IgA肾病中医证候分布及血清microRNA在疾病中的预测作用

Distribution of Traditional Chinese Medicine Syndromes of IgA Nephropathy and Predictive Value of Serum microRNA in Diseases

目的：探讨IgA肾病（IgA nephropathy）的中医证候分布规律及模拟mRNA（microRNA）对IgA肾病的预测价值。方法：收集109例经肾脏穿刺符合IgA肾病病理诊断的临床病例,遵循中医证候诊断标准,分为肺肾气虚、脾肾气虚、肝肾阴虚、气阴两虚、脾肾阳虚5型。分析中医证候分布情况与临床指标之间的关系。从出现率最高证型的患者中,随机抽取10例标本,健康人10例标本对照,运用实时荧光定量PCR技术对其血清中microRNA的表达水平进行检测。结果：109例患者的5种证型中,肺肾气虚型临床表现最轻,病理分级最低;脾肾阳虚型临床表现最重,病理分级最高;脾肾阳虚型肾小球滤过率较其余4型低,且该型24 h尿蛋白定量、血肌酐较其余4型高。其中气阴两虚证在IgA患者中出现频率最高,共49例,其血清中microRNA（miR）141,miR146a高于正常组（P〈0.05）,miR205,miR155,miR192低于正常组（P〈0.05）。结论：IgA肾病病理与临床理化指标改变加重的过程一定程度上反映了中医证型其病机演变规律为肺肾气虚-脾肾气虚-肝肾气虚-气阴两虚-脾肾阳虚;microRNA表达的差异与IgA肾病的严重程度及病情的进展密切相关,为IgA肾病的发病机制和诊断提供新的依据。

Objective： To investigate the distribution regularity of traditional Chinese medicine（ TCM）syndrome of IgA nephropathy and the predictive value of microRNA（ miR） on IgA nephropathy. Method： Totally109 clinical cases diagnosed as IgA nephropathy by renal puncture were collected. According to the diagnostic criteria of TCM syndromes,they were divided into four groups： lung and kidney deficiency group,spleen and kidney deficiency group,liver and kidney deficiency group,and Qi and Yin deficiency group. The relationship between TCM syndrome distribution and clinical indexes was analyzed. Among the patients with the highest syndromes,10 cases were randomly selected,with 10 healthy people as controls,and the expression of miR was detected by Real-time PCR. Result： Among the five syndromes,lung-kidney-Qi deficiency was the lightest clinical manifestation,with the lowest pathological grade; Spleen-kidney-Yang deficiency was the heaviest clinical manifestation,with the highest pathological grade; the glomerular filtration rate was lower than the other four types,whereas the 24-hour urine protein,serum creatinine were higher than the other four types. Among them,Qi and Yin deficiency syndrome had the highest frequency in IgA patients,with a total of 49 cases. The serum levels of miR141 and miR146 a were higher than those in normal group,while miR205,miR155 and miR192 were lower than normal group. Conclusion： The pathological changes of IgA nephropathy and the changes of clinical physical and chemical indexes aggravated to a certain extent. The pathogenesis evolution of TCM syndromes is that the pathogenesis of the syndromes of the kidney and kidney is Qi and kidney deficiency-spleen and kidney Qi deficiency-liver and kidney Qi deficiency-Qi and Yin deficiency-spleen and kidney Yang deficiency. The difference of miR expression is closely related to the severity of IgA nephropathy and the progression of the disease,which provides a new basis for the pathogenesis and diagnosis of IgA nephropathy.