基于“肠-肾”途径的健脾祛湿中药抗痛风病研究王雨褚梦真李文静林志健张冰摘要目的：從“肠-肾”途径探讨健脾祛湿中药防治痛风病作用。方法：10%果糖塑造大鼠高血尿酸模型，高钙高嘌呤食饵并限水诱导鹌鹑尿酸盐沉积模型，以菊苣、参苓白术散为示例药。生化检测大鼠血清尿酸（SUA）、粪便尿酸（FUA）水平，计算肾脏尿酸清除率（RCUA）;检测鹌鹑粪尿中尿酸含量，计算尿酸排泄量。免疫组化分析大鼠肠道ABCG2、肾脏URAT1、OAT1，及鹌鹑肠道Occludin、肾脏p-p65表达。六胺银染色分析尿酸盐沉积。结果：1）菊苣可显著降低模型大鼠SUA、增加FUA、RCUA，促进肠道ABCG2表达，减少肾脏URAT1表达。2）参苓白术散可显著减少模型鹌鹑肾脏尿酸盐沉积，增加尿酸排泄量，增加肠道Occludin表达，减少肾脏p-p65表达。结论：痛风病发生发展中存在“肠-肾”途径的病理改变，健脾祛湿中药通过调节“肠-肾”尿酸转运促尿酸排泄、改善肠道屏障功能及肾脏炎症状态以祛除尿酸盐沉积，共同发挥防治痛风病作用。关键词“肠-肾”途径;健脾祛湿中药;痛风病;高血尿酸;尿酸盐沉积StudyonAnti-goutDiseaseofTraditionalChineseMedicinesforInvigoratingSpleenandRemovingDampnessBasedonIntestineandKidneyAxisWANGYu，CHUMengzhen，LIWenjing，LINZhijian，ZHANGBing（SchoolofChineseMateriaMedica，BeijingUniversityofChineseMedicine，Beijing102488，China）AbstractObjective：Fromthe“intestine-kidney”axistoexploretheanti-goutdiseaseeffectoftraditionalChinesemedicineforinvigoratingspleenandremovingdampness.Methods：10%fructosecreatedaratmodelofhighblooduricacid，ahigh-calcium，high-purinedietandwaterrestrictioninducedquailuratedepositionmodel，withCichoriumintybusL.andShenlingbaizhuPowderasexampledrugs.Biochemicaldetectionofratserumuricacid（SUA）andfecaluricacid（FUA）levelsweredetected.Therenaluricacidclearance（RCUA）wascalculated;uricacidcontentinquailfecesandurineweredetected;uricacidexcretionwascalculated.RatintestineABCG2，kidneyURAT1，OAT1，quailintestineOccludin，andkidneyp-p65expressionwereanalyzedbyImmunohistochemistry.Hexaminesilverstainingwasusedtoanalyzeuratedeposition.Results：1）CichoriumintybusL.couldsignificantlyreduceSUAlevel，increaseFUAandRCUAlevelsofmodelrats，increaseexpressionofintestinalABCG2anddecreaseexpressionofrenalURAT1.2）ShenlingBaizhuPowdercouldsignificantlyreducetherenaluratedepositioninquails，increasetheexcretionofuricacid，aswellasraiseexpressionsofintestinalOccludinanddecreaseexpressionsofrenalp-p65.Conclusion：Therearesomepathologicalchangesof‘intestine-kidneyaxisinthedevelopmentofgoutdisease.TraditionalChinesemedicineforinvigoratingspleenandremovingdampnesscouldpreventandtreatthegoutdiseasebyadjustingtheuratetransportersintheintestineandkidneytopromoteexcretionofuricacid，andimprovingtheintestinalbarriersandrenalinflammatorystatetoremovetheuratedeposition.KeywordsIntestineandkidneyaxis;TraditionalChinesemedicineforinvigoratingspleenandremovingdampness;Goutdisease;Hyperuricemia;Uratedeposition：R242;R285.5：Adoi：10.3969/j.issn.1673-7202.2021.01.003痛风病是指与高尿酸血症、尿酸盐沉积密切相关的进展性代谢性疾病，2020年《高尿酸血症/痛风患者实践指南》根据临床疾病状态，将痛风病理进展分为了3个阶段、8个状态[1]，其中高血尿酸是痛风病发生的重要生化基础，尿酸盐沉积是诱发痛风病急性炎性反应的重要因素。由此提示，降低高血尿酸、减少尿酸盐沉积将有助于抑制痛风病的发生发展。中医学理论认为尿酸代谢异常引起的高血尿酸及其沉积属于“湿邪”“浊滞”范畴，临床常切入脾胃肠肾等器官以健脾化湿泄浊，取得了较好的疗效[2]，本组前期也发现健脾祛湿药物对实验性高血尿酸亦有显著的降低作用[3-4]。现代研究...