22例成人膜性肾病的临床特点与中医症候分析

An analysis of the TCM symptoms and clinical characteristics of 22 adults with membranous nephropathy

目的:分析22例成人膜性肾病的临床特点、中医症候。方法:回顾性分析2012年6月-2015年11月于我院住院并行肾穿刺活检术确诊为成人膜性肾病的22例患者的临床资料。对性别、年龄、病因、临床表现、病理类型,中医症候进行分析。结果:22例患者中男性12例(54.55%),女性10例(45.45%),男女比例是1.2∶1。平均年龄(51.77±16.13)岁。特发性16例(72.73%);继发性4例(18.18%),其中糖尿病2例,乙肝1例,强直性脊柱炎1例;其他不能分类的2例(9.09%),包括1例肺癌待排,1例系统性红斑狼疮病待排。病理类型方面,Ⅰ期4例(18.18%),Ⅱ期13例(59.09%),Ⅲ期3例(13.64%),不详2例(9.09%)。临床表现为肾病综合征19例(86.36%),肾炎综合征3例(13.64%);其中3例(13.64%)伴随肾功能不全;4例(18.18%)伴随贫血;4例(18.18%)伴随感染,包括肺炎2例,支气管炎1例,急性肾盂肾炎1例。中医方面,虚证10例(45.45%),实证9例(40.91%),虚实夹杂3例(13.64%)。病因:脾肾亏虚11例,肝肾气阴两虚3例,水湿2例,湿热毒6例,血瘀3例。病位多在脾、肾,其次在下焦、肝。结论:膜性肾病好发于中老年男性,特发性膜性肾病占比高,病理以Ⅱ期为主,临床表现主要为肾病综合征;男性伴随高血压、高血脂、贫血,病理分型越高。中医方面,膜性肾病以虚症为主,尤其为脾肾亏虚,病位多在脾、肾。

Objective:To analyze the TCM symptoms and clinical characteristics of22adults with membranous nephropathy.Methods:The clinical data of22patients with adult membranous nephropathy diagnosed in our hospital from June2012to November2015were retrospectively analyzed.The sex,age,etiology,clinical manifestation,pathologic type and TCM syndrome were analyzed.Results:In the22patients,12cases were male(54.55%),10cases were female(45.45%);the average age is(51.77±16.13)years old.16cases were idiopathic,and4cases were secondary,including2cases with diabetes,1case with hepatitis B,1case with ankylosing spondylitis and2cases(9.09%)with no classified disease.In this2cases(9.09%)with no classified disease,1case suffered from lung cancer and1case suffered from systemic lupus erythematosus.In the pathologic type,4cases(18.18%)were inⅠperiod,13cases(59.09%)were inⅡperiod,3cases(13.64%)were inⅢperiod and2cases(9.09%)were uncertain.The clinical manifestations of19cases(86.36%)were nephrotic syndrome,and3cases(13.64%)were nephritis syndrome.3cases(13.64%)were accompanied with insufficiency of renal function,4cases(18.18%)with anemia,and4cases(18.18%)with infection,including2cases of pneumonia,1cases of bronchitis and1cases of acute pyelonephritis.The TCM manifestations of10cases(45.45%)were Xuzheng,9cases(40.91%)were Shizheng,and3cases(13.64%)were Xushi Jiaza.The etiology of11cases were Pishen Kuixu,3cases were Ganshen Qiyin Liangxu,2cases were Shuishi,6cases were Shire Du,and3cases were Xueyu.The disease position is more in spleen,kidney,followed by Xiajiao and liver.Conclusion:In TCM manifestations,membranous nephropathy could mostly be found in middle-aged and old men,the idiopathic incidented highest,the pathologic manifestations was mainly in theⅡstage and the clinical manifestation associated with nephrotic syndrome.If there is a man accompanied with hypertension,hyperlipidemia and anemia,higher pathological types could be found.In TCM,Xu syndrome was most found in membranous nephropathy,especially the Pishen KuiXu syndrome,and more from spleen and kidney