IgA肾病血瘀证与临床病理的相关性研究

Study on the Relationship between Blood Stasis Syndrome and Clinical Pathology in Patients with IgA Nephropathy

目的探讨IgA肾病血瘀证与临床病理指标之间的相关性.方法分析94例IgA肾病血瘀证患者的临床与病理资料.结果94例IgA肾病患者中,血瘀证占61.70%,非血瘀证占38.30%.血瘀证组中医宏观辨证以舌质紫暗最常见;临床多表现为蛋白尿伴血尿,常伴高血压和肾功能不全;血肌酐、甘油三酯、血纤维蛋白原水平明显高于非血瘀证组,活化部分凝血活酶时间、尿型纤溶酶原激活物水平明显低于非血瘀证组;Lee's分级多见于Ⅲ～Ⅴ级者;肾小球球性硬化、肾小管间质总积分、间质炎细胞浸润、间质纤维化、肾小管萎缩和血管积分均显著高于非血瘀证组.结论IgA肾病血瘀证与临床指标及肾组织病变程度有关,中医宏观辨证与现代医学微观辨证相结合更有利于揭示IgA肾病血瘀证的实质.

Objective To explore the relationship between blood stasis Syndrome and clinical pathological parameters in patients with lgA nephropathy （IgAN）. Methods The clinicopathological data were analyzed of 94 IgAN patients of traditional Chinese medicine blood stasis syndrome. Results Of the 94 IgAN patients, 61.70% had blood stasis syndrome （BS） and 38.30% had non- blood stasis syndrome （non-BS）. In patients with BS, dark purple tongue proper was the symptom most commonly seen; the clinical manifestations were mostly proteinuria with hematuria, often accompanied with hypertension and renal dysfunction. Compared with those in patients without BS, plasma levels of serum creatinine （SCr）, triglyceride （TG） and plasma fibrinogen （FIB） were obviously higher, activated partial thromboplastin time （APTT）, and urokinase-type plasminogen activators （u-PA） significantly lower; and scores of glomerular sclerosis, tubular interstitial lesions, interstitial inflammatory cell infiltration, interstitial fibrosis, tubular atrophy and vascular sclerosis significantly higher. Besides, the Lee＇s grades in them of Ⅲ - Ⅴ were mostly seen. Conclusion Blood stasis syndrome of IgAN are correlated with certain clinical parameters and severity of renal pathological changes. The combination of TCM holistic syndrome differentiation and modern medicinal micro-differentiation is more favorable for making clear the nature of blood stasis Syndrome of IgAN.