209例IgA肾病患者中医证候分析及与临床指标相关性研究

Analysis on TCM Syndromes and Correlation Study of Clinical Indicators Related to 209 Patients with IgA Nephropathy

目的:通过对IgA肾病的中医证候分型及各证型与临床指标间相关性的研究,探讨本病客观的中医分型标准,为提高中医诊断该病的准确性及对诊断标准进一步规范化研究提供依据。方法:根据相关文献及德尔菲法的调查结果,找出该病种的常见中医证候,制定调查问卷。通过问卷收集209例IgA肾病患者的病史资料、中医临床症状、相关西医检查报告,运用频数分析、因子分析、聚类分析等多因素统计方法确定IgA肾病的中医分型,以及方差分析、非参数检验等方法分析临床指标在证型间的关系。结果:IgA肾病的中医证型分为肝肾阴虚型、气阴两虚型、脾肾阳虚兼瘀型及肺脾气虚兼湿热型。在209例被调查患者中气阴两虚患者比例最大,占33%,其余三型比例分别为肺脾气虚兼湿热型30%,脾肾阳虚兼瘀型25%,肝肾阴虚型12%。在四种证型中,脾肾阳虚兼瘀型24h尿蛋白定量高于气阴两虚、肺脾气虚兼湿热两型(P<0.01);脾肾阳虚兼瘀型的血清肌酐水平高于其他三型(P<0.01),肺脾气虚兼湿热型肌酐水平高于气阴两虚型(P<0.05);肺脾气虚兼湿热型血红蛋白值大于脾肾阳虚兼瘀型(P<0.05);四种证型在不同CKD分期中的分布差异有统计学意义(P<0.001);四种证型在男女比例中分布差异有统计学意义(P<0.05);而四种证型与尿红细胞计数、年龄、病程、发病季节的相关性差异无统计学意义。结论:IgAN的中医证候按本研究方法可分为四型,即肝肾阴虚型、气阴两虚型、脾肾阳虚兼瘀型及肺脾气虚兼湿热型。本病相关实验室指标在各证型间分布有一定规律性。研究结果对临床诊治该病及进一步研究具有参考价值。

Objective：To investigate the distribution pattern of TCM syndrome in patients with IgA nephropathy and its relationship with the main clinical indexes to improve the accuracy of TCM diagnosis of the disease and supply possible evidences to researching the normalization of its TCM syndrome.Methods：According to the pertinent literature and the findings of the Delphi method to determine the common syndromes of the disease and work out the questionnaire.209 cases collected by questionnaire in patients with case history of IgA nephropathy data, clinical symptoms of TCM, Clinical inspection reports etc,frequency analysis, factor analysis, cluster analysis multivariate statistical methods was adopted to determine the classification of IgA nephropathy in TCM syndromes, analysis of variance,and non-Parameter test methods w as conducted to analyze the relationship between different clinical indexes and the above syndromes.In order to determine the classification of IgA nephropathy in TCM syndromes and analyze the relationship between different clinical indexes and the above syndromes, we collected case history, clinical symptoms of TCM and Clinical inspection reports by questionnaire and apply statistical methods.Results：IgA nephropathy syndromes are divided into liver-kidney yin deficiency Syndrome, qi-yin deficiency Syndrome, Spleen-Kidney Yang deficiency and blood stagnation Syndrome, Lung-Spleen Qi Deficiency and Damp-Heat Syndrome. In the 209 patients, the proportion of qi-yin dificiency was 33%, followed by Lung-Spleen Qi Deficiency and Damp-Heat Syndrome 30%, Spleen-Kidney Yang deficiency and blood stagnation Syndrome 25%, liver-kidney yin deficiency Syndrome 12 %.The level of 24h urinary protein was higher in Spleen-Kidney Yang deficiency and blood stagnation Syndrome than in qi-yin deficiency Syndrome and Lung-Spleen Qi Deficiency and Damp-Heat Syndrome （P0.01）;and the levels of serum creatinine in Spleen-Kidney Yang deficiency blood stagnation Syndrome was highest of the four syndromes（P0.01）, and that level in Lung-Spleen Qi Deficiency and Damp-Heat Syndrome was higher than qi-yin deficiency Syndrome; The level of hemoglobin in Lung-Spleen Qi Deficiency and Damp-Heat Syndrome was higher than that of Spleen-Kidney Yang deficiency and blood stagnation Syndrome（P0.05）;there are differences in the distribution of the four syndromes in gender（P0.05）and different stages of CKD （P0.001）.Conclusion：IgA nephropathy syndromes can be divided into four types：liver-kidney yin deficiency Syndrome, qi-yin deficiency Syndrome, Spleen-Kidney Yang deficiency and blood stagnation Syndrome, Lung-Spleen Qi Deficiency and Damp-Heat Syndrome. Since there are certain regularity in the relevant indexes and distribution of the four syndromes.