IgA肾病继发局灶节段性肾小球硬化与中医虚、瘀、风湿的相关性——附182例临床病理与中医证候学分析

Correlation Between Clinical Manifestations and Pathological Symptoms of IgA Nephrology with Secondary Segmental Glomerulosclerosis

目的:探讨IgA肾病继发局灶节段性肾小球硬化(IgAN-sFSGS)的临床和病理表现与中医虚、瘀、风湿证候的相关性.方法:对182例IgAN-sFSGS患者进行临床一般情况、实验室指标、临床分型、肾病理各项参数和中医气阴两虚、脉络瘀阻、风湿内扰证候的半定量积分进行相关性分析,以研究中医证候演变规律及其在疾病发展中的意义.结果:IgA-sFSGS的中医证候,主要呈气阴两虚伴脉络瘀阻的二联证候(36例,占19.78%),以及在二联证基础上伴风湿内扰证的三联证候(146例,占80.22%).三联证与二联证在临床高血压/慢性肾衰竭型的构成比为24.66%与16.67%、在大量蛋白尿/肾病综合征型的构成比则为24.66%与2.78%,有统计学差异(P＜0.05,χ2=20.530).三联证患者的血肌酐、尿酸、尿蛋白定量均较二联证增高,而血白蛋白及肌酐清除率则较二联证降低(P＜0.05);肾病理损害程度则较二联证严重(P＜0.05～0.001).结论:(1)二联证是IgAN-sFSGS的基本证候;(2)由二联证向三联证演变显示本病病情由轻转重;反之则预示病情趋向稳定;(3)在IgAN-sFSGS的病情经过中,由二联转入三联时,若加用有效的祛风胜湿中药可望减轻或逆转病情.

Objective.To study the correlation between the clinical manifestations of Su, Yu and Fengshi in Chinese traditional medicine（TCM） and the clinical and pathological syndromes in IgA Nephrology with secondary segmental glonerulosclerosis（ IgAN - sFSGS）. Methods.General status, biochemical values, clinical typings, pathological parameters and clinical manifestations of Xu, Yu and Fengshi were observed in 182 patients with IgAN - sFSGS. Results. In IgAN - sFSGS, the clinical manifestations were either qiyinliangsu with mailuyuzu（di- united wymptoms, DS） or qiyinliangxu with mailuoyuzu and fengshinirao（Triad symptoms,T S）. Hypertension/chronic renal failure was more common in patients with TS than with those with DS（24.66% vs 16.67% ）, and the incidence of heavy proteinuria/nephritic syndrome was higher（24.66% vs 2.78% ） with a significant difference（P〈0.05, X^2 = 20. 530）. The values of blood creatinin, uric acid and urine protein in patients with TS were significantly high than those in patients with DS. However, the values of serum albumin and Creatinin Clearance were significantly lower than those in patients with TS（ P 〈 0.05）. The scores in most pathological parameters were significantly higher in the patients with TS than those in the patients with DS（ P 〈 0.05 - 〈 0. 001 ）. Conclusion： （ 1 ） Ds is the basic clinical manifestation in IgAN - sFSGS. （2）Evolution of DS to TS suggests that the patient＇ s condition may turn worse and vice versa. （3）If patients were actively treated by TCM of qufengshengshi when their clinical manifestations change from DS to TS, the patients＇ disease may be improved or reserved.