基于队列随访观察探讨过敏性紫癜性肾炎患者的中医证型

Investigation on traditional Chinese medicines syndromes of patients with henoch-schonlein purpura nephritis based on cohort follow-up observation

目的基于队列随访观察探索过敏性紫癜性肾炎中医辨证分型分布特点,指导临床诊治。方法收集2013年1月~2018年2月于浙江中医药大学附属广兴医院就诊,确诊为过敏性紫癜性肾炎的130例患者的一般资料、中医证候、肾穿刺病理报告及临床指标,并对患者辨证分组;分析中医证型的分布规律及各辨证分组间临床指标的差异。结果在130例过敏性紫癜性肾炎的患者中,男54例(占41.5%),女76例(占58.5%);平均年龄(33.04±16.55)岁。辨证包含肾虚证115例,包含瘀痹证113例,包含风湿证56例,包含肝风证27例,包含溺毒证3例。比较临床病理指标及预后情况发现:风湿证组患者的24 h蛋白定量及新月体比例大于非风湿证组,肾功能下降更快(P=0.011)。肝风证组血肌酐、24 h蛋白定量高于非肝风证组患者,而估算肾小球滤过率低于非肝风证组,肾功能下降更快(P=0.005)。风热证组基质炎细胞浸润和小管萎缩/间质纤维化程度高于非风热证组,其余临床指标及预后分析无明显差异。结论肾虚证和瘀痹证是过敏性紫癜性肾炎的基本证候,风湿证是本病主要证候,是可以及时干预、逆转病情的关键阶段,肝风证是本病的进展阶段,预后欠佳,风热证不是影响本病的主要证候。

Objective To explore the characteristics of traditional Chinese medicine(TCM)syndrome differentiation and distribution of Henoch-Schonlein purpura nephritis based on cohort follow-up observation,and to provide guidance in clinical diagnosis and treatment.Methods General information,TCM syndromes,renal puncture pathological reports and clinical indexes of 130 patients who were treated and diagnosed with henoch-schonlein purpura nephritis at Guangxing Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine from January 2013 to February 2018 were collected,and the patients were divided into syndrome differentiation groups;the distribution rules of TCM syndromes and the differences in clinical indexes among different syndrome differentiation groups were analyzed.Results Among 130 patients with henoch-schonleinpurpura nephritis,there were 54(accounting for 41.5%)males and 76(accounting for 58.5%)females,with an average age of(33.04±16.55)years old.After syndrome differentiation,there were 115 patients with kidney deficiency syndrome,113 patients with stasis syndrome,56 patients with rheumatic syndrome,27 patients with liver wind syndrome,and 3 patients with toxic drowning syndrome.After comparing the clinical case indexes and prognosis,it was found that the 24 h protein quantification and proportion of crescent body in the rheumatic syndrome group were higher than those in the non-rheumatic syndrome group,and the renal function decreased faster(P=0.011).The serum creatinine and 24 h protein quantification in the liver wind syndrome group were higher than those in the non-liver wind syndrome group,while the estimated glomerular filtration rate was lower than that in the non-liver wind syndrome group,and the renal function decreased faster(P=0.005).The degree of stromal inflammatory cell infiltration and tubular atrophy/interstitial fibrosis in the wind-heat syndrome group was higher than that in the non-wind-heat syndrome group,and there was no significant difference in other clinical indexes and prognostic analysis.Conclusion Kidney deficiency syndrome and stasis syndrome are the basic syndromes of henoch-schonlein purpura nephritis;rheumatic syndrome is the main symptom of this disease,and is the key stage to intervene and reverse the condition in time;liver wind syndrome is the progressive stage of the disease,with poor prognosis;and wind-heat syndrome is not the main syndrome affecting this disease.