单纯血尿伴(或不伴)轻度蛋白尿IgA肾病的证候及尿检分析

Analysis on TCM Syndromes and Urine Test of IgA Nephropathy Patients with Isolated Hematuria Ac-companied with or without Mild Proteinuria

目的初步探讨单纯血尿伴(或不伴)轻度蛋白尿的Ig A肾病患者中医证候分布特点及其与主要尿检结果(尿中红细胞计数、24 h尿蛋白定量)的相关性。方法回顾性分析116例单纯血尿伴(或不伴)轻度蛋白尿的Ig A肾病患者的临床资料,收集四诊资料,遵循Ig A肾病的中医证候诊断标准,先定急性、慢性,再辨主证、次证,先辨正虚、再辨邪实。确定中医证型,判断证候分布特点,分析各证候类型与尿检指标的关系。结果单纯血尿伴(或不伴)轻度蛋白尿Ig A肾病的中医证候分布以慢性迁延期为多,共84例(72.41%),呈虚实夹杂,其中虚证以气阴两虚最多,有46例,而邪实多见血瘀,湿热,分别为37例及31例。急性发作期共32例(27.59%),以外感风热者最多,有21例,同时也涉及脏腑虚损,本期有15例(12.93%)既往易感冒。急性期与慢性期的比较:尿中红细胞计数急性期显著高于慢性期(P<0.05),24 h尿蛋白定量慢性期显著高于急性期(P<0.05)。尿中红细胞计数外感风热组显著高于其他各组(P<0.05)。24 h尿蛋白定量脾肾阳虚组显著高于其他各证型组(P<0.05),其他各组间差异无统计学意义(P>0.05)。结论单纯血尿伴(或不伴)轻度蛋白尿的Ig A肾病患者在中医证候分布上与Ig A肾病的整体证候分布一致;血尿程度以外感风热证最重,蛋白尿以脾肾阳虚证最多。

Objective: To explore the correlation between TCM syndromes and routine urine test(urinary red blood cell count,24-hour urine protein quantitation) in Ig A nephropathy(Ig AN) patients with isolated hematuria accompanied with or without mild proteinuria. Methods: The clinical data of 116 Ig AN patients with isolated hematuria accompanied with or without mild proteinuria were analyzed retrospectively. Relevant four TCM diagnostic information was collected;syndromes were differentiated based on TCM syndrome criteria of Ig AN;TCM syndrome distribution characteristics were summarized,and then the correlation between TCM syndromes and the urine test was analyzed. Results: 84 cases(72.41%) were in the chronic persistent stage manifested with intermingled deficiency and excess syndrome. Qi-yin deficiency(46 cases) was the most commonly-seen deficiency syndrome,while blood stasis syndrome(37 cases) and damp-heat syndrome(31 cases) were the most two commonly-seen excessive syndromes. 32 cases(27.59%) were in the acute stage. Exogenous wind-heat syndrome(21cases) was the most commonly-seen syndrome. 15 cases(12.93%) were manifested with insufficiency of lung-qi.The correlation analysis showed that the urinary RBC count in exogenous wind-heat syndrome group was significantly higher than that in other groups(P < 0.05);the 24-hour urine protein quantitation in spleen-kidney yang deficiency group was significantly higher than that in other groups(P < 0.05). Conclusion: The syndrome distribution of Ig AN patients with isolated hematuria accompanied with or without mild proteinuria is in accordance with the distribution of overall Ig AN patients. Exogenous wind-heat syndrome group is manifested with the most severest hematuresis,while spleen-kidney yang deficiency group is manifested with the most severest proteinuria.