IgA肾病中医辨证的多元分析

Multivariate Analysis of TCM Syndromes of IgA Nephropathy

【目的】探讨IgA肾病的病理损害、临床表现及实验室检测指标与中医证型的关系。【方法】分别以Memphis肾活检计分系统指标、慢性肾炎中医辨证标准中的主证及兼夹证作为标准,进行主成分和因子分析,选出最能提示中医证型的病理指标及表达证型变化的证候指标,再将这些指标与标准证型作回归分析,建立各证型回归方程。【结果】①依据“肾活检计分系统”对123例IgA肾病的病理资料进行主成分分析,找出了表达肾小球变化大于85%信息的主成分,包括肾小球硬化、新月体、间质、免疫荧光IgA和补体C3因子。依据原发性肾小球肾炎中医辨证标准证候资料,进行主成分分析,找出了表达证型大于90%的证候信息,虚证:疲倦乏力;阳虚证:肢冷,舌苔白滑,脉沉细;阴虚证:口燥咽干,舌质红,脉细;肝郁证:急躁易怒,口苦,喜叹息,脉弦;血瘀证:舌质暗,舌有瘀斑点;痰湿证:四肢沉重,苔腻,脘痞纳呆;热毒证:咽痛,脓疮,舌苔黄干;湿热证:口苦口粘,苔黄腻。②通过多元回归分析得阴虚证、阳虚证、阴阳两虚证、血瘀证、痰湿证、肝郁证等回归方程。③Logistic非条件回归分析显示阳虚证与水肿关系最大,有水肿的患者出现阳虚的机率约是无水肿患者的1.6倍;阴虚证与尿血关系密切,肉眼尿血越严重阴虚证型表现越明显,肉眼血尿患者出现阴虚证型的机率约为无肉眼血尿患者的1.5倍;而腰背痛则无论阴虚、阳虚或阴阳两虚均可出现。【结论】肾小球硬化、新月体、肾小管萎缩、血管病变、免疫荧光IgA、C3等指标改变包含了IgA肾病病理改变的大部分信息(>85%)。IgA肾病的病理和临床表现与中医辨证相关联。阳虚证与水肿、阴虚证与尿血关系密切。

[ Objective] To explore the relationship of pathological changes, clinical manifestations and results of laboratory examination with TCM syndromes in patients with IgA nephropathy. [ Methods l With parameters in Memphis renal biopsy accessing system and principle syndromes and complicated syndromes in differentiation criteria of chronic nephritis as reference, pathological changes and clinical manifestations of IgA nephropathy were classified by principle component analysis and factor analysis. The regression equations of different syndromes were estabhshed after a regression analysis of the principle components of pathological changes and clinical manifestations with the standard syndromes. [ Results] （1） With the parameters in Memphis renal biopsy accessing system as reference, the principle components （reflecting over 85% information of glomerular changes） of pathological changes in 123 IgA nephropathy patients were glomemlosclerosis, crescent, stroma, immunofluorescence IgA and complement 3 （C3）. With principle syndromes and complicated syndromes in differentiation criteria of chronic nephritis as reference, the principle components （reflecting over 90% information of syndrome manifestations） were lassitude and weakness for deficiency syndrome, cold limbs, white tongue and slippery fur and deep-thready pulse for yang-deficiency syndrome, and dry mouth and throat, red tongue and thready pulse for yin-deficiency syndrome. For liver-stagnation syndrome, the principle components were impatience and irritability, bitterness in mouth, frequent sighing and wiry pulse; for bloodstasis syndrome, the principle components was purple tongue with ecchymosis; for phlegm-damp syndrome, the principle components were heaviness of limbs, greasy fur, abdominal distension and impaired appetite; for heat-toxic syndrome, the principle components were sore throat, purulent sore and yellowish tongue with dry fur; for damp-heat syndrome, the principle components were bitterness and stickiness in mouth, and yellowish greasy fur. （2） The regression equations of syndromes of yin deficiency, yang deficiency, yin-yang deficiency, blood stasis, phlegm damp and liver stagnation were obtained. （3） The results of non-conditional Logistic regression analysis showed that yangdeficiency syndrome was correlated with edema, the incidence of yang deficiency in edema patients being 1.6 times of that in patients without edema; yin-deficiency syndrome was positively correlated with gross hematuria, the incidence of yin deficiency in patients with gross hematuria being 1.5 times of that in patients without gross hematuria; pain in waist and back was the common signs in patients with yin deficiency, yang deficiency and yin-yang deficiency. [ Conclusion] Parameters of glomemlosclerosis, crescent, stroma, immunofluorescence IgA and C3 reflect over 85 % information of glomemlar changes in IgA nephropathy patients; there exists a relationship of TCM syndrome with pathological changes and clinical manifestations; yang-deficiency syndrome is correlated with edema and yin-deficiency syndrome is correlated with gross hematuria.