慢性移植物肾病患者血瘀证与其临床病理关系的研究

Correlation Between Blood Stasis Syndrome and Renal Pathology in Patients with Chronic Allograft Mephropathy

目的:研究慢性移植物肾病(CAN)患者血瘀证评分与其肾活检病理类型及临床指标的关系,探讨血瘀证在CAN病情发展过程中的作用,为临床使用活血化瘀中药治疗CAN提供依据。方法:对符合纳入标准的患者行血瘀证症状分级量化标准评分,分析患者肾活检病理类型以及年龄、移植时间、三酰甘油(TG)、胆固醇(CHO)、蛋白尿等临床指标与血瘀证评分的关系。结果:(1)共收集到符合标准的CAN患者64例,其中符合中医血瘀证患者50例(占78.13%),非血瘀证患者14例。(2)BanffⅠ级CAN患者8例,血瘀证评分为(26.75±1.98)分;BanffⅡ级CAN患者26例,血瘀证评分为(35.84±6.05)分;BanffⅢ级CAN患者16例,血瘀证评分为(48.43±4.93)分,三组之间血瘀证评分有统计学差异(P<0.05)。(3)CAN患者有合并蛋白尿或高血压的血瘀证评分均较高,与无合并症患者有统计学差异(P<0.05)。(4)患者血瘀证评分分别与移植时间、TG、CHO具有统计学差异(P<0.05)。结论:(1)血瘀证是CAN常见中医证候,CAN患者血瘀证与其病理分级及患者的蛋白尿、高血压、高血脂有密切关系;(2)研究结果为临床上应用活血化瘀中药(或改善微循环药物)治疗CAN提供理论依据,同时揭示了纠正CAN患者蛋白尿、高血压、高血脂的重要性。

Objective：To investigate the correlation between degree of bloodstasis syndrome（BSS） of Traditional Chinese Medicine（TCM） and renal pathology and cliniclal features in patients with Chronic allograft nephropathy （CAN）. Methods：Patients were enrolled with CAN conforming to the inclusive, and their degree of BSS were scored before renal biopsies. The correlation between the BSS score and the renal pathological type and clinical indices was analyzed. The clinical indices included age, course of transplantation, renal function and haemoglobin and so on. Results： （ 1 ） Among the 64 patients, 50 eases（ 78.13 % ） were diagnosed as BSS; （2） 8 cases were diagnosed as CAN Banff I ,and their t3SS scores were （26.75 ± 1.98） points. 26 cases were diagnosed as CAN Banff Ⅱ ,and their BSS scores were （35.84 ± 6.05） points. 16 cases were diagnosed as CAN Banff Ⅲ, and their BSS scores were （48.43 ± 4.93） points. There was significant difference among the three groups （P 〈 0.05）;（3） The BSS scores in the patients with albumimuia, hypertension and hyperlipemia were significantly higher than those in the patients without; （4） The BSS scores were significantly in correlation with course of transplantation, Triglyeride（TG） and Cholesterin（CHO） （P 〈 0.05）. Conclusion： （ 1 ） BSS is a TCM syndrome that is most commonly seen in patients with CAN. The renal banff classification of CAN is signifi- cantly correlated with BSS degree. （2） The BSS scores in the patients with albuminuria, hypertension and hyperlipemia were significantly higher than those in the patients without. （3） Activating blood circulation and dissipating blood stasis are necessary in CAN therapy. And the treatment of the complications of albuminuria and hypertension and hyperlipemia is necessary, too.