慢性肾脏病患心血管疾病风险增加，主要表现为心力衰竭。慢性肾脏病合并心衰十分常见，且常伴不良预后。慢性肾脏病独特的病理生理机制可能是慢性肾脏病合并心力衰竭患者与单纯心血管疾病患者病死率差距较大的原因。目前心力衰竭患者的治疗已经建立了强有力的证据，而慢性肾脏病合并心力衰竭患者的治疗尚无基于高水平的临床证据的指南推荐。本文总结归纳慢性肾脏病合并心力衰竭的诊断和治疗思路，为慢性肾脏病合并心力衰竭的防治提供一些参考。

ABSTRACT Chronic kidney disease (CKD) is a serious public health concern worldwide. Cardiovascular disease (CVD) is the leading cause of death in CKD patients. CKD combined with CVD (CKD-CVD) is a common disease with a poor prognosis. Modern medicine for the treatment of CKD-CVD currently focuses on controlling the traditional risk factors of CVD. However, its efficacy is lower than expected, and revascularization shows no notable benefit to patients. The reason for this unsatisfactory clinical outcome is that CKD-CVD has a specific pathophysiological mechanism and atypical clinical presentation. Due to the inadequacy of the therapeutic effects of modern medicine, Chinese medicine (CM) is recommended to delay disease progression. CM is widely used to treat CKD. Furthermore, some theoretical and clinical explorations on the CM treatments of CKD-CVD have been undertaken in recent years. However, clinical trials on the long-term effects of CM on cardiovascular outcomes in patients with CKD is lacking, especially studies on combined cardiac and renal endpoints. This article summarises the clinical characteristics and main treatments of CKD-CVD. Besides, based on CM theory, it is proposed that a deficiency of the spleen and kidney Qi, water dampness, dampness turbidity, and blood stasis contribute to the pathogenesis of CKD-CVD, treatment should focus on tonifying the spleen and kidney Qi, supplemented by smoothing the triple energizer, detoxification, and activation of blood circulation. In order to provide some reference for the combined treatment of Chinese and Western medicine for CKD-CVD.

IgA肾病发病机制复杂,患者临床表现异质性大,基于症状表现的传统中医辨证论治疗效尚不满意.笔者基于中医理论和中医思维,结合IgA肾病发病机制的现代医学研究进展及中国中医科学院广安门医院临床经验,提出对该病病因病机的新认识,从审因为先、攘外安内、三焦定位和靶方靶药等方面梳理IgA肾病的中医辨治策略,以供临床参考.

血栓性微血管病是以微血管性溶血性贫血、血小板减少及器官损伤为特征的一组急性临床综合征,病因繁复,症状多样,而合理的中医辨治可减轻重症临床表现,并有效改善疾病转归.本文基于温病理论,结合临床实践,就血栓性微血管病中医辨治策略进行阐述,为临床治疗提供借鉴.

临床上,心血管疾病是慢性肾脏病患者死亡的主要原因,而慢性肾脏病合并心血管疾病十分常见.目前,现代医学治疗心血管疾病以控制传统心血管危险因素为主,但并未使患者明显获益.本文立足中医理论和实践,提出慢性肾脏病合并心血管疾病病机是以肾虚为本,水湿、湿浊、血瘀为标,故治当补益脾肾为主,辅以疏利三焦、解毒活血等法,可取得一定疗效.

良性前列腺增生是中老年男性常见排尿障碍性疾病,严重影响患者生活质量.对比现代医学治疗,中医治疗具有明显优势.文章基于东垣学说理论和临床实践经验,认为良性前列腺增生从属"脾胃虚则九窍不通"范畴,而"脾胃气虚、升降失调、湿浊下流、肾失开阖"为本病发生发展的病机关键,与李东垣提出"阴火"理论类似,治疗可遵"补中、升阳、泻阴火"之法,随证加减,临床取得一定疗效,可为临床提供一定参考.

《伤寒杂病论》中张仲景重用芍药创立了桂枝加芍药汤、当归芍药散和小建中汤三方,三者在理法思维与脉证规律上均有差异,由泻实慢慢向补虚渐变,而其方证规律的理论基础正是基于《神农本草经》中芍药"苦平轻泄"的认识.后世医家不断总结张仲景重用芍药蕴含的"抑木"思想,在金元时期正式创立了"抑木法",针对"木亢乘土"和"土虚木乘"的病机,为治疗相关脾胃疾病创立了众多有效方剂.临床中应用抑木法、辨别木土相关病机虚实侧重以及最经典的方药加减,均不出仲景重用芍药三方的加减示范.因此,深究张仲景重用芍药方证规律,对于探讨"抑木"法治疗脾胃病具有重要的临床意义.

临床上,慢性肾脏病合并肌少症会显著增加跌倒、死亡等不良事件发生率,现代医学多采用运动、营养和药物治疗,但效果存在争议.本文基于中医理论及临床经验,结合现代医学研究成果,认为脾肾亏虚,痰湿、浊毒、瘀血内阻是慢性肾脏病肌少症的根本病机,而心虚脉痹是加速本病发展的关键因素,临床治疗以补益心脾肾、利湿活血解毒为基本原则,结合饮食调养和运动训练,随证治之,可达到未病者先防、已病者延缓疾病进展、提高生活质量的目的.

由于病理机制复杂,西医对新月体型IgA肾病尚无有效治疗措施,预后通常较差.本文从中医"内外合邪"角度对新月体型IgA肾病的辨治进行探讨,认为IgA肾病固有的内邪与外入之风热、湿热相合,蕴成毒瘀,是IgA肾病新月体产生的关键因素.因毒瘀伤肾为新月体型IgA肾病的根本病机,故治疗原则为扶正祛邪、调畅三焦.临证分缓急轻重,可取得积极疗效.

慢性肾脏病(chronic kidney disease,CKD)肌少症有多种病因,尿毒症毒素是其病因之一,且是CKD肌少症有别于其他肌少症的因素.对尿毒症毒素影响肌少症的文献进行汇总分析,一方面了解其发病机制,另一方面为CKD肌少症的治疗提供一定的参考.文章侧重对尿毒症毒素与CKD肌少症关系的研究进展进行综述,试图阐述从毒素清除方面治疗CKD肌少症也是非常有意义的研究方向,可能会发现治疗CKD肌少症的新策略.

功能性消化不良(FD)是典型的心身疾病,临床要心身并治.中医理论"因郁致病、因病致郁"的心身互动关系,蕴含着生物-心理-社会医学模式,与罗马Ⅳ标准提出的FD的"脑-肠互动异常"机制一致."肝气虚则恐,实则怒",肝气虚证不仅在证治关系上对肝气郁证作到有力补充,同时也蕴含着"因恐致病、因病致恐"的心身互动关系,临床对于FD的治疗具有重要的理法意义.肝气虚与肝气郁、肝气虚与胆气虚应加以鉴别,而肝气虚引起FD具有典型的病症以及心理特点.大补肝汤加减治疗肝气虚引起的FD,临床取得较好的疗效.

Chronic kidney disease (CKD) is a serious public health issue worldwide. Cardiovascular disease (CVD) has been identified as an important factor for the prognosis of patients with CKD and a leading cause of death. CKD-CVD is a very common disease which is often accompanied with poor anticipations. As shown in clinical studies, expected results were not obtained in reducing the CVD mortality of CKD patients by reducing traditional CVD risk factors, indicating that CKD-CVD may have its unique risk factors. Based on recent studies on CKD-CVD, this review presented the classification, atypical clinical manifestations, non-traditional risk factors, and basic pathophysiology-related knowledge of CKD-CVD. Current research conclusions can only explain part of the difficulties in the diagnosis and treatment of CKD-CVD. More high-quality basic experiments and clinical trials are still needed to provide evidences for the prevention and treatment of CKD-CVD.

冷球蛋白血症相关肾损害表现多样,常伴见多器官受累,临床易漏诊且治疗棘手.目前现代医学以免疫抑制为主的治疗易引发感染而致死亡.本文立足中医理论和实践,认为寒湿毒是冷球蛋白血症相关肾损害的关键病理因素,寒湿毒内生,蕴积肾脏是其根本病机,病位以肾为主,当遵《内经》"寒者热之",随证治之,可取得一定临床疗效.