基于中医证素探讨从风论治特发性膜性肾病的横断面研究  

Cross-sectional Study on Treatment of Idiopathic Membranous Nephropathy from Wind Based on Chinese Medicine Syndrome Element Analysis

作　　者：周甘来 谢璇[2] 李兆祯 ZHOU Ganlai;XIE Xuan;LI Zhaozhen(The Second Clinical Medical College of Beijing University of Chinese Medicine,Beijing China 100078;Dongfang Hospital,Beijing University of Chinese Medicine,Beijing China 100078;The First Hospital Affiliated to Lanzhou University,Lanzhou Gansu China 730000)

机构地区：[1]北京中医药大学第二临床医学院,北京100078 [2]北京中医药大学东方医院,北京100078 [3]兰州大学第一医院,甘肃兰州730000

出　　处：《中医学报》2025年第3期648-654,共7页Acta Chinese Medicine

基　　金：国家中医药管理局重点专科基金资助课题项目(040203001010)。

摘　　要：目的:探讨特发性膜性肾病(idiopathic membranous nephropathy,IMN)患者中医证素特点,为临床从风论治IMN提供循证依据。方法:79例IMN患者为研究对象,同期肾穿刺后确诊为微小病变肾病(minimal change disease,MCD)的患者24例为对照,进行回顾性横断面研究,采集四诊信息,对证候赋分计算确定证素,归纳总结证素与慢性肾脏病(chronic kidney disease,CKD)分期、病理分期的关系,同时印证IMN是否存在风邪病机。结果:(1)IMN患者病位证素主要为肾、脾,病性证素主要为湿、气虚、风、热(出现频率超过50%)。(2)不同CKD分期之间中医证素比较,差异无统计学意义(P>0.05)。(3)存在阴虚证素的IMN患者病理分期均为Ⅰ期,阴虚证素在不同病理分期之间分布比较,差异有统计学意义(P<0.05)。(4)不同的本虚证素之间热邪、湿浊、阳亢分布比较,差异有统计学意义(P<0.05),两两比较显示:存在热邪证素的IMN患者中表现为气虚的为44例,占97.87%(44/45),而表现为气虚患者同时存在热邪的占73.3%(44/60),差异有统计学意义(P<0.05);存在湿浊证素的IMN患者中表现为阳虚的为8例,占88.89%(8/9),而表现为阳虚患者同时存在湿浊的占50%(8/16),差异有统计学意义(P<0.05);存在阳亢证素的IMN患者中表现为阴虚的患者为2例,占100%(2/2),而表现为阴虚患者同时存在阳亢的占比为25%(2/8),差异有统计学意义(P<0.05)。(5)IMN组存在风邪证素的患者占73.74%(58/79),MCD组存在风邪证素的患者占37.5%(9/24),风邪证素在IMN、MCD之间比较,差异有统计学意义(P<0.05)。(6)存在风邪证素的IMN患者中同时存在水饮的患者为12例,占20.69%(12/58),而存在水饮证素同时表现出风邪证素的患者占48%(12/25),风邪与水饮实性证素分布比较,差异有统计学意义(P<0.05)。(7)存在风邪证素IMN患者血清抗M型磷脂酶A2受体(phospolipase A2 receptor,PLA2R)抗体阳性率为58.3%(14/24),PLA2R的表达与风邪证素比较,差异�Objective:To explore the syndrome element characteristics of Chinese medicine in patients with idiopathic membranous nephropathy(IMN),and to provide an evidence-based basis for the clinical treatment of IMN from perspective of Wind.Methods:79 patients with IMN were the study subjects,and 24 patients diagnosed with minimal change disease(MCD)after renal puncture in the same period were the controls.A retrospective cross-sectional study was carried out to collect information from the four diagnostic examinations,calculate and determine the elements of syndrome,and summarize the relationship between chronic kidney disease(CKD)and the elements of syndrome as well as the disease and the pathological staging,and to confirm the existence of Wind evil factor in IMN.Results:(1)In IMN patients,the disease location of syndrome elements were mainly Kidney and Spleen,and the pathologic syndrome elements were mainly Dampness,Qi deficiency,Wind and Heat(the frequency of occurrence was more than 50%).(2)Comparison of TCM syndrome elements between different CKD stages showed no statistically significant difference(P>0.05).(3)The pathological stages of IMN patients with the presence of Yin deficiency syndrome elements were all stage I.Comparison of the distribution of Yin deficiency syndrome elements between different pathological stages showed statistically significant differences(P<0.05).(4)Comparison of the distributions of Heat evil factor,Dampness and hyperactivity of Yang between different syndrome elements of root deficiency showed statistically significant differences(P<0.05),and two-by-two comparisons showed that:44 cases of IMN patients with the presence of syndrome elements of Heat evil factor manifested Qi deficiency,accounting for 97.87%(44/45),and 73.3%of the patients manifesting Qi deficiency suffer Heat evil factor at the same time(44/60),with statistically significant difference(P<0.05);the case number of IMN patients with the presence of Dampness and Turbidity syndrome elements who manifested Yang deficiency was

关 键 词：特发性膜性肾病 从风论治 中医证素 抗M型磷脂酶A2受体 横断面研究 

分 类 号：R277.592[医药卫生—中医学]