IgA肾病中医证型与肾脏病理的关系

The Relationship Between Renal Pathological Classifications and TCM Syndromes of IgA Nephropathy

目的:研究IgA肾病肾脏病理与中医证型之间的关系,探索IgA肾病中医辩证分型的客观依据。方法:将40例IgA肾病患者分为脾肾气虚、肝肾阴虚和气阴两虚三型,观察证型与肾脏病理的关系。结果:IgA肾病脾肾气虚型Lee氏分级多集中在Ⅱ～Ⅲ级,肝肾阴虚型多集中在Ⅳ～Ⅴ级,气阴两虚型在病理分级上较分散,但各组证型之间比较没有统计学差异(P>0.05);肝肾阴虚型Katafuchi各项积分均高于脾肾气虚型(P<0.05),其肾小管间质评分明显高于气阴两虚型(P<0.05)。结论:(1)脾肾气虚型IgA肾病患者病理损害较轻,肝肾阴虚型IgA肾病患者病理损害较其他两个证型更为严重。(2)MMP-2的表达强度同病理损害程度密切相关,而中医不同证型与MMP-2表达之间的关系还有待进一步研究。

Objctive： To explore the relationship between renal pathological classifications and TCM syndromes of IgA nephropathy （IgAN）. Methods 40 IgAN patients were divided into three types of TCM symptoms：deficiency of spleen-qi and kidney-qi（ type 1 ） ,deficiency of liver-yin and kidney-yin （ type 2）, deficiency of qi and yin （ type 3 ）. To explore the relationship between renal pathological classifications and TCM syndromes of IgAN. Results The majority of renal pathological lesions were Ⅱ～Ⅲ grade according to Lee＇s classification criteria in type 1 and Ⅳ～Ⅴ grade major in type 2 ,while there was no obviously tendency in type 3n,but there was no significant difference in the three types. Accumulated scorel of Katafuchi in type2 was obviously higher than which in type 1 （P 〈0. 05）, and the tubulointerstitial score of type 2 was obviously higher than which in type 3 （ P 〈0.05 ）. Conclusions （ 1 ） Pathological lesion in type of deficiency of spleen-qi and kidney-qi was better than others. In patients of IgAN ,the chnical manifestations and pathological le- sion in type of deficiency of liver-yin and kidney-yin（type 2） was more severity than the other two types. （2）there was intimate correlation between expression of MMP-2 and pathological lesion, but the relationship between different types and the expression of MMP-2 was waiting for researching.