中医药治疗心肾代谢综合征研究进展

Research progress in the treatment of cardiovascular-kidney-metabolic syndrome with traditional Chinese medicine

关键词:  心肾代谢综合征  中医药  辨证论治

Key words:  cardiovascular-kidney-metabolic syndrome  traditional Chinese medicine  treatment based on pattern identification

摘要:

心血管-肾脏-代谢综合征（CKM）涉及心脏、肾脏与代谢，传统专科碎片化诊疗方案难以有效阻断其进程。由于CKM的概念2023年才被提出，中医药对CKM的临床与基础研究尚处于起步阶段，证据基础相对有限。中医学整体观念与辨证论治契合CKM统一管理与个体防控的需求，为CKM的诊疗提供了新思路。基于现有文献分析与理论探讨，从临床症状及演变规律初步来看，CKM可尝试归属于中医学“脾瘅”“水肿”“胸痹”等范畴，其核心病机可能概括为心脾肾虚、痰瘀互结，证候呈现由脾及肾、由实转虚的动态演变趋势：1期脾虚湿盛、痰浊内生；2期脾肾两虚、痰瘀互结；3期痰瘀浊毒、损心伤肾；4期浊毒内盛、阴阳衰败。在机制研究层面，现有证据表明中药可通过调控腺苷酸活化蛋白激酶（AMPK）、核因子-κB（NF-κB）等多条通路，在能量代谢、抗纤维化、改善心肌重构等方面发挥多器官保护作用。基于上述理论分析，文章尝试系统梳理CKM的中医病机与证治规律，初步提出分期论治的框架性方案，并整合中药多器官保护的现代研究证据，以期为CKM的诊疗提供理论参考与实践启示。

Abstract:

Cardiovascular-kidney-metabolic (CKM) syndrome is a clinical condition involving the heart, kidneys, and metabolism. The traditional fragmented, specialty-based approach is insufficient to effectively halt its progression. Since the concept of CKM was introduced in 2023, research on CKM in traditional Chinese medicine (TCM) is still in its early stages, with limited evidence. The holistic concept and treatment based on pattern identification in TCM align with the need for integrated management combined with individualized prevention and control, offering a novel approach to CKM diagnosis and treatment. Based on current literature analysis and theoretical exploration, and from the perspective of clinical symptoms and patterns of progression, CKM may be tentatively categorized under the TCM concepts of "pi dan""edema" and "chest impediment". The core pathogenesis is preliminarily characterized as deficiency of heart, spleen and kidney, with intertwined phlegm and blood stasis, suggesting a dynamic evolution from the spleen to the kidney and from excess to deficiency: stage 1 manifests as spleen deficiency with dampness exuberance and internal generation of turbid phlegm; stage 2 presents as dual deficiency of the spleen and kidney with intermingling of phlegm and stasis; stage 3 involves turbid phlegm and stasis transforming into turbid toxins, damaging the heart and kidney; stage 4 is characterized by internal exuberance of turbid toxins with decline of both yin and yang. Regarding mechanistic studies, current evidence suggests that Chinese herbal medicines exert multi-organ protective effects-modulating energy metabolism, inhibiting fibrosis, and improving myocardial remodeling-by regulating multiple pathways including AMPK and NF-κB. Based on the above theoretical analysis, this paper attempts to systematically review the TCM pathogenesis and pattern differentiation and treatment principles of CKM, preliminarily proposes a stage-based treatment framework, and integrates evidence from modern studies on the multi-organ protective effects of Chinese herbal medicines, aiming to provide theoretical insights and practical implications for CKM management.