以血尿为分类因素的IgA肾病CKD1~4期患者中医证型差异  

Differentiation of TCM Syndromes of IgA Nephropathy Patients in CKD1~4 Stages with Hematuria as a Sorting Factor

作　　者：杨雨竹 刘伟伟 王惠玲[1] 管鑫 吴燕升 史丽强[1] 高建东[1] YANG Yuzhu;LIU Weiwei;WANG Huiling(Department of Nephrology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai,201203;Department of Nephrology,Traditional Chinese Medicine Hospital,Pudong New Area,Shanghai,201299)

机构地区：[1]上海中医药大学附属曙光医院肾病科,上海中医药大学中医肾病研究所,上海中医药大学肝肾疾病病证教育部重点实验室,上海市中医临床重点实验室,上海201203 [2]上海市浦东新区中医医院肾病科,上海201299

出　　处：《中国中西医结合肾病杂志》2024年第3期219-223,共5页Chinese Journal of Integrated Traditional and Western Nephrology

摘　　要：目的:通过探讨临床表现为单纯蛋白尿、蛋白尿伴血尿的IgAN患者二者间中医证型差异,阐明血尿证候基础,为IgAN临床辨证分型及指导其治疗提供参考依据。方法:采用流行病学现场调查的方法,收集230例IgAN患者的临床及病理资料,根据有无血尿症状分为单纯蛋白尿组(A组107例)和蛋白尿伴血尿组(B组123例)。观察比较两组间临床指标、病理分型、中医证型的差异,再分别与血尿进行相关性分析。结果:(1)一般资料:两组间年龄、性别、体重指数、病程、血压差异均无统计学意义(P>0.05);(2)生化指标:B组Scr、24 h UTP高于A组(P<0.05),eGFR低于A组(P<0.05);两组UA、BUN、Alb差异无统计学意义(P>0.05)。(3)病理资料:B组系膜增殖评分(M)、毛细血管内增生性病变(E)高于A组(P<0.05);两组肾小球节段性硬化或黏连(S)、肾小管萎缩或间质纤维化(T)差异无统计学意义(P>0.05)。(4)中医证型:本虚证A组以脾肾气虚证多见(36.45%),B组以气阴两虚证多见(42.28%);标实证A组以血瘀证多见(50.94%),B组以湿热证多见(57.39%)。(5)血尿的相关因素分析:将两组患者临床指标、病理资料、中医证型分别与血尿进行logistic回归,肾衰竭、中大量尿蛋白(24 h UTP≥1.0 g)、M1、E1、气阴两虚证、湿热证P<0.05,且OR值>1,与血尿相关。结论:(1)CKD1~4期IgAN患者血尿的证候基础可能为气阴两虚兼湿热,蛋白尿的证候基础可能多为脾肾气虚和血瘀;分布规律尤其在CKD1~2期患者更明显。(2)与单纯蛋白尿的IgAN患者相比,血尿可能是蛋白尿伴血尿患者预后不良的因素之一。在治疗时应充分认识到血尿在病程中的重要性,不能忽略血尿的治疗。Objective:Discussing the differences of TCM syndromes of IgAN between with proteinuria and with proteinuria and hematuria,to explore the basis syndromes of hematuria,which provided a reference for clinical syndrome differentiation and treatment of IgAN.Methods:According to the hematuria symptoms,the patients were divided into pure proteinuria group(107 cases in group A)and proteinuria with hematuria group(123 cases in group B).To observe and compare the differences of clinical indicators,pathological types and TCM syndromes between the two groups,and then analyze the correlation with hematuria respectively.Results:(1)General information:there were no statistically significant differences in age,sex,body mass index,course or blood pressure between the two groups(P>0.05).(2)Biochemical indexes:scr and 24 h UTP in group B were higher than that in group A(P<0.05),and eGFR was lower than that in group A(P<0.05).There were no statistically significant differences in UA,Bun,Alb between the two groups(P>0.05).(3)Pathological data:the mesangial proliferation score(M)and capillary proliferative lesions(E)in group B were higher than those in group A(P<0.05).There were no statistically significant differences in glomerular segmental sclerosis or adhesion(S),renal tubular atrophy or interstitial fibrosis(T)between the two groups(P>0.05).(4)TCM syndrome types:spleen-kidney qi deficiency syndrome was more common in group A(36.45%)and qi and Yin deficiency syndrome was more common in group B(42.28%).The blood stasis syndrome was more common in group A(50.94%)and dampness-heat syndrome was more common in group B(57.39%).(5)Analysis of related factors of hematuria:the two groups of patients'biochemical indicators,pathological data and TCM syndromes were analyzed with logistic regression of hematuria.Renal insufficiency,Large amount of urinary protein(24 h UTP≥1.0 g),M1,E1,deficiency of both qi and yin,damp-heat syndrome P<0.05,and OR value>1,were related to hematuria.Conclusion:(1)The syndrome basis of hematuria in CKD1~4 stage

关 键 词：IGA肾病 血尿 蛋白尿 中医证型 

分 类 号：R277.5[医药卫生—中医学]