123例不同中医证型IgA肾病患者实验室指标及病理特征分析

Analysis on Laboratory Indices and Pathological Characteristics of 123 IgA Nephropathy Cases with Different TCM Syndromes

目的观察IgA肾病患者不同中医证型与实验室指标、病理分级的关系。方法 123例IgA肾病患者辨证分为脾肾气虚、肝肾阴虚、气阴两虚3型,检测各证型患者血压、生化指标、评定病理分级,并分析其关系。结果 3组证型中肝肾阴虚型血肌酐(SCr)水平明显高于其他两型(P<0.01);脾肾气虚型白蛋白(Alb)水平低于气阴两虚型(P<0.05),24h尿蛋白定量大于气阴两虚型(P<0.05);脾肾气虚型总胆固醇水平高于肝肾阴虚和气阴两虚型(P<0.01);肝肾阴虚型IgG水平低于气阴两虚型(P<0.05);肝肾阴虚型收缩压高于气阴两虚型(P<0.05)。各证型患者病理分级中Ⅲ级、Ⅳ级最多见,共95例占77.24%,但各证型之间比较无统计学差异(P>0.05)。结论 IgA肾病患者以气阴两虚型最多见、病理分级较高,脾肾气虚型患者蛋白尿排泄多但病理改变相对较轻,肝肾阴虚型常伴肾功能不全和高血压。

Objective To observe the laboratory indices and pathological conditions of the IgA nephropathy cases with differ- ent TCM syndromes to analyze the correlation between them. Methods With TCM syndrome differentiation, the 123 eases were diagnosed as qi deficiency of the spleen and kidney, yin deficiency of the liver and kidney, and both qi and yin deficiency. Their blood pressure, biochemical indices, and pathological degrees were analyzed. Results Of the three syndromes, the ser- um ereatinine （SCr） level of yin deficiency of the liver and kidney was significantly higher than that of the other two syndromes （P〈0.01） ; the albumin （Alb） level of qi deficiency of the spleen and kidney was lower and the 24h urine protein quantity was more than that of both qi and yin deficiency （P〈0. 05） ; the total cholesterol （TC） level of qi deficiency of the spleen and kid- ney was higher than that of yin deficiency of the liver and kidney and both qi and yin deficiency （P〈0. 01） ; the IgG level of yin deficiency of the liver and kidney was lower than that of both qi and yin deficiency （P〈0. 05） ; and the systolic blood pressure （SBP） of yin deficiency of the liver and kidney was higher than that of both qi and yin deficiency （P〈0.05）. In the pathological degrees of all syndromes, the Ⅲ-1V degrees were most common, totally 95 cases, accounted for 77.24%, however the compar- ison among all syndromes showed no statistical difference （P^0.05）. Conclusion Of the IgA nephropathy eases, both qi and yin deficiency is the most common syndrome and its pathological degree is higher, those with qi deficiency of the spleen kidney have more proteinuria but relatively mild pathological change, and the cases with yin deficiency of the liver and kidney are often accompanied with renal insufficiency and high blood pressure.