系膜增生性IgA肾病临床病理特征、中医证候及预后因素研究  

Clinical pathological characteristics,traditional Chinese medicine syndromes and prognostic factorsof mesangial proliferative IgA nephropathy

作　　者：张鸿慧 金钟大[3] ZHANG Honghui;JIN Zhongda(Shenshan Hospital of the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Shanwei 516601,Guangdong,China;The Second Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510000,Guangdong,China;Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510000,Guangdong,China)

机构地区：[1]广州中医药大学第一附属医院深汕医院,广东汕尾516601 [2]广州中医药大学第二临床医学院,广东广州510000 [3]广东省中医院,广东广州510000

出　　处：《现代中西医结合杂志》2024年第22期3078-3087,共10页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：国家自然科学基金青年基金项目(82104779)。

摘　　要：目的探讨系膜增生性IgA肾病患者的临床病理特点、中医证型分布规律及与疾病预后相关的因素,为临床防治该病与进一步研究提供参考。方法采用回顾性研究方法,收集2008年4月—2023年12月在广东省中医院住院部、门诊就诊且经肾穿刺活检确诊的系膜增生性IgA肾病患者的基线资料(包括人口学资料、实验室检查资料、病理资料)、中医证候资料、随访资料。按照系膜增生程度将患者分为轻度增生组、中度增生组、重度增生组,比较3组患者实验室指标;按照系膜增生程度将患者分为轻度增生组与中重度增生组,比较2组患者中医证候情况;按照中医辨证分型将患者分为肺脾气虚证、气阴两虚证、肝肾阴虚证、脾肾阳虚证4组,比较4组患者实验室指标;按照患者随访预后分为发生终点事件组和未发生终点事件组,比较2组患者实验室指标及中医证候情况。Kaplan-Meier分析患者累计生存率、中位累计生存时间,Cox回归分析与系膜增生性IgA肾病预后相关的因素。结果共纳入112例患者。轻度增生组患者低密度脂蛋白胆固醇、血清IgA水平均明显低于中、重度增生组(P均<0.05),血清白蛋白水平明显高于中、重度增生组(P均<0.05),血红蛋白水平明显高于中度增生组(P<0.05);且轻度增生组患者肺脾气虚证、水湿证、眠差患者占比均明显高于中重度增生组(P均<0.05),脾肾阳虚证、口苦、腰膝酸软、泡沫尿患者占比均明显低于中重度增生组(P均<0.05)。不同中医证型组患者eGFR、血肌酐、血尿素氮、血尿酸、血清白蛋白、血红蛋白、血清IgA水平比较差异均有统计学意义(P均<0.05),其中肺脾气虚证组患者eGFR明显高于其他3组(P均<0.05),血肌酐水平明显低于肝肾阴虚证组、脾肾阳虚证组(P均<0.05),血尿素氮水平明显低于气阴两虚证组、脾肾阳虚证组(P均<0.05),血尿酸和血清IgA水平均明显低于脾肾阳�Objective It is to investigate the clinical pathologic characteristics,distribution regularities of traditional Chinese medicine(TCM)syndrome and factors related to the prognosis of patients with mesangial proliferative IgA nephropathy(IgAN),in order to provide reference for clinical prevention and treatment of this disease and further research.Methods A retrospective study was conducted to collect baseline data(including demographic data,laboratory examination data,and pathological data),TCM syndrome data,and follow-up data of patients with thylakoid proliferative IgAN who were treated in inpatient department and out-patient department of Guangdong Provincial Hospital of Traditional Chinese Medicine and diagnosed with renal puncture biopsy from April 2008 to December 2023.According to the degree of thylakoid hyperplasia,the patients were divided into mild hyperplasia group,moderate hyperplasia group and severe hyperplasia group,and the laboratory indexes of patients in the three groups were compared.According to the degree of thylakoid hyperplasia,the patients were divided into mild hyperplasia group and moderate-severe hyperplasia group,and the TCM syndromes of the patients in the two groups were compared.According to the differentiation of syndromes,the patients were divided into 4 groups:group of lung-spleen Qi deficiency syndrome,group of Qi-Yin deficiency syndrome,group of liver-kidney Yin deficiency syndrome,and group of spleen-kidney Yang deficiency syndrome,and the laboratory indexes of the patients in the four groups were compared.According to the patients’follow-up prognosis,they were divided into the group with endpoint events and the group without endpoint events,and the laboratory indexes and TCM syndromes of the patients in the two groups were compared.The patients’cumulative survival rate,median cumulative survival time were analyzed by Kaplan-Meier analysis,and the factors related to the prognosis of mesangial proliferative IgAN were analyzed by Cox regression analysis.Results A total of 112

关 键 词：系膜增生性IgA肾病 临床病理特征 中医证候 预后 

分 类 号：R692[医药卫生—泌尿科学]