中医药防治高尿酸血症伴肾功能不全的研究进展：机制、疗效与临床评价

Research Progress on Traditional Chinese Medicine in the Prevention and Treatment of Hyperuricemia with Renal Insufficiency: Mechanisms, Efficacy, and Clinical Evaluation

摘要: 高尿酸血症(hyperuricemia, HUA)不仅是痛风的重要致病因素，亦是慢性肾脏病(chronic kidney disease, CKD)进展的独立危险因素。部分患者进一步发展为高尿酸血症伴肾功能不全(hyperuricemia with renal insufficiency, HURI)及尿酸性肾病(uric acid nephropathy, UAN)。目前西医治疗主要依赖黄嘌呤氧化酶抑制剂和尿酸排泄药物，但长期应用易出现不良反应、疗效波动及高复发率等问题，亟需探索多靶点干预的替代治疗方案。近年来，基于中医药“多成分、多靶点”协同作用的特点，围绕“降尿酸–抗炎–肾保护”全链路干预的研究逐渐成为热点。基础研究表明，中药可通过调控尿酸代谢(如抑制黄嘌呤氧化酶、调节URAT1、GLUT9等转运体)、抑制炎症反应(如干预NLRP3/NF-κB信号通路)、延缓肾脏纤维化(如阻断TGF-β/Smad3信号通路)等多重机制发挥综合防治作用。临床研究亦证实，辨证施治的中药方剂如健脾渗湿解毒汤、健脾益肾祛瘀汤联合西药治疗，可有效降低血尿酸水平，改善肾功能(eGFR、Scr)及炎症指标，且具有良好的安全性。然而，现有研究普遍存在样本量小、缺乏严谨对照、结局指标单一等问题。未来应遵循PICOS原则，设计高质量、多中心、随机对照临床试验，以进一步阐明中医药在高尿酸血症相关肾损伤防治中的作用机制及临床价值。

Abstract: Hyperuricemia (HUA) is not only an important pathogenic factor of gout, but is also an independent risk factor for the progression of chronic kidney disease (CKD). Some patients may further develop hyperuricemia with renal insufficiency (HURI) and uric acid nephropathy (UAN). At present, conventional Western medical treatment mainly relies on xanthine oxidase inhibitors and uricosuric agents. However, long-term use may be associated with adverse reactions, variable efficacy, and a high recurrence rate. Therefore, alternative multi-target therapeutic strategies need to be further explored. In recent years, Traditional Chinese Medicine (TCM), characterized by multi-component and multi-target synergistic effects, has attracted increasing attention for its comprehensive intervention in uric acid reduction, anti-inflammation, and renal protection. Basic research has shown that Chinese herbal medicine may exert comprehensive preventive and therapeutic effects through multiple mechanisms, including regulation of uric acid metabolism, such as inhibition of xanthine oxidase and modulation of urate transporters including URAT1 and GLUT9; suppression of inflammatory responses, such as regulation of the NLRP3/NF-κB signaling pathway; and delay of renal fibrosis, such as inhibition of the TGF-β/Smad3 signaling pathway. Clinical studies have suggested that syndrome differentiation-based Chinese herbal prescriptions, such as Jianpi Shenshi Jiedu Decoction, Jianpi Yishen Quyu Decoction, combined with Western medicine, may reduce serum uric acid levels, improve renal function indicators including eGFR and Scr, and regulate inflammatory markers, with favorable short-term safety. However, current studies are generally limited by small sample sizes, lack of rigorous controls, and relatively narrow outcome indicators. Future studies should follow the PICOS principle and conduct high-quality, multicenter randomized controlled trials to further clarify the mechanisms and clinical value of TCM in the prevention and treatment of hyperuricemia-related kidney injury.