IgA肾病中医证型与黏膜免疫相关性横断面研究  

Cross-sectional Study on the Correlation Between Chinese Medicine Syndrome Types and Mucosal Immunity in IgA Nephropathy

作　　者：成庭柱 任翼 杜亚婷 冯雪[3] 孙士鹏[3] 饶向荣[1] 李深[1] CHENG Ting-zhu;REN Yi;DU Ya-ting;FENG Xue;SUN Shi-peng;RAO Xiang-rong;LI Shen(Department of Nephrology,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing,100053;Department of Chinese Medicine,Friendship Hospital Affiliated to Capital Medical University,Beijing,100050;Department of Clinical Laboratory,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing,100053)

机构地区：[1]中国中医科学院广安门医院肾病科,北京100053 [2]首都医科大学附属北京友谊医院中医科,北京100050 [3]中国中医科学院广安门医院检验科,北京100053

出　　处：《中国中西医结合杂志》2024年第3期309-315,共7页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金资助项目(No.81573791);北京市科学技术委员会首都临床特色应用研究(No.Z181100001718123)。

摘　　要：目的探讨IgA肾病(IgAN)患者中医证候分型及与黏膜免疫的相关性。方法采用横断面研究方法,纳入IgAN患者410例,收集患者中医证候资料,运用因子分析及聚类分析方法,总结中医证候分类。对其中118例患者血清低半乳糖基化IgA1(Gd-IgA1)及黏膜免疫相关标志物:B细胞活化因子(BAFF)、增殖诱导配体(APRIL)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)进行检测,分析不同中医证候患者血清Gd-IgA1含量及其与上述黏膜免疫相关标志物的相关性。结果共采集51个与IgAN证候紧密相关的症状、舌象及脉象,提取13个特征根>1的公因子,聚类为4类。将IgAN患者的中医证候归类为肺脾气虚证186例(45.36%),肝肾阴虚证102例(24.88%),脾肾阳虚证79例(19.27%),肝气郁滞证43例(10.49%)。肺脾气虚证患者Gd-IgA1含量为6.09(4.44,7.00)μg/mL,高于其他中医证型患者(P<0.01)。伴有不同部位黏膜炎症的IgAN患者Gd-IgA1含量较不伴有黏膜炎症的患者升高(P<0.01)。IgAN患者Gd-IgA1含量与黏膜免疫相关标志物APRIL、IL-6、TNF-α具有相关性(P<0.05)。结论IgAN患者临床常见证型为肺脾气虚证、肝肾阴虚证、脾肾阳虚证、肝气郁滞证,肺脾气虚证与黏膜免疫异常关系最密切。Objective To explore the Chinese medicine(CM)syndrome classification and its correlation with mucosal immunity in patients with IgA nephropathy(IgAN).Methods A cross-sectional study was performed,including 410 patients with IgAN.The data of CM syndrome were collected,and the CM syndrome classification was summarized by factor analysis and cluster analysis.Serum levels of galactosedeficient IgA1(Gd-IgA1)and mucosal immune-related markers,including B cell activating factor(BAFF),a proliferation inducing ligand(APRIL),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were measured in 118 patients.The correlation between serum Gd-IgA1 levels in different CM syndromes and these mucosal immune-related markers was analyzed.Results A total of 51 symptoms,tongue images and pulse images closely related to IgAN syndromes were collected,and 13 common factors with eigenvalues greater than 1 could be extracted,which could be clustered into 4 categories.The CM syndromes of IgAN patients were classified as Fei-Pi qi-deficiency syndrome in 186 cases(45.36%),Gan-Shen yin-deficiency syndrome in 102 cases(24.88%),Pi-Shen yang-deficiency syndrome in 79 cases(19.27%),and Gan qi depression syndrome in 43 cases(10.49%).The serum Gd-IgA1 levels of patients with Fei-Pi qi-deficiency syndrome was 6.09(4.44,7.00)μg/mL,which was significantly higher than that of patients with other CM syndromes(P<0.01).Gd-IgA1 levels were elevated in patients with IgAN at different sites of mucosal inflammation compared with patients without mucosal inflammation(P<0.01).Serum Gd-IgA1 levels in IgAN patients demonstrated correlations with mucosal immune-related markers APRIL,IL-6 and TNF-α(P<0.05).Conclusions The prevalent clinical CM syndromes in IgAN patients are Fei-Pi qi-deficiency syndrome,Gan-Shen yin deficiency syndrome,Pi-Shen yang-deficiency syndrome,and Gan qi depression syndrome.Fei-Pi qi-deficiency syndrome is most closely associated with abnormal mucosal immunity in IgAN.

关 键 词：IGA肾病 中医证候 黏膜免疫 低半乳糖基化IgA1 中西医结合 

分 类 号：R277.5[医药卫生—中医学]