慢性肾炎CKD 3期风湿内扰证的临床病理特点

The Clinical and Pathologic Characteristic of Wind-dampness Syndrome with Chronic Glomerulonephritis in Chronic Kidney Disease in The 3th Period

目的:为进一步了解慢性肾炎风湿内扰证的特点,以及在慢性肾脏病(CKD)3期中的作用地位。方法:根据有无风湿内扰证将56例慢性肾炎CKD 3期患者分成两组,分析比较两组的临床与肾病理学资料。结果:56例患者辨证风湿内扰证43例,无风湿内扰证13例,两组兼夹虚、瘀、湿热证例数及肾病理分布虽差异无统计学意义,但风湿内扰证患者兼夹肾络瘀痹严重,与无风湿内扰证患者比较,肾络瘀痹症状总积分以及尿血、舌下脉络瘀滞积分显著升高;风湿内扰证患者除尿RBC2、4 h尿蛋白定量等较无风湿内扰证患者差异有统计学意义外,平均动脉压(MBP)也显著升高;采用katafuchi评分发现,风湿内扰证患者肾小管间质积分显著高于无风湿内扰证患者;Andreoli评分发现,风湿内扰证患者活动性指数总积分、慢性化指数总积分显著高于无风湿内扰证患者,其中间质炎细胞浸润、纤维/纤维细胞新月体也以风湿内扰证患者明显(P<0.05)。结论:风湿内扰证是慢性肾炎CKD 3期患者中主要证候,风湿内扰加重肾络瘀痹,有致瘀致虚的演变趋势。风湿内扰与肾病理具有一定相关性,是慢性肾炎病情加重的主要病机。

Objective：To explore the characteristic and the role of Wind-dampness Syndrome with chronic glomerulonephritis in Chronic Kidney Disease in the 3th period（CKD 3）.Methods：56 CKD 3 patients with chronic glomerulonephritis are divided as two groups（group1 is with Wind-dampness Syndrome but group2 not） to comparie them with clinical and pathologic data.Results：There are 43 patients in group1 and 13 in group2.Both of them are insignificant in statistics on the numbers of patients which combine with Qi-Yin dual Deficiency Syndrome,Blood Stasis Syndrome or damp-heat Syndrome.And the result of the pathologic disposition is similar.But among the 56 patients who combine with Blood Stasis Syndrome,the scores of total,haematuria and sublingually-vessel stasis in group1 are higher than group2,the differences are significant in statistics.The urine red blood cell,24 hours urinary protein content,mean blood pressure（MBP） in group1 are also significantlly higher than group2.The results of semiquantitative scores of Katafuchi（such as renal tubule interstitial substance index）and Andreoli（such as activity index,chronicity index,inflammatory cell infiltration index） are similar.Conclusion：Wind-dampness Syndrome is the main syndrome of CKD 3 with chronic glomerulonephritis,and it will lead to Deficiency Syndrome and Blood Stasis Syndrome even make the latter more serious.It＇s correlated with pathological data and is the main pathogenesis of chronic glomerulonephritis.