小儿频复发性肾病中医证型与病理类型的相关性分析

Analysis of Correlation between Types of TCM Syndrome andPathology in Children with Frequent Relapse Nephrotic Syndrome

为探讨小儿频复发性肾病 (FRNS)的中医证型与病理类型的相关性 ,选择 5 0例FRNS患儿 ,采用中医辨证分型和肾穿刺活检病理诊断 ,比较治疗前后血、尿常规 ,血生化、2 4h尿蛋白定量、肾功能检查、免疫指标的变化 ,结果 :①中医证型以肝肾阴虚、脾肾阳虚为主 ,其次为湿热内蕴、肾虚血瘀 ,气阴两虚较少见。②西医分型肾炎型中气阴两虚型与其它证型比较差异显著 (P <0 .0 5 ) ;单纯型中肝肾阴虚与其它证型间有显著性差异 (P <0 .0 5 )。病理类型以弥漫系膜增生性肾小球肾炎 (MsPGN)、系膜增生性肾炎 +局灶节段性肾小球硬化(MsPGN +FSGS)和IgA肾病 (IgAN)为主 ,少数为IgM肾病 (IgMN)、膜性肾病 (MN)、膜增生性肾小球肾炎(MPGN)和局灶性肾炎 (FGN)。MsPGN中以肝肾阴虚多见 ,二者之间呈显著正相关 ;IgAN中湿热内蕴多见 ,二者呈显著正相关 ;MsPGN +FSGS主要见于肝肾阴虚、脾肾阳虚和肾虚血瘀 ,二者之间无显著差异。说明MsPGN、IgAN可以作为肝肾阴虚型和湿热内蕴型的客观指标和辨证依据 ,中药肾康灵对治疗肾虚血瘀型FRNS疗效显著 ,能显著降低复发率 ,减轻副作用。

To investigate the relationship between types of TCM syndrome-type and renal pathology in children with frequent relapse nephritic syndrome(FRNS),50 patient with FRNS were divided into types of yin deficiency of liver and kidney,yang deficiency of spleen and kidney,damp-heat accumulation,both kidney deficieny and blood stasis,both qi and yin deficiency according.All patients were taken percutaneous renal biopsies,and their renal pothomorphology was observed by light microscope,immunofluorescence and electron microscope.Related experimental indexes were examined in all patients.Results:①Yin deficiency of liver and kidney,and yang deficiency of spleen and kidney are commonly,then the damp-heat accumulation,both kidney deficiency and blood stasis.The both qi and yin deficiency is uncommon.②There were 38 cases with simple type NS and 12 cases with nephritic type NS in the all.The yin deficiency of liver and kidney was common in simple type NS(P<0 05),while both qi and yin deficiency was uncommon in nephritic type(P<0 05).The most common pathologies were mesangioprolierative(MsPGN),MsPGN combines focal segmental glomerulosclerosis(FSGS),IgA nephropathy(IgAN),IgM nephropathy (IgMN),membranous nephropathy (MN),membranoprolierative glomerulonephritis (MPGN),and focal glomerulonephritis (FNG) are uncommon.The yin deficiency of liver and kidney is common in MsPGN.There was a significant positive correlation between them,as well as between IgAN and damp-heat accumulation.Conclusion:Renal pathology could be the objective indexes for syndrome differentiation in TCM.ShenKangLing is good in treating FRNS of both kidney deficiency and blood stasis.