1148例IgA肾病患者的中医证候学研究——附两种辨证方案与临床病理相关性分析

Study on Syndrome-Manifestation of Traditional Chinese Medicine in 1148 Patients with IgA Nephropathy

目的:对IgA肾病进行大样本的中医证候学调研,旨在探索能正确反映IgA肾病中医证候、病机及其演变规律的创新辨证方案。方法:用流行病学现场调查方法,收集1148例IgA肾病患者的舌、苔、脉象,症状、实验室检查及肾病理资料。以原方案及新方案两种辨证方法,分别辨证,并比较其与临床病理的相关性。结果:新方案分肾虚、瘀痹、风湿、肝风和溺毒五证,每一证候有主症、次症,主症均设客观和定量指标,结果以肾虚证最为多见(38.9%),其次为风湿证(25.7%),肝风证(16.8%),瘀痹证(14.6%),溺毒证(4.0%)。各证候与实验室检测指标,以及肾病理的Katafuchi评分,Andreoli方法的AI/CI指数均具相关性,各证候间差异有统计学意义(P<0.05～0.01)。结论:IgA肾病辨证新方案,简明扼要,实用有效,贴近临床,有利于及时判断IgA肾病的独立危险因素,可逆因素,以及对预后的强预测因子。

Objective：To explore a new method of TCM syndrome-differentiation in patients with IgA nephropathy （IgAN）,which can show the exact pathogenesis and rule of syndrome-variation,through a large-sample investigation of syndrome-manifestation.Methods：Epidemiological field survey was adopted to collect the information of 1 148 IgA nephropathy patients,including tongue,pulse,symptoms,laboratory and renal biopsy findings.The old （B） and new （A） methods of syndrome-differentiation were made,and their correlations with clinic symptoms and renal biopsy were compared.Results：Method A included five syndromes--Qi-Yin Deficiency,Blood Stasis,Wind-dampness,Liver-wind and Ni-du,and each syndrome had its primary symptoms and secondary ones.The most common syndrome in the 1148 IgAN patients was Qi-Yin Deficiency（38.9%） followed by Wind-dampness（25.7%）,Liver-wind （16.8%）,Blood Stasis（14.6%） and Ni-du（4.0%）.The correlations between each syndrome and its laboratory and renal biopsy findings had significant difference with P〈0.01～0.05.Conclusion：Compared with Method B,Method A is more concise,pragmatic and effective.With Method A,the independent-risk factor,reversible factor and prognosis factor can be evaluated with much more ease.