α3基因水平分别较假手术组上调10.37倍、10.27倍及14.34倍.各时间点抗纤灵组COL4α3的基因表达水平,分别较模型组下调1.5倍、1.52倍和1.48倍.假手术组大鼠Col-Ⅳ只有极少量表达;模型组大鼠肾小球基底膜及肾间质表达显著增加,与假手术组相比有统计学意义;与模型组相比较,抗纤灵组及氯沙坦组各时间点阳性表达均显著减少;与氯沙坦组比较,7d,14 d,28 d时间点Col-Ⅳ蛋白阳性表达,抗纤灵组均显著减低;21d阳性表达也明显低于氯沙坦组.结论 抗纤灵冲剂干预肾间质纤维化的可能机制是通过MMP-9下调COL4α3基因及Col-Ⅳ蛋白在肾间质的表达.

Background Diabetes and impaired glucose regulation are very common in patients with coronary artery disease (CAD). In this study, we aim to investigate the prevalence of abnormal glucose regulation in men and women in Chinese CAD patients. Methods In this retrospective study, 4100 patients (male, n = 2873; female, n = 1227)with CAD were enrolled. The mean age of these patients was 63 years. The demographic data, medical history, echocardiography findings and blood investigations were collected and analyzed. Results In this population, 953 (24%) patients had definite diagnosis of type 2 diabetes mellitus, including 636 males (23%) and 317 females (27%). There was a higher prevalence of diabetes in females than men ( p < 0.05). For the remaining patients, 48% (n = 959) undergone an oral glucose tolerance test (OGTT), which revealed that 83 male patients (12%) and 41 female patients (16%) suffered from the type 2 diabetes ( p > 0.05). 283 men (40%) and 105 women (41%) had impaired glucose regulation (IGR) ( p > 0.05). Only 338 men (25%) and 109 women (19%) showed the normal glucose regulation, implying a higher prevalence of abnormal glucose regulation in females ( p < 0.01). The odd ratio (OR) showed that women were more prone to have diabetes mellitus or IGT than men and the OR was 1.44 and 1.43 respectively. Conclusion Abnormal glucose regulation is highly prevalent in CAD patients. The women are more prone to have diabetes mellitus or IGT than men.

本文记录了何立群教授关于糖尿病肾病的临证诊疗思路,何教授认为该病病机总属本虚标实,虚实夹杂.脾肾气阴亏损为发病之始,病久阴损及阳,中晚期则见脾肾阴阳俱虚;标实之瘀血贯穿糖尿病肾病发病全程.治疗当以益气养阴、补肾温阳、祛风活血化瘀为主要原则,早期补益气阴顾其本,中晚期共举脾肾之阳助其运,久病祛风活血通肾络贯穿治疗全程,以常达变,病证结合,邪正兼顾,标本兼治,终获良效.

Abstract Background: To investigate the relationship between body mass index (BMI) and proteinuria in stage 2-4 chronic kidney disease (CKD) patients. Methods: This study conducted a multicenter, cross-sectional study of 804 stage 2-4 CKD patients. Multivariate regression analysis, One-way ANOVA and subsequent multiple comparisons analysis were used to explore the relationship between BMI and proteinuria in pre-dialysis CKD patients. Results: Among stage 2-4 CKD patients, those with excessive proteinuria accounted for 85.32% of the total. BMI was an independent risk factor for the presence of proteinuria and positively correlated with the volume of proteinuria. Subgroup studies suggested that in stage 2-3a CKD patients, BMI was closely related to the presence and volume of proteinuria. However, in stage 3b-4 CKD patients, there was non-association between BMI and proteinuria. Furthermore, in stage 2-3a but not stage 3b-4 CKD patients, those with obesity (BMI≥ 28 kg/m2) had higher levels of proteinuria, compared with those with normal weight (BMI< 24 kg/m2) and overweight (24 kg/m2≤ BMI < 28 kg/m2). Conclusion: BMI is associated with the presence and volume of proteinuria in patients with early stage (stage 2-3a) CKD but not late stage (stage 3b-4) CKD. This result suggests that only in early stage CKD patients, weight control is beneficial for reducing proteinuria.Trial registration: ChiCTR-INR-17014069, Registered December 21, 2017.

防治肾纤维化是延缓慢性肾脏疾病进展为终末期肾病的主要策略.何立群教授临证40年,致力于中医药防治肾纤维化的研究,先后研发了抗纤灵方、矢志方、糖肾宁方等方剂,运用中医药防治肾纤维化、延缓慢性肾病进展有独到的理论和经验.何立群教授重视肾纤维化过程中风、湿、热、瘀、毒等病邪因素与人体正气之间的关系,指出肾纤维化进展与正虚邪滞、肾络成积形成肾脏微形癥瘕密切相关,从扶正祛邪、调气行血、轻剂缓图、分阶段论治4个方面随证施治,其防治肾纤维化体现了中医整体观、辨证施治的灵活和用药取舍的轻灵,值得临床学习和借鉴.

中医的肾脏无论形态结构、生理功能,还是病理变化,均与经络学说中的络脉密切相关.该文从肾与络脉的关系入手,探讨肾与络脉在形态结构、生理功能、病理变化上的联系,并以此为基础,从络病学角度,阐述中药经验方抗纤灵的组方思路,拓展从络论治肾病的思路.

介绍何立群教授运用清化祛瘀法治疗慢性肾脏病的临床经验.认为慢性肾脏病以脾肾亏虚为主,与湿热、瘀血相关,治以清化祛瘀.临证用药重视清化湿热,因势利导;活血祛瘀,切忌伤正;清化祛瘀,灵活变通.并附验案1则.

目的:观察益气固本调免方治疗慢性肾炎脾肾气虚证的临床疗效.方法:将128例慢性肾炎CKD1～3期脾肾气虚证患者随机分为治疗组(益气固本调免方)和对照组(肾炎康复片)各64例,疗程4个月,比较两组患者治疗前后血尿、蛋白尿、肾功能、中医证候情况.结果:治疗组患者临床疗效优于对照组,差异有统计学意义(P＜0.05).治疗后,对照组患者尿红细胞数目无明显变化(P＞0.05),24h尿蛋白定量较治疗前降低(P＜0.05).治疗组患者治疗后尿红细胞数和24h尿蛋白定量均较治疗前降低,差异均有统计学意义(P＜0.01).治疗后,治疗组患者尿红细胞数和24h尿蛋白定量均低于对照组,差异均有统计学意义(P＜0.01).两组患者治疗前、治疗后eGFR比较,差异均无统计学意义(P＞0.05).治疗组患者中医证候疗效优于对照组,差异有统计学意义(P＜0.01).两组患者治疗后中医证候积分和总积分均较治疗前降低,差异均有统计学意义(P＜0.05).治疗组患者治疗后纳少、胃脘胀、尿频、浮肿积分与对照组比较,差异均无统计学意义(P＞0.05).治疗组患者治疗后腰脊酸痛、疲倦乏力、大便溏薄、夜尿多积分和总积分均低于对照组,差异均有统计学意义(P＜0.05).治疗组患者大便溏薄和疲倦乏力积分变化与尿红细胞数、24h尿蛋白定量呈正相关.结论:益气固本调免方可有效改善慢性肾炎脾肾气虚证患者的血尿和蛋白尿,同时能改善患者的中医证候.

[目的]观察温阳消癥方对5/6肾切除小鼠肾功能、肾脏病理、纤维化指标及转化生长因子-β1(transforming growth factor-β1,TGF-β1)/Smad3通路的影响,探讨该方对肾纤维化的保护作用及可能的机制.[方法]40只C57BL/6小鼠中随机选取10只作为假手术组,30只制作5/6肾切除模型,造模2周后测血清肌酐,确定造模成功,并将造模组随机分为温阳消癥组、缬沙坦组、模型组.温阳消癥组予温阳消癥方灌胃,缬沙坦组予缬沙坦灌胃,模型组与假手术组予等体积0.9％氯化钠注射液灌胃,给药8周后测定血清肌酐、尿素氮,苏木精-伊红(hematoxylin-eosin,HE)及Masson染色观察肾脏病理学改变,实时荧光定量聚合酶链式反应(Real-time fluorescence quantitative polymerase chain reaction,Real-time qPCR)和免疫印迹法检测肾组织 α-平滑肌肌动蛋白(α-smooth muscle actin,α-SMA)、纤维连接蛋白(fibronectin,FN)、TGF-β1、Smad3的mRNA和蛋白表达.[结果]与假手术组比较,模型组肾脏纤维化改变明显,血清肌酐、尿素氮、胶原染色阳性率及α-SMA、FN、TGF-β1、Smad3的mRNA和蛋白表达均显著升高(P＜0.01).与模型组比较,温阳消癥组和缬沙坦组小鼠的肾脏病理纤维化形态改变较轻,血清肌酐、尿素氮、胶原染色阳性率,α-SMA、FN、TGF-β1的mRNA和蛋白表达,Smad3蛋白表达均显著降低(P＜0.01);Smad3 mRNA表达降低(P＜0.01,P＜0.05).与缬沙坦组比较,温阳消癥组的α-SMA mRNA和蛋白表达,以及TGF-β1 mRNA表达显著降低(P＜0.01);胶原染色阳性率和FN mRNA表达降低(P＜0.05).[结论]温阳消癥方可改善5/6肾切除小鼠肾功能,减轻病理改变,下调肾纤维化标志物α-SMA及FN的表达,减轻细胞外基质(extracellular matrix,ECM)异常堆积,其机制可能与抑制TGF-β1/Smad3信号通路有关.

目的:观察液压扩张法联合贝前列素钠片对动静脉内瘘成熟的影响.方法:选择2019年01月—2020年12月于我院肾内科行动静脉内瘘术的患者100例,随机分为对照组和联合干预组.对照组采用常规端侧吻合动静脉内瘘术,术后采用常规治疗方法及术后护理;联合干预组术中在常规端侧吻合动静脉内瘘术基础上加用液压扩张法,术后口服贝前列素钠片,每次1片,每日3次,共服药8周.观察两组术后8周患者吻合管内径及血流量、动静脉内瘘成熟不良发生率、术后并发症发生率及超敏C反应蛋白水平的变化.结果:8周后,综合干预组吻合管径及内瘘血流量明显高于对照组(P<0.01),综合干预组内瘘成熟不良发生率及并发症发生率明显低于对照组(P<0.01),超敏C反应蛋白水平亦明显低于对照组(P<0.01).结论:液压扩张法联合贝前列素钠口服对于促进患者内瘘成熟具有良好的作用,值得临床推广.

童少伯教授认为慢性肾脏病的基本病机特点为正虚邪实,早期脾肾气阴两虚为主,日久脾肾失司,水湿不化,导致水湿、瘀血、湿热等病理因素产生,伴随全程.童老对慢性肾脏病的诊治有其独到的见解和心得,在治疗慢性肾病时注重扶正与祛邪,补益法和祛湿降浊化瘀通络法并重,擅于将中药药对灵活运用在肾脏病的临床治疗中,如黄芪与当归、菟丝子与枸杞子、生地黄与牡丹皮、黄连与肉桂、薤白与丹参、知母与黄柏、益智仁与粉萆薢、清水豆卷与茯苓皮、陈皮与半夏、鬼箭羽与汉防己,并取得显著效果.今择其常用药对介绍如下,探寻其用药规律,传承其学术思想.

目的 探讨生脉注射液联合泼尼松和环磷酰胺治疗膜性肾病的临床疗效.方法 选择2017年6月—2020年6月上海市第六人民医院金山分院收治的53例膜性肾病的患者,随机分为对照组(25例)和治疗组(28例).对照组口服泼尼松片,1 mg/kg,1次/d,8周后每2周减量5 mg,减至30 mg/d,再每2周减量2.5 mg,减至20 mg/d;再每4周减2.5 mg,至10 mg/d维持;并静脉滴注注射用环磷酰胺,首月每半月600 mg加入生理盐水100 mL,然后每月800 mg加入100 mL生理盐水,1次/月,共6个月.治疗组在对照组治疗的基础上静脉滴注生脉注射液,40 mL加入250 mL生理盐水,1次/d,治疗14 d停药16 d为1个疗程,共6个疗程.观察两组患者临床疗效,比较治疗前后两组患者24 h尿蛋白定量(24 h Upro)、C反应蛋白(CRP)、降钙素原(PCT)水平.结果 治疗后,治疗组总有效率为78.57％,显著高于对照组64.00％(P<0.05).治疗3个月和6个月后,两组患者24 h Upro水平显著降低,但PCT、CRP升高(P<0.05),且治疗组治疗后24 h Upro、PCT、CRP水平低于对照组同期(P<0.05).结论 生脉注射液联合糖皮质激素及环磷酰胺治疗膜性肾病可以提高临床疗效,降低炎症反应的程度.

目的:观察抗纤灵对慢性肾功能衰竭(chronic renal failure,CRF)模型Smad2-KO小鼠心脏I型胶原(collagenⅠ,CoⅠ)、Ⅲ型胶原(collagenⅢ,CoⅢ)、血管紧张素Ⅱ(AngiotensinⅡ,AngⅡ)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素6(Interleukin-6,IL-6)水平的影响,探讨抗纤灵治疗CRF的作用机制.方法:将18只假手术Smad2-KO小鼠随机分为假手术组(蒸馏水0.5 mL,灌胃)、抗纤灵假手术组(抗纤灵复方20 g/kg,0.5 mL灌胃)、缬沙坦假手术组(缬沙坦20 mg/kg,0.5 mL灌胃),每组6只.将24只CRF模型Smad2-KO小鼠随机分为模型组(蒸馏水0.5 mL,灌胃)、抗纤灵模型组(抗纤灵复方20 g/kg,0.5 mL灌胃)、缬沙坦模型组(缬沙坦20 mg/kg,0.5 mL灌胃),每组8只.灌胃8周后取材,Elisa法检测心脏AngⅡ的水平,Western blot法测心脏CoⅠ、CoⅢ、TNF-α、IL-6的相对表达.结果:与假手术组比较,模型组的AngⅡ、CoⅠ、CoⅢ、TNF-α、IL-6均显著增高(P<0.01),缬沙坦假手术组的AngⅡ下降(P<0.05).与模型组比较,抗纤灵模型组的AngⅡ有改善(P<0.05),CoⅠ、CoⅢ、TNF-α、IL-6有显著改善(P<0.01).缬沙坦模型组的CoⅠ、CoⅢ、AngⅡ、TNF-α、IL-6均明显改善(P<0.01).抗纤灵模型组与缬沙坦模型组组间比较,缬沙坦在改善AngⅡ方面优于抗纤灵组(P<0.05),其余指标两组间比较差异无统计学意义(P>0.05).结论:抗纤灵可改善CRF模型Smad2-KO小鼠心脏病变的作用机制可能与降低炎症因子的表达、调节RAS和减少心脏胶原的过度沉积有关.

何立群教授认为,慢性肾脏病乃本虚标实之证,多为虚实夹杂,尤以脾肾亏虚为本,继而出现水湿、痰浊、血瘀等实邪,这些实邪作用于机体,影响机体功能失常,病情迁延,反复发作难愈.何立群教授论治慢性肾脏病,调理肺脾肾三脏,注重阴阳表里的调和,扶助正气的同时,兼顾祛除邪气,多法联用,随证治之.