慢性肾小球肾炎(CKD3期)肾络瘀痹证的临床研究

Clinical Study of Shenluo Yubi Symptom in Chronic Glomerulonephritis (CKD 3 Stage) Patients

目的:探讨慢性肾小球肾炎、慢性肾脏病(CKD)3期肾络瘀痹证的中医证候特点及临床病理表现。方法:①采用前瞻性临床研究方法。②研究对象:西医诊断为慢性肾小球肾炎(CKD3期)、中医辨证为肾络瘀痹证(瘀痹证)。合并证有肾气阴(血)虚证(肾虚证)、风湿内扰证(风湿证)、湿热内蕴证(湿热证)。③分析瘀痹证发生率、中医证候及临床病理特点。结果:①慢性肾小球肾炎(CKD3期)肾络瘀痹证发生率74.2%,其中瘀痹肾虚风湿三联证最多见,瘀痹肾虚二联证次之,单独瘀痹证少见。②瘀痹证中尿血积分值最高,且尿血与UPro/24h、UAlb/Cr呈正相关性。③瘀痹证肾脏病理半定量评分(Andreoli评分):慢性损伤评分为6.08±1.38,急性损伤评分为3.60±0.82,急慢性损伤并存,慢性损伤明显高于急性损伤,差异有统计学意义(P<0.01)。瘀痹证在肾间质炎细胞浸润程度、慢性损伤总分、硬化肾小球比例、肾小管间质纤维化程度上均重于非瘀痹证(P<0.05)。结论:慢性肾脏病肾络瘀痹证并不少见,并常常与其他中医证候并存。瘀痹证各症状中以镜下多形性红细胞尿持续存在最具特征,在中医辨证中引入尿象检测将有助于提高辨证精准度。CKD3期肾病理急慢性损伤并存,慢性损伤积分重于急性损伤;瘀痹证肾病理与临床辨证相符。

Objective：To investigate the clinical pathological manifestation and traditional Chinese medical （TCM） characteristics of Shenluo Yubi （Yubi） symptom in chronic glomerulonephritis （ CKD3 ） patients. Methods ： A prospective clinical study was applied. The patients who were chronic glomerulonephritis （ CKD 3 stage） had Shenluo Yubi symptom with Shenqi Yinxu （Shenxu）,Fengshi Neirao （Fengshi） and Shire Neiyun （Shire） symptoms were divided respectively by syndrome differentiation. The occurrence rate of Yubi symptom,TCM characteristics and renal pathological manifestation were analyzed. Results ： ①Occurrence rate of Yubi symptoms in chronic glomerulonephritis （ CKD3 ） patients was 74.2%. The number of the patients with three manifestations （Yubi, Shenxu and Fengshi symptoms） was highest while the number of the patients with two manifestations （ Yubi and Shenxu symptoms） was higher and the number of patients with Yubi symptoms was rare. ②The scores of hematuria were higher in Yubi symptom and were correlated with UPro/24 h and UAlb/Cr. ③ According to Andreolig scores,the patients with CKD3 stage both had acute and chronic pathological injury of nephrology,and the scores of chronic pathological injury were higher （6.08 1.38） than that of the acute injury （3.60 0.82） （P 〈 0.01 ）. The scores of renal interstitial inflammatory cell infiltration, chronic pathological injury, glomerular sclerosis and tubulointerstitial fibrosis were higher in the patients with Yubi symptom than non -Yubi symptoms （P 〈 0. 05 ）. Conclusion ： Shenluo Yubi symptom in chronic glomerulonephritis （ CKD3 ） patients is common and accompanied with other TCM symptoms. Hematuria is correlated closely with Yubi symptoms and would be useful in dialectics of Yubi symptom in the future. Andreoli＇s scores shows chronic and acute injury coexist while chronic manifestation is more obvious. Pathological manifestation is accordance with clinical characteristics for the patients with Yubi symptom.