Ⅱ型心肾综合征中医病机演变规律初探

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Ⅱ型心肾综合征中医病机演变规律初探

吴华芹1，张并璇1，赵畅2，杨阳柳林1，宋庆桥1

1.中国中医科学院广安门医院，北京100053；

2.北京市大兴区中西医结合医院，北京100076

摘要：目前对Ⅱ型心肾综合征（cardiorenal syndrome，CRS）病机认识尚不统一，主要有心肾不交、心肾阳虚和血不利为水3种，这些观点从不同层面反映了疾病发展阶段的病理特征。Ⅱ型CRS是心病及肾、心肾同病的状态，其发展多呈慢性经过，每一阶段有其不同的病理特点，分析其动态变化，探讨其病机演变规律，对开展疾病早期防治具有重要意义。本文基于文献研究和临床观察，提出Ⅱ型CRS病机演变规律主要经历4个阶段，即早期为心气不足、初期为阴虚火旺、中期为血瘀水停、后期为阳虚水泛，以期更有效指导临床辨证施治，减少疾病发生，延缓病情进展。

关键词：心肾综合征；心力衰竭；病机

中图分类号：R259.41 文献标识码：A 文章编号：1005-5304(2019)07-0001-04

DOI：10.3969/j.issn.1005-5304.2019.07.001 开放科学（资源服务）标识码（OSID）：

Exploration for Evolution of TCM Pathogenesis of Type Ⅱ Cardiorenal Syndrome WU Huaqin1, ZHANG Bingxuan1, ZHAO Chang2, YANG Yangliulin1, SONG Qingqiao1

1. Guang'anmen Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing 100053, China;

2. Beijing Daxing District Hospital of Integrated Chinese and Western Medicine, Beijing 100076, China

Abstract:The understanding of TCM pathogenesis of type Ⅱcardiorenal syndrome (TⅡCRS) is still not uniform at present. It mainly includes three viewpoints: disharmony between heart and kidney, yang deficiency of heart and kidney, and the unfavorable blood transform into water, which reflect the pathological features of the disease at different stages from different aspects. TⅡCRS is the stage of heart disease affecting kidney, and the condition of simultaneous occurrence of both heart and kidney disease. Besides, the development of TⅡCRS is usually chronic and each stage has different pathological features. Furthermore, to analyze its dynamic changes and explore its evolution mechanism will be of great significance for carrying out early disease prevention and treatment. Based on the literature studies and clinical observations, this article proposed that the evolution of TCM pathogenesis of TⅡCRS mainly has four stages: deficiency of heart qi syndrome at stage 1, hyperactivity of fire due to yin deficiency syndrome at stage 2, blood stasis and water diffusion syndrome at stage 3 and water overflowing due to yang deficiency syndrome at the last stage, with the purpose to guide clinical syndrome differentiation in clinic, reduce the incidence of the disease and delay the progression of the disease.

Keywords: cardiorenal syndrome; heart failure; pathogenesis

Ⅱ型心肾综合征（cardiorenal syndrome，CRS）是指慢性心功能不全导致的肾脏损伤或肾功能不全的一组临床综合征，临床以喘憋、水肿、尿少等为主要临床表现。随着人口老龄化加剧，高龄心力衰竭（以下简称“心衰”）带病生存患者增加，Ⅱ型CRS患者

基金项目：国家自然科学基金（81573799）；中国中医科学院广安门医院所级课题（2014s287）

通讯作者：宋庆桥，E-mail：sqqbj@ 已成为心衰住院患者的重要群体，因此积极开展Ⅱ型CRS的防治具有重要临床意义。

1 对Ⅱ型心肾综合征的认识

中医古籍无“CRS”病名，后世根据其临床表现，

将其归属“喘证”“水肿”“心悸”“痰饮”等范畴。目前对Ⅱ型CRS的病机认识尚不统一，归纳起来主要有“心肾不交”“心肾阳虚”和“血不利为水”，此3种学说均可在一定程度上概括Ⅱ型CRS发展到某个阶段的病理过程，但不能从整体上对其病机进行高度