原发性局灶节段性肾小球硬化患者中医证型分布与临床、病理关系及预后分析

Correlation among Syndrome of TCM,Clinical Manifestations,Pathological Symptoms and Prognosis of Primary Focal Segmental Glomerulosclerosis

目的探讨原发性局灶节段性肾小球硬化(pFSGS)患者中医证型与临床病理及预后相关性。方法选取1996年至2012年期间住院行肾活检连续确诊的pFSGS患者,收集患者中医证候、临床病理资料,并进行随访,探讨其相关性。结果(1)纳入102例pFSGS,均有脉络瘀阻证,占100%,无单一证型者;二联证有66例,占64.7%,其中气阴两虚、脉络瘀阻(气阴二联证)24例,占23.5%,风湿内扰、脉络瘀阻(风湿二联证)42例,占41.2%;气阴两虚、脉络瘀阻、风湿内扰(三联证)36例,占35.3%。(2)风湿二联证及三联证二者尿蛋白定量、NS患者比例、尿NAG/Cr、血总胆固醇、HDL、LDL均较气阴二联证高(P<0.05),血清白蛋白、IgG水平较气阴二联证低(P<0.05)。(3)IgM免疫沉积率以风湿二联证最高,达76.3%,较气阴二联证差异有统计学意义(P<0.05)。(4)纳入pFSGS患者以非特异病理亚型为主,3组证型分布差异无统计学意义(P>0.05),塌陷型2例分别具风湿二联证和三联证,尖端型4例均具风湿二联证,门部型平均分布于3组证型中。(5)随访患者中新进展至终点事件有5例,分别具风湿二联证2例和三联证3例,但生存分析3组无差异(P>0.05)。结论PFSGS患者以二联证为主要证型,其中以风湿二联证及三联证临床表现较重,预后相对较差。

Objective To analyze the relationship among TCM Syndrome, clinical pathology and prognosis of pFSGS. Methods One hundred and two patients with pFSGS in the Department of Nephrology between 1996 and 2012 were retrospectively studied. We analyzed the relationship among TCM Syndrome, clinical pathology and prognosis of pFSGS. Results 1) All the 102 pFSGS patients have mailuoyuzu syndrome, without single syndrome. Among them, 66 patients have bigeminy syndrome, accounting for 64.7%, wherein qiyinliangxu, mailuoyuzu syndrome(qiyin-united syndrome) accounting for 23.5%, fengshineirao, mailuoyuzu syndrome(fengshi-united syndrome) accounting for 41.2%. 36 patients have sheqiyinliangxu, mailuoyuzu, fengshineirao(triad syndrome), accounting for 35.3%. 2) Fengshi-united syndrome and triad syndrome are both higher in urinary protein, the proportion of NS patients, urinary NAG/Cr, serum total cholesterol, HDL, LDL, than that in qiyin-united syndrome(P<0.05). But they are lower in serum albumin, IgG levels than that in qiyin-united syndrome(P<0.05). 3) The IgM immune deposition rate in fengshi-united syndrome is 76.3%, higher than qiyinunited syndrome(P<0.05). 4) Collapsing variant have two cases, each of them has fengshi-united syndrome and triad syndrome. The tip FSGS has 4 cases with fengshi-united syndrome. 5) Five cases in the follow-up patients with normal baseline serum creatinine progressed to endpoint events, among them have fengshi-united syndrome in two cases and triad syndrome in three cases. However, the survival rates of these three groups syndrome are not significant difference(P>0.05). Conclusion PFSGS patients all have mailuoyuzu syndrome, without single syndrome. The qiyin-united and fengshi-united syndromes are the main syndrome types. Fengshi-united syndrome and triad syndrome groups have serious clinical manifestation, and maybe have a worse outcome.