中医药改善铁代谢对治疗肾性贫血的研究进展

王雪雯; 周刊

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急救与防护 ›› 2026, Vol. 1 ›› Issue (3) : 68-72.

综述

中医药改善铁代谢对治疗肾性贫血的研究进展

王雪雯¹, 周刊^1,*

作者信息 +

Research Progress on the Improvement of Iron Metabolism by Traditional Chinese Medicine in the Treatment of Renal Anemia

WANG Xuewen¹, ZHOU Kan^1,*

Author information +

文章历史 +

摘要

慢性肾脏病（CKD）患者常伴发肾性贫血（RA）,除促红细胞生成素（EPO）绝对或相对不足外,机体铁代谢紊乱亦参与RA发生。因此,纠正铁代谢紊乱是治疗RA的重要环节。现阶段研究表明,中医药能够通过调控铁代谢改善RA,在RA的临床治疗中疗效确切,具有广阔的发展前景。本文系统梳理了运用中药单药及复方靶向调节铁代谢以改善RA的相关文献,并对铁代谢的中医辨治进展进行汇总与分析,旨在为RA的综合防治提供新思路。

Abstract

Patients with chronic kidney disease (CKD) often suffer from renal anemia (RA). Besides the absolute or relative insufficiency of erythropoietin (EPO), the disorder of iron metabolism in the body also participates in the occurrence of RA. Therefore, correcting the disorder of iron metabolism is an important part of treating RA. Current studies have shown that traditional Chinese medicine can improve RA by regulating iron metabolism. In clinical practice, it has proven to be effective and has a promising future. This article systematically reviews the relevant literature on the use of single Chinese medicine and compound medicines to target and regulate iron metabolism to improve RA, and summarizes and analyzes the progress in the diagnosis and treatment of iron metabolism in traditional Chinese medicine. The aim is to provide new ideas for the comprehensive prevention and treatment of RA.

导出引用

王雪雯, 周刊. 中医药改善铁代谢对治疗肾性贫血的研究进展[J]. 急救与防护. 2026, 1(3): 68-72

WANG Xuewen, ZHOU Kan. Research Progress on the Improvement of Iron Metabolism by Traditional Chinese Medicine in the Treatment of Renal Anemia[J]. First Aid & Protection. 2026, 1(3): 68-72

参考文献

[1] 中国病理生理学会肾脏病专业委员会糖尿病肾脏疾病贫血共识专家组.糖尿病肾脏疾病肾性贫血认识与管理中国专家共识(2023年版)[J].中华肾脏病杂志,2023,39(3):229-244.
[2] 苗畅贤,包品,阎小璐,等.血液透析分别联合血液透析滤过和血液灌流对患者肾性贫血的影响[J].河北医学,2021,27(5):823-826.
[3] 中国医师协会肾脏内科医师分会肾性贫血指南工作组.中国肾性贫血诊治临床实践指南[J].中华医学杂志,2021,101(20):40.
[4] LI Y, SHI H, WANG W M, et al.Prevalence, awareness, and treatment of anemia in Chinese patients with nondialysis chronic kidney disease: first multicenter, cross-sectional study[J].Medicine, 2016, 95(24): e3872.
[5] 黄思梅,胡煜琳.罗沙司他与重组人促红素联合静脉铁剂治疗铁达标的维持性血液透析患者肾性贫血的疗效比较[J].中国临床医生杂志,2023,51(5):574-577.
[6] 李海男,印璞,金玉芬,等.慢性肾脏病促红细胞生成素抵抗原因分析及研究进展[J].中国实验诊断学,2020,24(11):1927-1931.
[7] BAYIR H, DIXON S J, TYURINA Y Y, et al.Ferroptotic mechanisms and therapeutic targeting of iron metabolism and lipid peroxidation in the kidney[J].Nature Reviews Nephrology, 2023, 19(5): 315-336.
[8] HANNA R M, STREJA E, KALANTAR-ZADEH K.Burden of anemia in chronic kidney disease: beyond erythropoietin[J].Advances in therapy, 2021, 38(1): 52-75
[9] SHAIKH W, SURATKAL L, BHAVE A.Rare case of hemolytic anemia and distal renal tubular acidosis in an adult due to homozygous SLC4A1 mutation[J].Indian Journal of Nephrology, 2023, 33(3): 209-212.
[10] 中国医师协会肾脏内科医师分会肾性贫血指南工作组.中国肾性贫血诊治临床实践指南[J].中华医学杂志,2021,101(20):1463-1502.
[11] Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease[J].Kidney Int, 2024, 105(4S):S117-S314.
[12] 李伟英,陈崴.肾性贫血铁代谢指标的评估、判读及应用[J].中国实用内科杂志,2020,40(12):1010-1014.
[13] LI Y, SHI H, WANG W M, et al.Prevalence, awareness, and treatment of anemia in Chinese patients with nondialysis chronic kidney disease: first multicenter, cross-sectional study[J].Medicine, 2016, 95(24): e3872.
[14] WISH J B.What are the Considerations in Balancing Benefits and Risks in Iron Treatment?: The Benefits of Intravenous Iron[C]//Seminars in dialysis. 2016, 30(1): 20-22.
[15] 黄雁. 铁蛋白评估铁储备对治疗维持性血液透析患者贫血的临床价值[J].临床肾脏病杂志,2017,17(9):561-563.
[16] AGARWAL A K, YEE J. hepcidin[J].Advances in chronic kidney disease, 2019, 26(4): 298-305.
[17] BABITT J L, LIN H Y.Molecular mechanisms of hepcidin regulation: implications for the anemia of CKD[J].American journal of kidney diseases, 2010, 55(4): 726-741.
[18] AREZES J, FOY N, MCHUGH K, et al.Antibodies against the erythroferrone N-terminal domain prevent hepcidin suppression and ameliorate murine thalassemia[J].Blood, The Journal of the American Society of Hematology, 2020, 135(8): 547-557.
[19] 郑婧,熊瑛,张曙红,等.铁调素在肾性贫血中的研究进展[J].广西医科大学学报,2023,40(11):1914-1920.
[20] 安继仁,杨新栎,高晓萌,等.铁代谢的中医病机探讨与中药干预机制研究进展[J].中医药学报,2023,51(12):106-112.
[21] 邢玉瑞. 中医基础理论[M].北京:人民卫生出版社,2011.
[22] 王扬钢,茅燕萍.茅燕萍对肾性贫血的诊治经验[J].世界最新医学信息文摘,2019,19(86):209.
[23] 李雯圆,李红,王政丽,等.彭涛教授基于“脾肾同治”理论辨治肾性贫血经验[J].亚太传统医药,2025,21(1):99-102.
[24] 刘琼,王旭方,江燕,等.余承惠教授治疗肾性贫血经验撷菁[J].中国医药导报,2019,16(12):130-133.
[25] 刘梅洁,吴佳莹,李艳,等.左归丸对骨质疏松症模型大鼠铁过载的影响[J].中医杂志,2018,59(9):777-780.
[26] 何苗,齐利丽,朱丽红,等.当归补血汤对妊娠期大鼠铁缺乏症状的改善作用及对铁代谢的影响[J].中医药导报,2021,27(9):25-30.
[27] 武晓妹,董叶朋,何宇川,等.滋肾生血方对维持性血液透析肾性贫血的疗效及对铁代谢、血脂的影响[J].河北中医药学报,2022,37(4):44-47.
[28] DING L, TAN Y, XU L, et al.Shengxuening Extracted from Silkworm Excrement Mitigates Myelosuppression via SCF‐Mediated JAK2/STAT3 Signaling[J].Chemistry & Biodiversity, 2021, 18(6): e2100139.
[29] ZENG Q, WANG X H, YANG L P, et al.Shengxuening versus oral iron supplementation for the treatment of renal anemia: A systematic review[J].Journal of Translational Internal Medicine, 2020, 8(4): 245-254.
[30] MEI H, WU N, HUANG X, et al.Possible mechanisms by which silkworm faeces extract ameliorates adenine-induced renal anaemia in rats[J].Journal of Ethnopharmacology, 2021, 266: 113448.
[31] 胡建广,闫静,钟小仕,等.生血宁片联合rhEPO对老年肾性贫血患者微炎症状态的影响[J].实用中西医结合临床,2019,19(11):20-22.
[32] 刘璐,许岭,王允吉,等.生血宁片结合罗沙司他治疗肾性贫血临床疗效研究[J].中华中医药学刊,2022,40(9):247-250.
[33] 张磊,王亿平,金华,等.清肾颗粒对肾性贫血患者炎症/铁调素轴及铁代谢的干预机制:单中心前瞻性随机对照研究[J].南方医科大学学报,2019,39(10):1155-1159.
[34] 刘哲. 健脾生血颗粒联合左卡尼汀治疗慢性肾衰竭肾性贫血患者的效果[J].中国民康医学,2020,32(22):100-102.
[35] 蒋亚丽,王辉.当归药性与功用考证[J].中医药导报,2019,25(11):72-74,77.
[36] 周美丽,韩妮萍.当归的有效成分及药理作用研究进展[J].环球中医药,2024,17(7):1420-1427.
[37] 任伟钰,郑宜鋆,张月梅,等. 当归多糖药理作用的研究进展[J].时珍国医国药,2020,31(10):2484-2487.
[38] ZHANG Y, LI M M, ZENG F, et al.Study to establish the role of JAK2 and SMAD1/5/8 pathways in the inhibition of hepcidin by polysaccharides from Angelica sinensis[J].Journal of ethnopharmacology, 2012, 144(2): 433-440.
[39] ZHANG Y, CHENG Y, WANG N, et al.The action of JAK, SMAD and ERK signal pathways on hepcidin suppression by polysaccharides from Angelica sinensis in rats with iron deficiency anemia[J].Food & function, 2014, 5(7): 1381-1388.
[40] 张晨宇,刘波,袁志军,等. 基于Hepcidin/OPG-RANKL轴探讨当归多糖改善大鼠肾性贫血线粒体功能异常的作用机制[J].中药材,2020,43(7):1697-1701.
[41] 国家药典委员会.中国药典[S].北京:中国医药科技出版社,2015:194
[42] 高志杰,朱彤彤,牛新茹,等.鸡血藤化学成分及药理活性研究进展[J].辽宁中医药大学学报,2022,24(4):67-74.
[43] 侯岚,李保生,韦宝敏,等.鸡血藤提取物通过PI3K/AKT通路对缺铁性贫血大鼠的药效和作用机制研究[J].海南医科大学学报,2025,31(13):970-978.
[44] 姚惠,杨维佳,杨敏春,等.口服铁剂联合鸡血藤水煎液治疗缺铁性贫血对机体铁代谢的临床疗效及安全性分析[J].中华全科医学,2016,14(4):540-543
[45] GUAN Y, AN P, ZHANG Z, et al.Screening Identifies the Chinese Medicinal Plant Caulis Spatholobi as an Effective HAMP Expression Inhibitor1-3[J].The Journal of nutrition, 2013, 143(7): 1061-1066.
[46] 陈大勇,张凤先,侯丹阳,等.黄芪化学成分及药理作用研究进展[J].人参研究,2025, 37(5): 92-96.
[47] 叶枝红,谢海纳,钱知知,等.黄芪甲苷对“铁超载”所致小鼠肝损伤的保护作用[J].中国实验方剂学杂志,2018,24(8):116-121.
[48] SONG Q, ZHAO Y, YANG Y, et al.Astragaloside IV protects against retinal iron overload toxicity through iron regulation and the inhibition of MAPKs and NF-κB activation[J].Toxicology and Applied Pharmacology, 2021,410:115361.
[49] 聂取,王洪新.基于TLR4/NF-κB通路探讨黄芪甲苷对炎症性贫血的改善作用[J].中国中医药科技,2020,27(4):542-546.