慢性肾小球肾炎中医证型与肾间质纤维化相关指标的关系

Correlation between the TCM Syndromes of Chronic Glomerulonephritis and the Related Indices of Tubulointerstitial Fibrosis

目的 探讨慢性肾小球肾炎(CGN)患者中医证型与血清肾间质纤维化相关指标纤维连结蛋白(FN)、Ⅳ型胶原(ColⅣ)的相关性。方法 180例CGN患者中肾功能正常组90例,肾功能不全组90例,另选正常对照组60例,对CGN患者进行中医辨证分型,并且检测血尿素氮(BUN)、肌酐(SCr)和血清FN、ColⅣ的水平,并对各指标做相关性分析。结果 CGN患者较正常对照组FN降低、ColⅣ升高(P<0.05);并且肾功能不全组患者较肾功能正常组FN降低、ColⅣ升高更明显(P<0.05)。CGN患者BUN、SCr水平与血清FN呈负相关,与血清ColⅣ水平呈正相关(P<0.05);在肾功能不全组中,脾肾阳虚证患者血清FN降低最多、ColⅣ增高最明显(P<0.05);湿热证患者血清FN降低最明显,血瘀证型患者血清ColⅣ增高最明显(P<0.05)。结论 CGN肾功能正常患者最多见肺肾气虚证,肾功能不全患者最多见脾肾阳虚证,CGN患者中医证型与FN、ColⅣ水平存在一定的相关性。

Objective To study the correlation between the TCM syndromes of chronic glomerulonephritis（CGN）and tubulointerstitial fibrosis（TIF）related indices,i.e.serum fibronectin（FN）and collagen type Ⅳ（Col Ⅳ）.Methods Of the 180 CGN patients,90 with normal renal function and 90 with renal insufficiency were set in two groups respectively.Another 60 healthy subjects were set as normal control group.The CGN patients were diagnosed with TCM syndrome differentiation.The levels of blood urea nitrogen（BUN）and serum creatinine（SCr）,FN,and Col Ⅳ were determined and the correlations of them were analyzed.Results The CGN patients had low FN and high Col Ⅳ level in comparing with the normal control group（P0.05）,those with renal insufficiency had lowered FN and significantly higher Col Ⅳ compared with those with normal renal function（P0.05）.The level of BUN and SCr of CGN patients were negatively correlated with the level of FN and positively correlated with the level of Col Ⅳ（P0.05）.In the renal insufficiency group,the level of FN of those who were with the spleen and kidney yang deficiency was decreased at most and the level of Col Ⅳ was increased most obviously（P0.05）.The level of FN of those who were with the damp-heat was decreased at most and the level of Col Ⅳ of those who were with the blood stasis was increased most obviously（P0.05）.Conclusion The CGN patients with normal renal function are mostly involved in the lung and kidney qi deficiency,while those with a renal insufficiency are mostly likely to have the spleen and kidney yang deficiency.There exists correlation between the TCM syndromes and level of FN and Col Ⅳ of CGN patients.