IgA肾病107例中医证型与临床、病理及实验室检查相关性分析

Correlation analysis of TCM syndrome types with clinical,pathological and laboratory examination in 107 cases of IgA nephropathy patients

目的:回顾性分析IgA肾病(IgAN)患者的中医证型分布特点与临床、病理资料在中医证型中的分布差异,揭示各中医证型与IgAN临床,病理与实验室检查的关系。方法:回顾性分析行肾穿刺活检后病理诊断明确为IgAN的患者107例,包括一般资料、临床及实验室资料、病理资料,IgA肾病患者的病理损害以牛津病理分型为评价标准,采用统计学软件SPSS分析IgAN患者的中医证型分布特点,比较不同中医证型患者的临床、病理资料,并采用Logistic回归分析方法进行IgA肾病中医证型与IgA肾病临床、病理与实验室检查相关性分析。结果:107例IgAN患者,本虚证各中医证型分布以气阴两虚证和肺脾气虚证为主,标实证中医证型分布以肾络瘀痹证和下焦湿热证为主。本虚证性别、牛津病理分型E、牛津病理分型T、牛津病理分型C、红细胞计数(RBC)、白细胞计数(WBC)、血红蛋白(HB)、血小板(PLT)、血肌酐(Scr)、24h尿蛋白(UTP)、血清白蛋白(ALB)、总胆固醇(TC)及低密度脂蛋白(LDL-C)在中医证型的分布差异存在统计学意义(P<0.1),标实证有无前驱感染、牛津病理分型S和牛津病理分型C在中医证型的分布差异存在统计学意义(P<0.1)。将以上指标纳入多因素Logistic回归分析,回归分析显示,性别为女性、牛津分型T、PLT、UTP与气阴两虚证呈负相关;牛津分型C及UTP与脾肾阳虚证正相关;性别为女性与肺脾气虚证呈正相关,牛津病理分型C与低密度脂蛋白与肺脾气虚证为负相关;牛津分型C与肾络瘀痹证呈正相关;牛津分型S与风湿内扰证呈正相关;牛津分型S与下焦湿热证呈负相关。结论:IgAN患者的中医证型分布中,本虚证以气阴两虚证和肺脾气虚证为主,标实证以肾络瘀痹证和下焦湿热证为主。在IgAN患者的预后因素中,性别、牛津分型T、牛津分型S、牛津分型C、PLT、UTP、LDL-C与IgAN患者中医证型具有相关性。

Objective:To retrospectively analyze the distribution characteristics of TCM syndrome types in patients with IgA nephropathy(IgAN)and the distribution differences of clinical and pathological data in TCM syndrome types,and reveal the relationship between TCM syndrome types and clinical,pathological and laboratory examination of IgAN.Methods:Retrospective analysis was made on 107 patients with IgAN including general data,clinical and laboratory data,and pathological data.The pathological damage of IgA nephropathy patients was evaluated by Oxford pathological classification,and the distribution characteristics of TCM syndrome types of IgAN patients were analyzed by statistical software SPSS,The clinical and pathological data of patients with different TCM syndrome types were compared,and logistic regression analysis was used to analyze the correlation of clinical,pathological and laboratory examination of TCM syndrome types of IgA nephropathy.Results:In the study of IgAN patients,the distribution of TCM syndrome types of this deficiency syndrome was mainly the deficiency of qi and yin and lung-spleen qi deficiency syndrome,while the distribution of TCM syndrome types of standard excess syndrome was mainly the Shenluo Yubi symptom and the syndrome of dampness-heat in the lower jiao.There were statistically significant differences in the distribution of gender of the deficiency syndrome,Oxford Pathology Type E,Oxford Pathology Type T,Oxford Pathology Type C,red blood cell count(RBC),white blood cell count(WBC),hemoglobin(HB),platelet(PLT),serum creatinine(Scr),24-hour urine protein(UTP),serum albumin(ALB),total cholesterol(TC)and low-density lipoprotein(LDL-C)in the TCM syndrome types(P<0.1),There were statistical differences in the distribution of syndrome types of traditional Chinese medicine(TCM)in the presence or absence of prodromal infection,Oxford pathological type S and Oxford pathological type C(P<0.1).The above indicators were included in the multifactor logistic regression analysis.The regression analysis showed that gender was female.Oxford type T,platelets,24h urine protein were negatively correlated with the deficiency of qi and yin;Oxford type C and 24h urinary protein are positively correlated with spleen and kidney yang deficiency syndrome.There was a positive correlation between female gender and the lung-spleen qi deficiency syndrome,and a negative correlation between Oxford pathological classification C and low density lipoprotein and the lung-spleen qi deficiency syndrome.Oxford type C was positively correlated with the Shenluo Yubi symptom;Oxford type S was positively correlated with the endorheumatism syndrome;Oxford type S was negatively correlated with the syndrome of dampness-heat in the lower jiao.Conclusion:In the distribution of TCM syndrome types of IgAN patients,the primary deficiency syndrome is mainly the deficiency of qi and yin and lung-spleen qi deficiency syndrome,while the secondary syndrome is mainly the stagnation of kidney collateral and the damp heat of lower energizer.Among the prognostic factors of IgAN patients,gender,Oxford type T,Oxford type S,Oxford type C,PLT,UTP,LDL-C are related to the TCM syndrome types of IgAN patients.