IgA肾病5型辨证与微观辨证的相关性研究

Correlation Study between Five Syndrome Differentiation and Microscopic Syndrome Differentiation of IgA Nephropathy

目的:观察Ig A肾病五型辨证与肾脏病理的相关性,探索Ig A肾病中医微观辨证依据。方法:选取2012年1月至2013年2月浙江中医药大学附属广兴医院收治的符合入选标准的原发性Ig A肾病患者373例,收集患者一般情况,中医四诊及辨证分型、肾病理资料,分析比较Ig A肾病五型辨证与肾脏病理的相关性。结果:373例原发性Ig A肾病患者常见证候是肾虚证、肾虚证+瘀痹证、单独瘀痹证、单独风湿证、风湿证+瘀痹证和肝风证+风湿证6种。免疫荧光提示单独风湿证、风湿证+肝风证均和C1q沉积具有一定的相关性。Katafuchi评分可作为Ig A肾病五型辨证的微观辨证参数,积分高低可以反映病机的演变与发展。含有风湿证的Ig A肾病牛津分型积分高,提示肾脏病理活动性大,病情易进展迅速。结论:Ig A肾病五型辨证分型与免疫荧光C1q沉积、Katafuchi评分及牛津分型等大部分肾脏病理指标具有相关性。

Objective： To observe the correlation between TCM syndrome differentiation of IgA nephropathy and renal pathology,and explore the basis of TCM microcosmic syndrome differentiation.Methods： A total of 373 patients with primary IgA nephropathy in our hospital from January 2012 to February 2013 were enrolled in the study.The general data of patients,the four diagnoses and syndrome differentiation of TCM,and the pathological data of nephropathy were collected to analyze the correlation between the syndrome differentiation of IgA nephropathy and renal pathology.Results： The common TCM syndromes of 373 IgA nephropathy patients were kidney deficiency syndrome,kidney deficiency with stasis bi syndrome,stasis bi syndrome,wind-dampness syndrome,wind-dampness and stasis bi syndrome,and the liver wind syndrome and wind-dampness syndrome.Immunofluorescence suggested that there was certain correlation between wind-dampness syndrome,wind-dampness and liver wind syndrome and C1 q deposition.Katafuchi score could be used as the microcosmic parameter of IgA nephropathy TCM syndrome differentiation,and the score level could reflect the evolution and development of pathogenesis.IgA nephropathy with wind-dampness syndrome had a high score of Oxford classification,which suggested that the renal pathological activity was high and the disease was easy to progress rapidly.Conclusion： The TCM syndrome differentiation of IgA nephropathy is correlated with most renal pathological indexes such as immunofluorescence C1 q deposition,Katafuchi score and Oxford classification.