635例特发性膜性肾病患者的中医证型与肾脏病理相关性研究

Correlation between Chinese medicine syndromes and renal pathology in 635 patients with idiopathic membranous nephropathy

目的探讨特发性膜性肾病(IMN)患者的中医证型分布情况及与肾脏病理的相关性。方法回顾性分析2008—2022年于陕西省中医医院住院行肾穿刺活检术确诊为IMN的635例患者资料,收集患者的中医证型、病理分期、病理特征,比较各证型、病理分期及特征之间的异同。结果中医证型分为6类,以脾肾亏虚、风湿扰络证最多(39.84%),然后依次为脾虚水泛证(36.38%)、阳虚癥积证(10.24%)、脾虚湿热证(9.13%)、气阴两虚证(2.68%)、瘀水互结证(1.73%)。膜性肾病Ⅰ期213例(33.70%),Ⅱ期408例(64.25%),Ⅲ期12例(1.89%),Ⅳ期2例(0.32%)。膜性肾病Ⅰ期、Ⅲ期以脾虚水泛证多见,膜性肾病Ⅱ期以脾肾亏虚、风湿扰络证多见;气阴两虚证及瘀水互结证不见于膜性肾病Ⅲ期,膜性肾病Ⅳ期患者中1例为气阴两虚证,1例为瘀水互结证。中医证型与肾小球硬化、肾小管萎缩相关(P均<0.05),与增生、肥大、水肿、淋巴单核、泡沫细胞、空泡变性、管型的分布情况相关(P均<0.05),与球囊粘连、重度空泡变性、颗粒变性、再生、浆细胞、球周纤维化的分布情况无相关性(P均>0.05)。结论IMN患者的中医证型与肾脏病理分期及部分病理特征存在相关性,可为中医辨证用药提供依据。

Objective It is to explore the distribution of Chinese medicine syndrome types in patients with idiopathic membranous nephropathy(IMN)and their correlation with renal pathology.Methods The data of 635 patients who were diagnosed with IMN by nephronepuncture biopsy in Shaanxi Provincial Hospital of Traditional Chinese Medicine from 2008 to 2022 were retrospectively analyzed,and the syndrome types,pathological stages,and pathological characteristics of the patients were collected,and compared the differences and similarities among the syndrome types,pathological stages,and pathological characteristics were compared.Results The Chinese medicine syndromes were categorized into 6 types,the most was syndrome of spleen-kidney deficiency and wind-dampness harassing collaterals(39.84%),followed by syndrome of spleen deficiency and water flooding(36.38%),syndrome of Yang deficiency and mass accumulation(10.24%),syndrome of spleen deficiency and dampness-heat(58 cases)(9.13%),syndrome of Qi-yin deficiency(2.68%),and syndrome of water and blood stasis binding(1.73%).There were 213 cases(33.70%)of stage I membranous nephropathy,408 cases(64.25%)of stageⅡmembranous nephropathy,12 cases(1.89%)of stageⅢmembranous nephropathy,and 2 cases(0.32%)of stageⅣmembranous nephropathy.Syndrome of spleen deficiency and water flooding was more common in stage I and stageⅢmembranous nephropathy,syndrome of spleen-kidney deficiency and wind-dampness harassing collaterals was more common in stageⅡmembranous nephropathy;syndrome of Qi-yin deficiency and syndrome of water and blood stasis binding were not found in stageⅢmembranous nephropathy,and one case was syndrome of Qi-yin deficiency and one case was syndrome of water and blood stasis binding in the patients with stageⅣmembranous nephropathy.The Chinese medicine syndrome types were correlated with glomerulosclerosis and tubular atrophy(all P<0.05),and with the distributions of hyperplasia,hypertrophy,edema,lymphomononuclei,foam cells,vacuolar degeneration,and urinary cylinder(all P<0.05),but not with the distributions of glomerular adhesion,severe vacuolar degeneration,granular degeneration,regeneration,plasma cells,and periglomerular fibrosis(all P>0.05).Conclusion There is a correlation between the Chinese medicine syndrome types and the renal pathological stage and some pathological characteristics in patients with IMN,which can provide some evidences for Chinese medical differentiation medication.