IgA肾病中医证候分型与临床及病理的相关性

Relevance of TCM Syndrome Types of Primary IgA Nephropathy with Clinical Manifestation and Pathological Changes

目的研究和探讨原发性IgA肾病中医各证候分型与临床表现及病理改变的相关性,明确该病宏观表现与微观改变之间的联系。方法对120例经肾活检确诊的原发性IgA肾病患者的临床及病理资料进行统计,分析中医证候与临床指标及病理指数之间的关系。结果中医证候分型中,气阴两虚型所占比例最大;脾肾阳虚型的尿素氮比肺肾气虚型高,其内生肌酐清除率较肺肾气虚型、脾肾气虚型及气阴两虚型低,且该型24 h尿蛋白定量、血肌酐较其他四型均高;肝肾阴虚型间质炎细胞浸润积分、肾小管萎缩积分以及气阴两虚型肾小球萎缩积分与总积分均高于脾肾气虚型;肝肾阴虚与间质炎细胞浸润及血管壁增厚有相关性;气阴两虚与肾小球增生呈正相关;脾肾阳虚与间质纤维化、肾小管萎缩、血管壁增厚相关。结论 IgA肾病临床与病理加重的过程在一定程度上反映了中医证型脾(肺)肾气虚→气阴两虚→肝肾阴虚→脾肾阳虚的演变过程,中医证候分型与临床表现和病理改变之间具有相关性。

Objective To study and discuss the relevance of TCM syndrome types of primary IgA nephropathy with clinical manifestation and pathological change, identify the relationship between the macro manifestation and micro changes of kidney. Methods The clinical and pathological data of 120 patients diagnosed as primary IgA nephropathy with renal biopsy were collected. The relevance of TCM syndrome with clinical indicator and pathological indexes was analyzed. Results In TCM syndrome types, deficiency in both qi and yin had the largest proportion. The urea nitrogen content of spleen-kidney yang deficency was higher than that of lung-kidney qi deficiency, and its creatinine clearance rate was lower than that of lung-kidney qi deficiency, spleen-kidney qi deficiency and deficiency in both qi and yin, moreover, its serum creatinine and 24 h urine protein were higher than the other four types. The score of interstitial inflammatory cell infiltration and renal tubular atrophy score of liver-kidney yin deficiency syndrome, glomerudar atrophy score and the total score of deficiency syndrome in both qi and yin were higher than that of spleen-kidney qi deficiency. There was relevance between interstitial inflammatory cell infiltration and the thickening of blood vessel wall. Deficiency in both qi and yin had positive relation to glomerular hyperplasia. Spleen-kidney yang deficiency was related to interstitial fibrosis, renal tubular atrophy and thickening of blood vessel wall. Conclusion To some extent, the clinical and pathological deterioration of IgA nephropathy reflect the evolution process of TCM syndrome from spleen （lung）-kidney qi deficiency to deficiency in both qi and yin, liver-kidney yin deficiency and spleen-kidney yang deficiency. There is relevance of TCM syndrome types with clinical manifestation and pathological changes.