IgA肾病患者中医证型与尿红细胞形态的特点分析

Morphological Features of Urine Erythrocytes in IgA Nephropathy Patients with Different Syndrome Patterns

目的:观察IgA肾病(IgAN)患者与其他原发性肾小球肾炎,及IgAN不同中医证型间尿细胞形态的特点。方法:以肾活检确诊为IgA肾病的90例患者及其他原发性肾小球肾炎、泌尿系结石患者各30例为研究对象,根据相差镜下尿红细胞的形态特点,比较不同疾病及IgA肾病不同中医证型之间的关系。结果:IgA肾病芽孢状(G1)细胞出现的频率高于泌尿系结石,但低于其他原发性肾小球肾炎,差异有显著性意义(P<0.05)。在Ⅱ级或Ⅱ级以下,芽孢状与非芽孢状比较,差异有非常显著性意义(P<0.01);在Ⅲ～Ⅳ级间,芽孢状与非芽孢状比较,差异无显著性意义(P>0.05);在Ⅴ级间,芽孢状与非芽孢状比较,差异有非常显著性意义(P<0.01)。芽孢分布以脾肾阳虚型为多见(9例)占56.25%,与非芽孢脾肾阳虚型比较,差异有非常显著性意义(P<0.01);非芽孢以气阴两虚型(39例)为多见,占52.72%,与芽孢状气阴两虚型比较,差异有显著性意义(P<0.05)。结论:IgA肾病患者G1细胞出现的频率与其他原发性肾小球肾炎间有明显差异,且不同中医证型间尿红细胞形态有一定的差异;脾肾阳虚型患者其尿红细胞的形态多样性较其他证型多,且G1出现频率高,其病理分级也相对较重,多为Ⅲ级以上。

Objective:To observe the morphological features of urine erythrocytes in IgA nephropathy patients with different syndrome patterns and in primary glomerular nephritis patients.Methods:This study enrolled 90 IgA nephropathy patients confirmed by renal biopsy,30 primary glomerular nephritis patients,and 30 urinary calculi patients.The morphological features of urine erythrocytes from the subjects were compared under phase contrast microscope.Results:The occurrence rate of germ-like cells was higher in IgA nephropathy patients than that in urinary calculi patients, but lower than that in primary glomerular nephritis patients,the difference being significant (P<0.05).The occurrence rate of germ-like cells differed from that of non - germ - like cells in IgA nephropathy classified into gradeⅡor belowⅡby Lee' s scale,and in gradeⅤIgA nephropathy(P<0.01),but the difference was insignificant between gradeⅢand gradeⅣIgA nephropathy(P>0.05).Germ - like cells dominated in 9(56.25%) IgA nephropathy patients with deficiency of spleen and kidney yang,which differed from the non - germ - like cells in the same syndrome pattern(P<0.01);non-germ-like cells dominated in 39(52.72%) IgA nephropathy patients with deficiency of Qi and yin,which differed from the germ - like cells in the same syndrome pattern(P<0.05).Conclusion:The occurrence rate of germ - like cells in IgA nephropathy patients varies from different syndrome patterns, and differs from that in primary glomerular nephritis patients.The diversity of urine erythrocytes is obvious in IgA nephropathy patients with deficiency of spleen and kidney yang,with higher occurrence rate of germ - like cells and higher Lee' s grading (usually over gradeⅢ).