IgA肾病中医湿热证微观辨证病理指标研究

Study on Pathological Indicators in TCM Microcosmic Syndrome Differentiation in Dampness-heat Syndrome of Ig A Nephropathy

目的探讨Ig A肾病中医湿热证微观辨证相关性病理指标,为Ig A肾病湿热证候诊断寻找客观依据。方法多家医院协作收集数据,对研究对象根据湿热证诊断标准进行中医辨证并量化评分,同时行肾穿刺活检病理诊断,判断Ig A荧光强度,进行牛津分类、Katafuchi积分和蒋氏评分,分析湿热证与微观病理指标的关系。结果湿热证Ig A+++^++++相对占比较高,Ig A+++与Ig A++++中湿热证组占比明显高于非湿热证组;湿热证组节段性肾小球硬化或粘连占比、肾小球节段病变及间质炎性细胞浸润Katafuchi评分、破坏毛细血管袢活动性病变蒋氏评分显著高于非湿热证组;湿热证与上述病理指标评分呈显著正相关,与肾小球球性硬化、肾血管透明变性评分呈显著负相关。结论 Ig A肾病湿热证与部分病理特征具有相关性,将相关性病理指标引入Ig A肾病微观辨证之中可提高辨证准确率。

Objective To explore the association of pathological indicators with TCM microcosmicsyndrome differentiation in dampness-heat syndrome of IgA nephropathy;To find the objectiveevidence of diagnosis for dampness-heat syndrome of IgA nephropathy. Methods A prospectivestudy was conducted to collect data in multi clinical centers. Patients were diagnosed with TCMsyndrome type according to the dampness-heat syndrome diagnostic criteria. Meanwhile, allpatients were performed percutaneous renal biopsy, by which the immunofluorescence intensityof IgA nephropathy was assessed. Hass, Oxford, Katafuchi and Jiang’s classification methods wereused to calculate scores to analyze the relationship of dampness-heat syndrome type andpathological indicators. Results The levels of fluorescence intensity were mainly graded as Ⅲ-Ⅳ inpatients of dampness-heat syndrome, but the grades Ⅲ and Ⅳ were significantly higher indampness-heat syndrome than in others. In the Katafuchi scoring method, the scores forsegmental glomerular sclerosis or adhesion, glomerular segmental lesions and interstitialinflammatory cell infiltration were all apparently higher in dampness-heat syndrome comparedwith others. Jiang’ scoring method showed that the destroying the capillary loops active lesionsscore was significantly higher in dampness-heat syndrome than in those of non-dampness-heatsyndrome. The findings also showed the positive correlation between the dampness-heatsyndrome and these pathological indicators, and the negative correlation between thedampness-heat syndrome and glomerular sclerosis, renal vascular transparent denaturation.Conclusion There is apparent correlation between the dampness-heat syndrome of IgA nephropathy and some pathological indicators. Introducing relevant pathological indicators into TCM microcosmic syndrome differentiation of IgA nephropathy can improve diagnostic accuracy.