杨霓芝教授辨治无症状镜下血尿经验
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摘要
无症状镜下血尿是一种常见的临床发现,各家对其进展、预后莫衷一是,目前现代医学尚缺乏有效治疗方法。杨霓芝教授主张衷中参西、病证结合积极治疗无症状镜下血尿,认为本病病位主要在脾肾,病机是气虚、阴虚为本,湿、热、瘀为标。治疗上,杨教授强调益气活血法为立法遣方之本,贯穿治疗始终,同时,辨证配合清热利湿、凉血止血、滋阴养血法。尤其注意止血不留瘀,调整阴阳以平为期。此外,杨教授还秉承"未病先防,既病防变,瘥后防复"治未病思想,多途径以提高临床疗效。
Asymptomatic Microhematuria(AMH) is a common clinical finding,and the progress and prognosis of patients with AMH are still in dispute. Modern medical currently still lacks effective treatment methods. Professor Yang Nizhi advocates that active treatment of AMH via integrating Chinese and western medicine as well as combining disease with syndrome;meanwhile,believes that the main pathological position of AMH is in the Spleen and Kidney;the pathogenesis is Qi deficiency and Yin deficiency in origin,and Damp-Heat stasis in superficiality.With respect to the treatment,Supplementing Qi and activating Blood circulation emphasized by Professor Yang,which is basis of therapy and prescription throughout AMH. At the same time,it should combine with therapy of clearing Heat and removing Dampness,cooling Blood and hemostasis,nourishing Yin and enriching Blood according to syndrome differentiation.To stop bleeding without inducing stasis and regulating Yin-Yang to seek equilibrium of all parts of human body also emphasized by Professor Yang. Nevertheless,Professor Yang upholds the theory of"preventive treatment of disease"such as"preventing measure taken before the occurrence of disease","preventing measure taken after the occurrence of disease" and"preventing measure taken afterrecovery", which are helpful to improve the clinical curative effect.
Asymptomatic Microhematuria(AMH) is a common clinical finding,and the progress and prognosis of patients with AMH are still in dispute. Modern medical currently still lacks effective treatment methods. Professor Yang Nizhi advocates that active treatment of AMH via integrating Chinese and western medicine as well as combining disease with syndrome;meanwhile,believes that the main pathological position of AMH is in the Spleen and Kidney;the pathogenesis is Qi deficiency and Yin deficiency in origin,and Damp-Heat stasis in superficiality.With respect to the treatment,Supplementing Qi and activating Blood circulation emphasized by Professor Yang,which is basis of therapy and prescription throughout AMH. At the same time,it should combine with therapy of clearing Heat and removing Dampness,cooling Blood and hemostasis,nourishing Yin and enriching Blood according to syndrome differentiation.To stop bleeding without inducing stasis and regulating Yin-Yang to seek equilibrium of all parts of human body also emphasized by Professor Yang. Nevertheless,Professor Yang upholds the theory of"preventive treatment of disease"such as"preventing measure taken before the occurrence of disease","preventing measure taken after the occurrence of disease" and"preventing measure taken afterrecovery", which are helpful to improve the clinical curative effect.
引文
[1]DAVIS R,JONES JS,BAROCASs DA,et al.Diagnosis,Evaluation and Follow-up of Asymptomatic Microhematuria (AMH) in Adults:AUA Guideline[J].JUrol,2012,188(6 Suppl):2473-2481.
[2]CHEN W,LIU Q,WANG H,et al.Prevalence and Risk Factors of chronic kidney Disease:a Population Study in the Tibetan Population[J].Nephrol Dial Transplant,2011,26:1592-1599.
[3]DAVIS R,JONES JS,BAROCAS DA,et al.Diagnosis,Evaluation and Follow-up of Asymptomatic Microhematuria (AMH) in Adults:AUA Guideline[J].J Urol,2012,188(6 Suppl):2473-2481.
[4]RITCHIE CD,BEVAN EA,COLLIER SJ.Importance of Occult Haematuria Found at Screening[J].Br Med J Clin Res Ed,1986,292:681-683.
[5]THOMPSON IM.The Evaluation of Microscopic Hematuria:a Population-based Study[J].J Urol,1987,138:1189-1190.
[6]HORIE S,ITO S,OKADA H,et al.Japanese Guidelines of The Management of Hematuria ,2013[J].Clin Exp Nephrol,2014,18(5):679-689.
[7]庄永泽.持续性镜下血尿肾活检必要性的探讨[J].肾脏透析肾移植杂志,2014,23(5):451-452.
[8]SHARP VJ,BARNES KT,ERICHSON BA.Assessment of Asymptomatic Microscopic Hematuria in Adults[J].Am Fam Physician,2013,88(11):747-754.
[9]ISEKI K,KONTA T,ASAHI K,et al.Association of Dipstick Hematuria with All-cause Mortality in the General Population:Results from The Specific Health Check and Guidance Program in Japan[J].Nephrol Dial Transplant,2018,33(5):825-832.
[10]ISEKI K,IKEMIYA Y,ISEKI C,et al.Proteinuria and The Risk of Developing End-stage Renal Disease[J].Kidney Int,2003,63:1468-1474.
[11]EITNER FRANK,FLOEGE JüRGEN.In search of a Better Understanding of IgA Nephropathy-associated Hematuria[J].Kidney International,2012,82(5):513-515.
[12]VIVANTE A,AFEK A,FRENKEL-NIR Y,et al.Persistent Asymptomatic Isolated Microscopic Hematuria in Israeli Adolescents and Young Adults and Risk for End-Stage Renal Disease[J].JAMA,2011,306(7):729-736.
[13]YAMAGATA K,ISHIDA K,SAIRENCHI T,et al.Risk Factors for Chronic Kidney Disease in a Community-based Population:a 10-year Follow-up Study[J].Kidney Int,2007,71:159-166.
[14]何志军,马路,潘涛,等.单纯性肾性血尿患者肾活检病理资料分析[J].中国中西医结合肾病杂志,2014,15(1):64-65.
[15]段小军,张蕾,金华,等.杨霓芝从阴虚湿热论治肾性血尿经验[J].上海中医药杂志,2010,44(3):2225.
[16]MOHAMMAD KS,BDESHA AS,SNELL ME,et al.Phase Contrast Microscopic Examination of Urinary Erythrocytes to Iocalise Source of Bleeding:an Overlooked Technique?[J].J Clin Pathol,1993,46(7):642-645.
[17]王海燕.肾脏病学[M].2版.北京:人民卫生出版社,1998:457-511.
[18]张再康,王立新,包崑,等.杨霓芝教授运用益气活血法治疗慢性肾脏病的学术思想[J].中国中西医结合肾病杂志,2009,10(2):98-100.
[2]CHEN W,LIU Q,WANG H,et al.Prevalence and Risk Factors of chronic kidney Disease:a Population Study in the Tibetan Population[J].Nephrol Dial Transplant,2011,26:1592-1599.
[3]DAVIS R,JONES JS,BAROCAS DA,et al.Diagnosis,Evaluation and Follow-up of Asymptomatic Microhematuria (AMH) in Adults:AUA Guideline[J].J Urol,2012,188(6 Suppl):2473-2481.
[4]RITCHIE CD,BEVAN EA,COLLIER SJ.Importance of Occult Haematuria Found at Screening[J].Br Med J Clin Res Ed,1986,292:681-683.
[5]THOMPSON IM.The Evaluation of Microscopic Hematuria:a Population-based Study[J].J Urol,1987,138:1189-1190.
[6]HORIE S,ITO S,OKADA H,et al.Japanese Guidelines of The Management of Hematuria ,2013[J].Clin Exp Nephrol,2014,18(5):679-689.
[7]庄永泽.持续性镜下血尿肾活检必要性的探讨[J].肾脏透析肾移植杂志,2014,23(5):451-452.
[8]SHARP VJ,BARNES KT,ERICHSON BA.Assessment of Asymptomatic Microscopic Hematuria in Adults[J].Am Fam Physician,2013,88(11):747-754.
[9]ISEKI K,KONTA T,ASAHI K,et al.Association of Dipstick Hematuria with All-cause Mortality in the General Population:Results from The Specific Health Check and Guidance Program in Japan[J].Nephrol Dial Transplant,2018,33(5):825-832.
[10]ISEKI K,IKEMIYA Y,ISEKI C,et al.Proteinuria and The Risk of Developing End-stage Renal Disease[J].Kidney Int,2003,63:1468-1474.
[11]EITNER FRANK,FLOEGE JüRGEN.In search of a Better Understanding of IgA Nephropathy-associated Hematuria[J].Kidney International,2012,82(5):513-515.
[12]VIVANTE A,AFEK A,FRENKEL-NIR Y,et al.Persistent Asymptomatic Isolated Microscopic Hematuria in Israeli Adolescents and Young Adults and Risk for End-Stage Renal Disease[J].JAMA,2011,306(7):729-736.
[13]YAMAGATA K,ISHIDA K,SAIRENCHI T,et al.Risk Factors for Chronic Kidney Disease in a Community-based Population:a 10-year Follow-up Study[J].Kidney Int,2007,71:159-166.
[14]何志军,马路,潘涛,等.单纯性肾性血尿患者肾活检病理资料分析[J].中国中西医结合肾病杂志,2014,15(1):64-65.
[15]段小军,张蕾,金华,等.杨霓芝从阴虚湿热论治肾性血尿经验[J].上海中医药杂志,2010,44(3):2225.
[16]MOHAMMAD KS,BDESHA AS,SNELL ME,et al.Phase Contrast Microscopic Examination of Urinary Erythrocytes to Iocalise Source of Bleeding:an Overlooked Technique?[J].J Clin Pathol,1993,46(7):642-645.
[17]王海燕.肾脏病学[M].2版.北京:人民卫生出版社,1998:457-511.
[18]张再康,王立新,包崑,等.杨霓芝教授运用益气活血法治疗慢性肾脏病的学术思想[J].中国中西医结合肾病杂志,2009,10(2):98-100.