糖尿病肾病患者的临床特征及中医证型与肾脏病理相关性研究  

A study on the correlation between clinical characteristics and traditional Chinese medicine syndromes and renal pathology in patients with diabetic nephropathy

作　　者：蒋梦洁 朱勤[2] 余安安 陈洪宇[2] JIANG Mengjie

机构地区：[1]浙江中医药大学杭州临床医学院,浙江杭州310053 [2]浙江中医药大学附属杭州市中医院,浙江杭州310007

出　　处：《中医临床研究》2024年第32期35-42,共8页Clinical Journal Of Chinese Medicine

基　　金：浙江省基础公益研究计划项目(LTGY23H270007);浙江省中医药管理局项目(2023ZF137)。

摘　　要：目的:探讨糖尿病肾病患者的临床特征、中医证型分布及其与肾脏病理特征的相关性。方法:收集2017年1月25日-2023年6月16日于杭州市中医院住院并经肾活检确诊为糖尿病肾病的159例患者的临床资料、中医证型、病理类型,分析其特征及相关性。结果:病理类型分析显示,最常见的糖尿病肾病病理类型是结节性糖尿病肾小球硬化症,在糖尿病肾病合并其他肾脏病方面,急慢性肾小管间质病变和免疫球蛋白(Immunoglobulin,Ig)A肾病最为常见;临床特征与病理类型分析显示,肾小球分级与IgG/尿液肌酐、血钾水平呈极显著正相关,与身体质量指数(Body Mass Index,BMI)、血红蛋白、尿比重、尿渗透压、血浆白蛋白呈极显著负相关。肾小管间质病变[肾小管萎缩与间质纤维化(Interstitial Fibrosis andTubularAtrophy,IFTA)评分、间质炎症评分]与血肌酐呈显著正相关,与糖化血红蛋白呈显著负相关。肾脏小动脉玻璃样变与年龄、血肌酐呈显著正相关,与尿渗透压、肾小球滤过率呈显著负相关。肾动脉粥样硬化与年龄呈显著正相关。中医证型中,标实证以风湿证、血瘀证最为常见,本虚证以气阴两虚证、脾肾气虚证显著。不同中医证型与肾脏病理特征的分布及相关性分析表明,风湿证与肾小球分级、溺毒证与IFTA评分、血瘀证与肾动脉粥样硬化均存在显著相关性。结论:中医辨证分型结合肾脏病理特征有助于优化糖尿病肾病患者的个体化治疗。Objective:To explore the correlation of clinical characteristics,distribution of TCM syndromes and renal pathological characteristics of patients with diabetic nephropathy.Methods:The clinical data,TCM syndrome types,and pathological characteristics of 159 diabetic nephropathy patients hospitalized in Hangzhou Traditional Chinese Medicine Hospital from January 25,2017 to June 16,2023 were collected,and their characteristics and correlation were analyzed.Results:In terms of pathological types,the most common pathological type of diabetic nephropathy was nodular diabetic glomerulosclerosis.Among patients with diabetic nephropathy plus other kidney diseases,acute or chronic renal tubulointerstitial lesions and IgA nephropathy were the most common.Analysis of clinical characteristics and pathological types revealed a significant positive correlation between glomerular grading and IgG/urine creatinine,serum potassium levels.Conversely,there was a highly significant negative correlation between glomerular grading and BMI,hemoglobin,urine specific gravity,urine osmotic pressure,and plasma albumin.Tubulointerstitial lesions(IFTA score,interstitial inflammation score)exhibited a significant positive correlation with serum creatinine and a significant negative correlation with glycosylated hemoglobin.Hyaline degeneration of renal arterioles was significantly positively correlated with age and serum creatinine,and significantly negatively correlated with urinary osmolarity and glomerular filtration rate.Renal artery atherosclerosis was significantly positively correlated with age.In the TCM syndrome differentiation,the most common exterior excess syndrome types were wind-damp syndrome and blood stasis syndrome.The boot deficiency syndromes were mostly both Qi(气)and Yin(阴)deficiency syndrome,and spleen and kidney Qi deficiency syndrome.The distribution and correlation analysis between different TCM syndrome types and renal pathological characteristics showed that there were significant correlations between wind-damp synd

关 键 词：糖尿病肾病 中医证型 肾脏病理特征 肾小球病变 相关性 

分 类 号：R587.1[医药卫生—内分泌]