原发性肝癌分子靶向药物相关蛋白尿中西医结合诊疗专家共识

原发性肝癌分子靶向药物相关蛋白尿中西医结合诊疗专家共识工作组

doi:10.12449/JCH260505

原发性肝癌分子靶向药物相关蛋白尿中西医结合诊疗专家共识

DOI: 10.12449/JCH260505

原发性肝癌分子靶向药物相关蛋白尿中西医结合诊疗专家共识工作组

基金项目:

国家科技重大专项 (2024ZD0526200);

深圳市“医疗三名工程” (SZZYSM202411013)

利益冲突声明：本文不存在任何利益冲突。

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- 文章访问数: 12
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- 被引次数: 0
出版历程
- 收稿日期: 2026-04-17
- 录用日期: 2026-04-21
- 出版日期: 2026-05-20

Expert consensus on the integrated traditional Chinese and Western medicine diagnosis and treatment of proteinuria associated with molecular targeted drugs for primary liver cancer

Work Group of Expert Consensus on the Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment of Proteinuria Associated with Molecular Targeted Drugs for Primary Liver Cancer

Research funding:

National Science and Technology Major Project (2024ZD0526200);

Shenzhen Medical and Health “Three Famous Projects” (SZZYSM202411013)

摘要

摘要: 蛋白尿是原发性肝癌患者接受分子靶向药物治疗过程中常见的不良反应，属于中医学“尿浊”“水肿”“虚劳”等范畴。目前肝癌靶向药物相关蛋白尿尚缺乏特效的临床治疗和监测管理手段，中西医结合是有效的防治手段。本标准工作组在遵循循证医学原则的基础上，结合近年来的临床实践总结，参考国内外最新发表的相关指南与专家共识，通过文献调研、证据等级评价及多学科专家讨论等方法，建立起体现中医药特色优势且便于临床医生操作的中西医结合诊疗专家共识，旨在为中西医结合防治肝癌靶向药物相关蛋白尿的临床实践提供参考。
- 肝肿瘤 /
- 蛋白尿 /
- 中西医结合疗法 /
- 诊疗准则
Abstract: Proteinuria is a common adverse reaction in patients with primary liver cancer undergoing molecular targeted therapy and falls in the categories of “turbid urine”， “edema”， and “consumptive disease”， among others， in traditional Chinese medicine. Currently， there is a lack of specific clinical treatments and monitoring and management strategies for proteinuria associated with targeted drugs for liver cancer， and integrated traditional Chinese and Western medicine therapy is an effective prevention and treatment method. Following the principles of evidence-based medicine and using the methods of literature review， grading of evidence， and multidisciplinary expert discussions， the work group established an expert consensus on integrated traditional Chinese and Western medicine diagnosis and treatment with unique advantages of traditional Chinese medicine and convenient clinical operation with reference to recent clinical practice experience and the latest guidelines and expert consensus statements in China and globally， in order to provide a reference for the clinical practice of integrated traditional Chinese and Western medicine therapy for proteinuria associated with targeted drugs for liver cancer.
- Liver Neoplasms /
- Proteinuria /
- Integrated Chinese Traditional and Western Medicine Therapy /
- Practice Guideline

HTML全文

注： ACEI，血管紧张素转换酶抑制剂；ARB，血管紧张素受体拮抗剂。

图 1 肝癌靶向药蛋白尿的临床管理流程

Figure 1. Clinical management process of proteinuria induced by hepatocellular carcinoma targeted drugs

下载: 全尺寸图片幻灯片

表 1 临床证据分级标准

Table 1. Grading criteria for clinical evidence

证据等级	具体描述
Ⅰ级	随机对照试验及其系统综述、N-of-1试验系统综述
Ⅱ级	非随机临床对照试验、队列研究、N-of-1试验
Ⅲ级	病例对照研究、前瞻性病例系列
Ⅳ级	规范化专家共识、回顾性病例系列、历史性对照研究
Ⅴ级	非规范化专家共识、病例报告、经验总结

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表 2 GRADE系统推荐强度等级

Table 2. Strength grading of recommendations in GRADE system

推荐强度	具体描述	强度等级
强推荐	充分考虑到了证据的质量、患者可能的预后情况及治疗获益大于风险或风险大于获益	1级
选择性推荐	证据价值参差不齐，推荐意见存在不确定性，或推荐的治疗意见获益风险相当，更倾向于较低等级的推荐	2级
注：GRADE，推荐意见分级的评估、制订和评价。

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表 3 靶向药蛋白尿的中医病机演变规律

Table 3. Evolution law of TCM pathogenesis of proteinuria induced by targeted drugs

分型	主要中医病机	临床表现	实验室检查
轻型	湿热瘀毒蕴结	尿泡沫略多，舌红苔黄腻	尿常规中尿蛋白为+，伴/不伴24 h尿蛋白定量<1 g
中型	脾肾气虚，封藏失职	尿泡沫明显增多，足部水肿，乏力	尿常规中尿蛋白为++～+++，24 h尿蛋白定量在 1～3.5 g
重型	脾肾不足，阳虚不固	尿中大量泡沫，畏寒肢冷，下肢浮肿，乏力倦怠	尿常规中尿蛋白为++++，24 h尿蛋白定量>3.5 g

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表 4 NCI蛋白尿分级标准

Table 4. NCI Grading criteria for proteinuria

分级	具体描述
0级	蛋白尿阴性
1级	尿蛋白+，或24 h尿蛋白定量≥正常上限值但<1.0 g
2级	尿蛋白++和+++，或24 h尿蛋白定量在1.0～3.5 g
3级	尿蛋白++++，或24 h尿蛋白≥3.5 g，血清白蛋白正常
4级	肾病综合征
注：NCI，美国国家癌症研究所。

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表 5 治疗靶向药蛋白尿的中成药汇总

Table 5. Summary of Chinese Patent Medicines for targeted drug-induced proteinuria

证型	推荐中成药	安全性	证据等级	推荐强度
湿热蕴结证	黄葵胶囊^［57］	个别患者用药后出现上腹部胀满不适	Ⅲ级	强推荐
瘀阻肾络证	肾康注射液^{［50，59］}	个别患者使用后可能会出现红肿瘙痒，恶心呕吐和头痛头晕等症状	Ⅴ级	选择性推荐
湿热血瘀证	雷公藤多苷片^［60］	个别患者出现黄疸、转氨酶升高，严重者可出现肝肾功能损伤等	Ⅴ级	选择性推荐
湿浊证	海昆肾喜胶囊^［50］	个别患者服用后可能出现胃脘不适，纳差	Ⅴ级	选择性推荐
气阴两虚证	肾炎康复片^{［50，59］}	比较安全	Ⅴ级	选择性推荐
脾肾气虚证	百令胶囊^{［50，59］}	个别患者可能出现牙龈肿痛或咽干咽痛等表现	Ⅴ级	强推荐
脾肾气虚证	金水宝胶囊^{［50，59］}	同上	Ⅴ级	强推荐
脾虚湿浊血瘀证	尿毒清颗粒^{［50，59］}	个别患者服用后可能会出现排便次数增多	Ⅴ级	选择性推荐
脾胃气虚、浊瘀内阻证	肾衰宁胶囊^{［50，59］}	个别患者服用后可能会出现排便次数增多	Ⅴ级	选择性推荐

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