心肌损伤是尿毒症患者的首要死因。PINK1/Parkin介导的线粒体自噬参与心肌损伤的发生发展。近年来，浊邪作为一 种新型毒邪的代表，已逐渐被研究者推广。该文通过梳理有关浊邪的文献记载，分析其病邪特性及致病特点，认为从正虚 浊伏角度能更全面认识尿毒症心肌损伤的发病机理。尿毒症中，PINK1/Parkin 下调引起线粒体自噬减弱，导致活性氧 （ROS）、炎症因子水平升高，最终引起心肌细胞损伤，这与中医之正虚（主要为肾虚）致浊邪（湿、瘀、痰、毒等）产生，引起 浊伏脉络，暗耗心脉导致心脉虚损的过程相似。基于PINK1/Parkin通路介导的线粒体自噬障碍机制可较好地阐释尿毒症心肌 损伤的正虚浊伏中医病机及扶正祛浊干预尿毒症心肌损伤的原则。在中医正虚浊邪的理论指导下，探索具有特异性的 PINK1/Parkin激动剂，可为尿毒症心肌损伤的治疗拓展思路。

Myocardial injury is the leading cause of death in uremic patients. PINK1/Parkin-mediated mitochondrial autophagy is involved in the progression of myocardial injury. In recent years， pathogenic turbidity has been gradually accepted as a representative of a new type of toxic pathogens by the researchers of traditional Chinese medicine（TCM）. This paper sorts out literature about pathogenic turbidity，analyzes the etiological and pathogenic characteristics of pathogenic turbidity，and suggests that the pathogenesis of uremia-induced myocardial injury can be more comprehensively clarified from the perspective of healthy-qi deficiency resulting in latent pathogenic turbidity. In the patients with uremia，the down-regulation of PINK1/Parkin causes the weakening of mitochondrial autophagy，which leads to the elevation of levels of reactive oxygen species（ROS）and inflammatory factors，and eventually causes the injury of myocardial cell. The above pathogenic mechanism is similar to the process of traditional Chinese medicine（TCM）in which the deficiency of the healthy-qi（in particular kidney deficiency） results in the production of the pathogenic turbidity（showing as dampness，blood stasis，phlegm，toxin and so on）and then causes the pathogenic turbidity hide in vessels and collaterals and gradually injure the heart vessels， and eventually results in the deficiency of heart vessels. The mitochondrial autophagy mechanism mediated by the PINK1 / Parkin pathway is suitalbe for explaining the TCM pathogenesis of uremia-induced myocardial injury，characterized by healthy-qi deficiency resulting in latent pathogenic turbidity， and also is suitable for interpretating the principle of supporting healthy-qi to eliminate pathogenic turbidity for treating uremia-induced myocardial injury. Under the guidance of the theory of healthy-qi deficiency and turbid pathogens in TCM，the development of specific PINK1 / Parkin agonists may expand the approach for the treatment of uremia-induced myocardial injury.

R256；R692.5

国家自然科学基金项目（编号：81960843）；福建省自然科学基金项目（编号：2023J01121169）；龙岩市科技计划项目（编号： FLY2022CWS010098）；福建医科大学启航基金项目（编号：2022QH1340）