无症状尿检异常型IgA肾病患者中医证治特点及其对蛋白尿缓解的影响  

Characteristics of traditional Chinese medicine syndromes and treatment ofprimary IgA nephropathy presenting with asymptomatic urinaryabnormalities and its effect on proteinuria remission

作　　者：蔡玉媛 张荣玲 侯渊圣 申妙莹 邹川[3] CAI Yuyuan;ZHANG Rongling;HOU Yuansheng;SHEN Miaoying;ZOU Chuan(The Second Clinical Medical College,Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong,China;Department of Nephropathy,Longyan Hospital of Traditional Chinese Medicine,Longyan 364000,Fujian,China;Department of Dialysis,Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510120,Guangdong,China)

机构地区：[1]广州中医药大学第二临床医学院,广东广州510405 [2]龙岩市中医院肾病科,福建龙岩364000 [3]广东省中医院透析科,广东广州510120

出　　处：《暨南大学学报（自然科学与医学版）》2023年第1期60-68,共9页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：国家自然科学基金项目(81873142);国家中医药管理局国家中医临床研究基地业务建设科研项目(JDZX2015202)。

摘　　要：目的:探讨无症状尿检异常型IgA肾病(IgAN)患者的中医证治特点,分析中医证治对蛋白尿缓解的影响。方法:回顾性分析广东省中医院116例无症状尿检异常型IgAN患者中西医临床资料。根据血尿水平分为尿红细胞计数(URBC)≤100个/μL组与URBC>100个/μL组,探讨两组患者的中医证治特点。收集随访资料,以蛋白尿缓解为结局,采用Kaplan-Meier生存曲线分析蛋白尿累积缓解率,COX回归模型分析蛋白尿缓解的影响因素。结果:纳入患者多有疲倦乏力、口干、腰脊酸痛的表现;中医本证多为脾肾气虚证、气阴两虚证,兼证主要为湿热夹瘀证、血瘀证。Kaplan-Meier生存分析显示,本证组间及兼证组间的蛋白尿累积缓解率差异均无统计学意义,但腰脊酸痛组的蛋白尿累积缓解率显著低于无腰脊酸痛组(P<0.05)。COX单因素回归分析显示,血尿程度重、腰脊酸痛为蛋白尿缓解的危险因素,三芪口服液、益肾化湿颗粒可促进蛋白尿缓解(P<0.05)。COX多因素回归模型显示,中医证型对蛋白尿缓解无影响(P>0.05),三芪口服液可促进蛋白尿缓解(P<0.05)。结论:镜下血尿程度重(URBC>100个/μL)、伴有腰脊酸痛是无症状尿检异常型IgAN患者蛋白尿缓解的危险因素,三芪口服液可有助于蛋白尿缓解。Objective:To investigate the characteristics of traditional Chinese medicine(TCM)syndromes and treatment in IgA nephropathy(IgAN)patients with asymptomatic urinary abnormalities,and analyze the effect of TCM syndromes and treatment on proteinuria remission.Methods:The clinical data of 116 patients with IgAN,who presented with asymptomatic urinary abnormalities in Guangdong Provincial Hospital of Chinese Medicine were analyzed retrospectively.According to hematuria level,the patients were divided into urine red blood cell count(URBC)≤100/μL group and URBC>100/μL group,and the characteristics of TCM syndromes and treatment between two groups were analyzed.Clinical data were collected during follow-up and the outcome was defined as proteinuria remission.Kaplan-Meier survival analysis was conducted for cumulative proteinuria remission rate,and COX regression model was used to analyze the influence factors of proteinuria remission.Results:Most of patients had clinical manifestations of fatigue,dry mouth,and low back pain.The most common original syndromes were spleen-kidney qi deficiency syndrome and qiyin deficiency syndrome,and the accompanying syndromes mainly included dampness-heat with blood stasis syndrome and blood stasis syndrome.Kaplan-Meier survival analysis showed that there was no significant difference in cumulative proteinuria remission rate among groups in original syndrome and accompanying syndrome,but the cumulative remission rate of proteinuria was significantly lower in the group with low back pain pain than in that without(P<0.05).COX univariate regression analysis showed that hematuria and low back pain were the risk factors for proteinuria remission,while Sanqi Oral Solutions and Yishen Huashi Granules promoted proteinuria remission(P<0.05).COX multivariate regression model showed that TCM syndromes type had no affect on the remission of proteinuria(P>0.05),while Sanqi Oral Solutions promoted proteinuria remission(P<0.05).Conclusion:The high degree of microscopic hematuria(URBC>100/μL)and lo

关 键 词：无症状尿检异常 IGA肾病 中医证治 蛋白尿缓解 

分 类 号：R259[医药卫生—中西医结合]