IgA肾病中医邪实证候与靶器官病理特征的相关性研究

Correlation Study on Pathological Characteristics of Target Organs and Excess Evil Syndrome in IgA Nephropathy

目的探讨IgA肾病中医邪实证候与肾脏靶器官病理之间的关系。方法采用多中心协作的研究方法收集数据,将266例IgA肾病患者根据中医辨证分型标准分为外感风热证(49例)、下焦湿热证(100例)、痰湿证(43例)和血瘀证(74例),各证型同时行肾穿刺活检病理诊断,进行Hass分级、牛津分类、Katafuchi积分和蒋氏评分,分析中医邪实证候与病理指数的关系。结果各证候与Hass分级具有相关性(r=0.341,P<0.01)。外感风热证与内皮细胞节段性增生及破坏毛细血管袢节段活动性病变具有关联性;下焦湿热证与HassⅢ级、破坏毛细血管袢节段活动性病变(高评分)、内皮细胞节段性增生、肾小球节段病变、局灶性间质炎性细胞浸润、局灶性间质纤维化及小管萎缩具有关联性;血瘀证与HassⅣ级、肾小球球性硬化、肾小球节段性硬化/黏连(segmental glomerulosclerosis,S)、系膜增生(mesangial hypercellularity,M)、血管透明变性、多灶状间质炎性细胞浸润、多灶状间质纤维化及小管萎缩具有关联性;痰湿证以Ⅰ和Ⅲ级为主,但与其他病理参数无关联性。结论中医邪实证候与IgA肾病部分病理特征具有相关性,邪实证候一定程度上可以反映IgA肾病靶器官病理损害程度、活动性与慢性病变及预后,相关病理特征及其发展变化可以提示中医邪实证候类型及其演变规律。

Objective To explore the correlation between pathological characteristics of target organs and excess evil syndrome in IgA nephropathy.Methods Data were collected in multicenter cooperation.Totally 266 IgA nephropathy patients were typed into exogenous wind-heat affection syndrome（49 cases）,lower energizer damp-heat syndrome（100 cases）,damp-phlegm syndrome（43 cases）,and blood stasis syndrome（74 cases）.Meanwhile,percutaneous renal biopsy was performed in all patients for Hass classification,Oxford classification,Katafuchi integral,and Jiang＇s classification methods.The correlation between excess evil syndrome and pathological index was analyzed.Results Four syndrome types were correlated with their Hass levels（r=0.341,P0.01）.Affection of exogenous wind-heat syndrome was correlated with segmental proliferation of endothelial cells and damaged active lesions of segmental capillary loops.Lower-energizer damp-heat syndrome was associated with Hass Ⅲlevel,destroying active lesions of capillary loops,segmental proliferation of endothelial cells,glomerular segmental lesions,focal interstitial infiltration of inflammatory cells,focal interstitial fibrosis and tubular atrophy.Blood stasis syndrome was associated with Hass Ⅳ level,glomerular sclerosis,segmental glomerulosclerosis（S）/adhesion,mesangial hypercellularity（M）,angiohyalinosis,multi-foci interstitial infiltration of inflammatory cells,multi-foci interstitial fibrosis and tubular atrophy.Phlegm-damp syndrome had higher proportions of Hass Ⅰ and Ⅲ levels,but with no association with other pathological parameters.Conclusions Excess evil syndrome was associated with partial pathological characteristics of IgA nephropathy.It could reflect pathological damage degree of target organs,activities,chronic lesions,and prognosis of IgA nephropathy to certain extent.Correlated pathological characteristics and its evolution could indicate excess evil syndrome types and their evolution rules.